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More ER visits can result in better care

By ALEX CUKAN

ALBANY, N.Y., July 7 (UPI) -- The increase in U.S. hospital ER patient loads can mean longer waits and more crowded conditions for some hospitals, but for other ERs the increase can mean more efficient and more patient-friendly care, experts told United Press International.

About 13 percent of emergency departments have been eliminated from U.S. hospitals, while trips to ERs have risen 14 percent, for a record high of nearly 114 million annually, according to data compiled by the Centers for Disease Control and Prevention in Atlanta for 2003, the most recent data available.

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Conventional wisdom says much of the spiraling cost of hospital care is due to the poor or uninsured seeking treatment at ERs because they lack a primary-care physician.

It turns out, however, that much of the increase in ER visits is due to doctors directing more patients to seek emergency treatment when they are not available evenings or weekends, experts said.

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"ERs were designed for a serious emergency like a heart attack or a gunshot wound," said Robert B. Helms, a resident scholar at the American Enterprise Institute in Washington. "But it's very expensive to treat a patient in a hospital ER for something that is not time sensitive -- it's more efficient to go to a physician than clogging the ER."

For some hospitals, even 60,000 ER visits per year can be handled efficiently when it comes to staffing, space and equipment, said Dr. Tom Scaletta, head of the 60,000-visit emergency department of Edward Hospital in Naperville, Ill., and vice president of the American Academy of Emergency Medicine.

"On average, the cost of a marginal patient with a strep throat is no greater than having (him or her) treated at a doctor's office," Scaletta said. "Ideally, you want a well-equipped facility, properly staffed with patients not waiting long."

He said timing is the critical factor.

"Some can accommodate emergency visits and urge their patients to call them first in an emergency," Scaletta said. "Other doctors will tell you right off to go the emergency room with a suspected strep throat."

Despite the increase in visits, the average wait time to see an ER physician was 48.9 minutes in 2003, but that varied considerably, according to the CDC report.

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"Some ERs are competitive in wait times with a scheduled well-baby visit to a doctor," Scaletta said.

An efficient ER can also be a more compassionate ER. Space and funding of most big-city hospitals usually are limited, so probably no more than 20 percent of hospitals offer the "new-model" approach to patient care, which can include computerized medical records, private treatment rooms and separate treatment faculties for children and adults.

All of these approaches can increase both treatment efficiency and constitute a more patient-friendly environment, according to Dr. Matt Miles, director of pediatric emergency medicine at the Albany Medical Center.

"Once an ER gets to the point that it can no longer accommodate the amount of patient visits, the hospital board might decide to expand and rehab the ER," Miles said. "At Albany Med the increase in ER patients visits drove the move to redo the ER."

Scaletta's suburban ER also utilizes the new model, but even the ultra-busy ER at Kings County Hospital in New York City has begun a $500 million expansion that includes a 340-bed inpatient bed tower and a new Emergency Center.

"Many ERs are no longer considered a back-door function -- but as the hospital's front door," he said. "Some 100 million people visit an ER each year -- one in three people. It's a brilliant marketing opportunity for the hospital to impress the patient with the quality and promptness of care."

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Alex Cukan covers health and health policy matters for UPI Science News. E-mail: [email protected]

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