Ask The Audience: Emergency Rooms, Ctd

by Patrick Appel

A reader writes:

I was very unhappy to read the post from a pediatric emergency physician claiming that 75 percent of his patients do not need to be in the ER.  This is a widely perpetuated myth  that is completely unsupported by any data.  The CDC in 2008 issued its yearly report (pdf) on emergency department visits and found that only 12 percent of ER visits are for non-urgent reasons.

That number has dropped every year. And yet the public, the press and far too many policymakers continue to perpetuate the myth that ERs are overcrowded because of people who do not need to be there.  Most people who come to the ER are sick and have no place else to turn.  It's not pretty, but that's how it is.

The issue of emergency department crowding is a critically important one as the nation (and Washington) take up health care reform. People want a simple solution and yet the realities are far more complex.  Emergency departments are crowded because as the number of emergency patients rises, the number of emergency departments continues to drop.  We have more people using fewer resources, a problem that is expected to become catastrophic within a few years as large numbers of baby boomers age. 

Emergency care accounts for only 3 percent of the nation's health care expenditures.  It is a priceless public resource and should be funded accordingly.

A reader writes:

Another Pediatric ER attending physician here - I too spend most of my time seeing patients that don't have what we would define as a truly emergent or even terribly urgent medical problems.  I don't think it is as simple as people not being patient enough to wait to see their regular doctor.  Many families have trouble even getting through to their doctor's offices, and when they do, the wait for an appointment is often laughably long.  So these families will keep coming.

My recommendation is that we heavily staff emergency departments with providers such as physician assistants and nurse practitioners to see the lower acuity patients, with ER physicians spending the majority of their time on the more complex and critically ill patients.

NPs and PAs take less time to train, incur less educational debt, cost the hospital less to employ and are plenty qualified to deal with the problems your other reader mentioned - pimples, sore throats, diaper rashes, etc.

Despite the occasional resentment felt by those of us who are spinning our wheels spending hour after hour taking care of patients who would have been just fine waiting to see their regular doctors, I try to remember that people are there by-and-large, particularly when it comes to pediatrics, because they're really worried about their kids and simply don't know what constitutes a true medical emergency.