POSTED ON APRIL 29, 2016, BY JUCM IN MARKETPLACE
Renee Y. Hsia, MD, MSc1,2; Ari B. Friedman, MS3; Matthew Niedzwiecki, PhD1,2 [+] Author Affiliations
JAMA Intern Med. Published online April 18, 2016. doi:10.1001/jamainternmed.2016.0878
Patients who don’t need to be visiting the emergency room at all are too often not only evaluated, but admitted into the hospital through the ED. Some even wind up in critical care units, according to a new study published in JAMA Internal Medicine.
While some patients may be heading to the ED because they’re unsure of the most appropriate setting for their symptoms, others claim lack of access to primary care as the main reason. The authors included 240 million visits between 2009 and 2011 in the study; 17.8 million were classified as “nonurgent.”
Diagnostics, including blood tests and imaging, were done in over 47% of those visits; intravenous fluids, casting, and splinting were performed in almost one third. Worse, 776,000 visits that were deemed to be nonurgent resulted in hospital admissions, with 16.2% of those being critical care unit admissions.
Such misuse of ED resources for conditions that could be treated in an urgent care setting results not only in excess cost to patients and the healthcare system, but also draws resources away from truly emergent—even life-threatening—cases that really do have to be in the ED. One solution would be for urgent care centers to work more closely with hospitals on referral arrangements and to better educate the public on the level of care available in urgent care.
Personal comment: Patients need an incentive to use UC rather than the ER, and hospitals have to be held financially responsible for the 776,000 visits that were nonurgent yet resulted in admissions. One route to better resource allocation is to have the offsite attending be the gate keeper. If on every admission, this gate keeper must remotely review the case and give his or her digital agreement, then this is (sad but true) a strong disincentive to avoid unnecessary admissions.