Emergency room use has increased significantly in recent years. Many believe this is because some users do not have a regular source of primary care. When emergency rooms are used inappropriately, that is, not in a true emergency, concerns arise about cost but also about the continuity of care and other quality issues. A recent report in the Annals of Emergency Medicine tries to identify the extent of emergency room crowding by looking not only at visits but at length of visit compared to capacity, in order to get a measure of crowding. The researchers also sought to identify reasons for greater ER use and crowding. (Annals Study) A critical aspect of the emergency room situation is that the number of ERs has declined even as ER visits grow twice as fast as the population. Crowding may lead to delays in care, to more errors and to greater patient dissatisfaction. Data from a national surgery of ER use was the source for the analysis.
The researchers found that both number and duration of visits has increased in the period 2001 to 2008. They created a measure of occupancy and tried to identify factors correlated with higher or lower occupancy. On a daily basis, ER occupancy is at a low at 7 am and reaches a peak around 8 pm. Occupancy increased faster than visits suggesting that visits were lasting longer, which may mean that capacity is strained, that more services are being delivered or that more difficult cases are coming to the ER. ER visits by Medicare patients increased the most and private insureds’ visits decreased slightly, perhaps due to the greater copays faced by these patients in recent years. Rural vs urban or type of hospital ownership did not seem related to occupancy rate. The data does not suggest that there are more non-urgent visits. It may be that there is little that can be done to reduce ER usage and we should instead focus on how we can make visits less expensive and more efficient.