Got your hands full? ER crowding outgrowing ER visits

January 12th, 2015

With ER visits outpacing population growth in the past decade, it may be surprising to learn that ER crowding grew even more rapidly than ER visits.

According to a study recently published in the Annals of Emergency Medicine, ER visits increased by 1.9% per year in the past decade, while crowding – or mean occupancy – grew by 3.1% per year.

How is this possible and where are the numbers coming from? According to the lead researcher of the study, Stephen Pitts, MD, MPH, of the Department of Emergency Medicine at Emory University in Atlanta, GA, “We were surprised that ordering blood tests and administering IV fluids, along with other aspects of patient care, contributed more to crowding than advanced imaging.”

Although advanced imaging grew by 140% during the study period, and is often the culprit of ER delays and cost growth, Dr. Pitts states, “Ironically, it is possible that innovations intended to speed patients through the ER – such as authorizing the early ordering of blood work and X-rays at triage – may be bogging down patient flow instead.”

The data, which researchers analyzed from ER visits during 2001 to 2008, provided several clues into the increasing numbers. Among those clues:

• Visits during traditional office hours increased significantly more than visits after hours.
• Visits for Medicare patients and adults age 45-64 grew faster than any other group.
• Non-urgent use of the emergency department exerted little or no impact on crowding.

The study’s co-author, Jesse M. Pines, MD, MBA, of the Departments of Emergency Medicine and Health Policy at George Washington University in Washington, DC, notes that the study’s findings need to be considered in the context of a wider health care debate in this country. “Lengthy work-ups in the emergency department are not always a bad thing if they prevent a costly hospitalization. The problem is that more and more demands are being placed on emergency departments, and the mood in the health policy community is to shrink emergency departments, not grow them. While everyone would agree that preventing emergencies is ideal, policies designed to pinch off an already overwhelmed emergency care system are not.”

ERs across the country are feeling the pressure. “A rapidly rising tide of older, sicker patients, combined with an increasingly interventionist practice style, is putting enormous pressure on a shrinking supply of emergency departments. This has ominous implications for patient safety and access to emergency care in the U.S.,” Dr. Pitts concludes.