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Report: ER visits climb while emergency departments fall

By Kathleen Fackelmann
USA TODAY

The number of visits to the nation's emergency rooms climbed 20% the past decade, even as the number of emergency departments was shrinking, a report out today says.

The findings add to the evidence suggesting that more and more Americans face long waits in overcrowded and sometimes short-staffed emergency rooms.

The report by the Centers for Disease Control and Prevention in Atlanta suggests the aging population fueled some of the increase. That will continue in the coming decades as baby boomers reach their senior years and develop chronic medical problems, says Linda McCaig, the report's author. Seniors were the heaviest users of emergency rooms.

The report found that trips to the emergency room in 2001 rose to 107.5 million, up from 89.8 million in 1992. Meanwhile, numbers of emergency departments fell 15%. Some closed because they lost money and others because of mergers or hospital closures. The pressures of more demand and fewer emergency rooms mean that patients wait longer for care or that ambulances are diverted to other hospitals, McCaig says.

A March report from the federal General Accounting Office said two-thirds of emergency departments reported diverting ambulances during 2001, and nearly 1 in 10 hospitals said that happened 20% of the time. Reasons behind the heavy use of ERs:

* People with inadequate or no insurance often visit the emergency room because they can't get routine medical care.

* Adverse medical care such as an allergic drug reaction or complications as a result of shorter hospital stays led to about 1.4 million visits to the nation's emergency rooms in 2001.

* The report classifies 10% of emergency room visits as non-urgent. In some cases, people go to the emergency room because it's the fastest way to get care after hours. For example, the report found a peak in pediatric admissions at night. That's probably because most pediatrician offices are closed then, McCaig says.

Hospitals also get a lot of patients who find it's more convenient to go to the local hospital for care, adds Rick Wade of the American Hospital Association. He says many doctor offices are in the suburbs, and people in inner city neighborhoods may find it easier to go to the hospital for their care.

In many emergency departments, patients are lined up waiting for admission to hospital beds, says Arthur Kellermann, spokesman for the American College of Emergency Physicians in Washington, D.C. Lackluster insurance reimbursement has led many hospitals to close beds or entire wards, which means patients are left waiting in the emergency room or lined up in the hallways.

The crowding, coupled with a severe nursing shortage, has led to hectic conditions in many emergency rooms, Kellermann says. Those conditions can lead to mistakes, including errors in medication or treatment, he says.

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