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By Jonathan Springston, Editor, Relias-AHC Media
A new report from the CDC reveals that out of about 137 million ED visits in 2015, only 5.5% were for nonurgent conditions. Further, data show many patients aren't waiting long for treatment once they arrive at an ED, with 68% of patients seen within one hour and 35% within less than 15 minutes.
"Emergency care is a unique success story," ACEP President Paul Kivela, MD, MBA, FACEP, said in a statement. "No other medical specialty is the safety net for millions of patients with such a broad range of symptoms and conditions. The nation's emergency physicians care for any patient, any time, regardless of ability to pay — and we play an increasingly integral role in our health system."
The data emerged as part of the CDC’s sweeping National Hospital Ambulatory Medical Care (NHAMC) survey, which showed the leading causes of ED visits were injuries (such as falls or motor vehicle accidents), stomach pain, and chest pain. Patients over the age of 65 years (15.6%) and patients under the age of 15 years (19.8%) were the leading users of emergency care.
“Patients are living longer, managing more complex and chronic conditions, and for many reasons may not always receive regular primary care," Kivela said. "This means the emergency department is now more than ever the 'front door' to the hospital — our care and reimbursement models must continue to evolve to reflect this reality."
Patients also continued presenting with chronic conditions such as hypertension (23.6%), diabetes (10.9%), asthma (9.8%), substance/alcohol abuse (9.4%), depression (9.3%), and coronary artery disease (6%). In the February issue of ED Management, author Dorothy Brooks delivered a detailed report about Atlanta’s Grady Memorial Hospital’s plan to care for high-needs patients who frequent the ED (those who have visited six times in six months).
Under the Chronic Care Clinic (CCC) plan, navigators intervene with these patients when they present to the ED and connect them to the CCC, which offers services to meet patients' social and medical needs. The program's goal is to transition these patients to primary care so their underlying needs can be addressed. Among 41 patients enrolled in the program, ED visits per quarter have been reduced from 185 to 84, saving 100 visits per quarter for this group. The program has produced 65% fewer ED visits, 17% fewer inpatient admissions, and 146% more outpatient or ambulatory visits, and the cohort’s monthly costs have declined by 50%. Thus far, administrators have found that social limitations rather than chronic diseases have been a primary factor in these patients’ frequent ED use.
“These patients have difficulty navigating the medical system, so the easiest thing for them to do is walk into the ED. It is hard for them to understand how to pick up the phone and call for a cardiology appointment, figure out how to get Medicaid, or how to get their Medicare part B coverage,” explains Kelley Carroll, MD, the vice president and chief of ambulatory medicine in the Grady Health System. “They don’t have self-management skills, so the navigator and the community health worker are teaching them those skills along with the RN.”
For much more emergency medicine news, be sure to check out the latest issues of ED Management, ED Legal Letter, Critical Care Alert, Emergency Medicine Reports, Pediatric Emergency Medicine Reports, and Trauma Reports.