A third of ER visits aren't emergencies, state reports

Health Care panel's update of '02 study says use for non-critical illness is growing rapidly

December 21, 2006|By M. William Salganik | M. William Salganik,Sun reporter

Emergency room use continues to accelerate in Maryland, and more than a third of the visits are for conditions that could be treated elsewhere, the Maryland Health Care Commission reported yesterday.

The report, prepared at the request of legislative leaders, is an update of one the commission did - with similar findings - in 2002. Commission members expressed frustration with the persistence of the trends.

"This thing has been around and getting worse for a very long time," said Constance Row, a commission member and former hospital administrator. While a variety of organizations - state agencies, the hospitals, insurers - have tracked trends and talked about possible solutions, Row asked, "In the end, who's going to sit down and say, `OK, here's the plan'?"

Nearly 2.3 million emergency department visits were logged in Maryland for the 12 months that ended June 30 - up 23 percent since fiscal year 2000. That's more than the 18 percent increase during the whole decade of the 1990s. From 1990 to 2006, statewide emergency department volumes are up from 4,000 patient visits a day to 6,200.

Of those visits, the report said, 18 percent were for conditions that weren't emergencies at all, and 17 percent required rapid treatment but could have been dealt with in primary care doctors' offices. The report doesn't estimate the cost to patients and insurers of the unneeded visits.

As emergency departments fill up, hospitals increasingly are going on "yellow alert," where they take only the most serious ambulance patients, or "red alert," when all ambulances are diverted to other hospitals. The total number of alert hours statewide tripled between 2003 and 2006, but still represents less than 1 percent of all hours.

Pamela Barclay, director of the commission's center for hospital services, who presented the report, said there are no data to show whether patients are damaged by waits or by diversions from crowded emergency rooms.

The problem is national. According to the report, Maryland ranks 29th among states in rate of emergency room use, with 389 visits per 1,000 people during 2004. The report also cites a national study that found higher rates of unnecessary visits than were logged in Maryland.

Solutions, commissioners said, are complex, and might start with making other treatment locations available.

"People don't have access to a doctor over the weekend, so they end up going to emergency rooms," said Commissioner Robert Moffit.

The report recommends studying alternative ways to provide treatment, including urgent care centers and free-standing emergency facilities. Also, Barclay said, the Maryland Community Health Resources Commission, created last year, is considering ways to make primary care more available.

And, commissioners suggested, insurers might be able to discourage inappropriate emergency room use by imposing higher co-payments.

Hospitals can expand their emergency departments - and many have. Statewide, the capacity of emergency departments grew from 1,472 spaces in 2003 to 1,682 in 2006. But, Barclay said, "Expanding emergency departments doesn't necessarily fix the problem."

"You have to figure out how to get the patients out the back," said Dr. Andrew N. Pollak, a commission member and professor of orthopedics at the University of Maryland Medical Center. Often, he said, patients are kept in emergency departments because beds are not available elsewhere in the hospital.

Barclay said the commission has approved about 400 additional hospital beds statewide in $3 billion worth of capital projects, which are in the construction or planning stages.


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