"Nationwide each day, emergency departments are seeing 48,000 more patients across the country. That's about 12 more patients per day for each emergency department," says Linda McCaig, lead author of the latest report from the National Hospital Ambulatory Medical Care Survey, done by the U.S. Centers for Disease Control and Prevention (CDC).
Emergency rooms logged about 38.4 visits per 100 people in 2001, up from 35.7 visits in 1992, an 8 percent increase. This is the first time an overall trend has been reported since the CDC first began collecting data in 1992.
During 2001, an estimated 107.5 million visits were made to hospital emergency departments (EDs), compared to almost 90 million in 1992. Emergency departments account for approximately 10 percent of all ambulatory medical care visits in the United States.
The increase is due largely to a growing population and to a larger number of elderly, who tend to visit emergency rooms more often than younger people.
"Those are the main reasons, [but] we can speculate that people may have problems finding a primary care physician or scheduling an appointment in a timely fashion and so they find it more convenient to go to the ED," says McCaig, who is a health scientist with the CDC's National Center for Health Statistics in Hyattsville, Md. "Some people prefer to go there. They can get same-day service, they can see a specialist, they can have an MRI. Also, the percentage of senior citizens who have Medicare only has been increasing, so sometimes they find it hard to find a primary care physician."
Overcrowded, pressured emergency departments are now just more so. "We've been mandated to see everybody, there's less of us, managed care has made it harder for people to see their doctor, and we have an expanded role in providing primary care," says Dr. Neal Shipley, chairman of emergency medicine at North General Hospital in New York City. "We have financially strapped hospitals, financially strapped emergency departments. There's a nursing shortage. So many things are contributing to ED overcrowding. All of these things coming to a head in 2003 have been building and building."
Here are the report's main findings:
- Injuries, poisoning, and adverse effects of medical care account for 36.6 percent of ED visits. Falls, assaults, and motor vehicle incidents were the leading cause of injuries, representing about 40 percent of these visits.
- Abdominal pain, chest pain, and fever are the most common reasons presented by patients for visiting an ED. Contusions, acute upper respiratory infections, and open wounds are the most frequent primary diagnoses. About 30 percent of patients came to the ED with a blood pressure exceeding 140/90.
- Almost 75 percent of patients who visit EDs receive medications while they're there. That works out to an average of two drugs per patient. Of these drugs, pain relief medications were the most commonly prescribed in 2001, representing more 34.2 percent of the total. Antibiotics were the second most frequently dispensed, followed by medications to treat respiratory tract problems.
- The elderly visit emergency departments most frequently, with about 60 visits for every 100 persons aged 75 years or older. This compares to about 38 visits per 100 people for the general population. Nursing home residents, surveyed for the first time, accounted for between 2 and 3 percent of all ED visits in 2001. One-third of these visits were for injuries and/or poisoning.
- About 3 percent of visits, or 3 million individual visits, involved patients who had been in the ED within the last 72 hours. About 6 percent of all visits were follow-ups of the same problem. Patients were admitted to the hospital 12 percent of the time and were referred to another physician or clinic 40 percent of the time. "We're being asked to discharge that patient to outpatient follow-up that may or may not be easily accessible, so they come back again," Shipley says.
- Patients spent an average of three hours in the emergency department. For 400,000 visits (0.4 percent), the patient spent 24 hours or more in the ED.
- Imaging was provided at 40 percent of all visits. Use of MRI/CAT scans has increased by more than 160 percent since 1992. Because there are fewer hospital beds and fewer admissions, Shipley says, more tests are having to be done in the ED. "Testing in the ED has become more complicated. Now we're getting CAT scans in the ED, he says. "Those used to be tests that were done in the hospital."
- Arrivals of elderly patients in the ED peaked at 11 a.m., while children tended to arrive between 7 and 8 p.m.
- And some 2.5 million visits (2.3 percent) were related to the patient's use of alcohol, another person's use of alcohol, or both.