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Survey says: Hospital emergency rooms are busy and getting busier
[May 01, 2011]

Survey says: Hospital emergency rooms are busy and getting busier


May 01, 2011 (The Morning Call - McClatchy-Tribune Information Services via COMTEX) -- Ask Dr. Alexander Rosenau about the trend he's witnessing in the emergency department and he can sum it up in one word: more.

More patients. More serious symptoms. More people with complex, multiple illnesses.

"At Lehigh Valley and most of the emergency departments in the Valley, growth is continuing unabated, and I would say the acuity remains very high," said Rosenau, senior vice chairman of emergency medicine at Lehigh Valley Health Network.



Rosenau's observations are in line with a survey released Thursday by the American College of Emergency Room Physicians, which showed that more than 80 percent of the 1,768 doctors who responded reported that emergency department usage was "significantly" or "somewhat" increased. Nearly nine in 10 expected the trend to continue in the next year. The survey found some disturbing trends. It showed that the "most important reason" for the increased use of the emergency department, at 28 percent, was an increase in patients without health coverage. Additionally, nearly all the doctors who responded said they saw Medicaid patients who resorted to the emergency department because they could not get an appointment with a doctor who would take their insurance.

To Rosenau, such findings support a belief that has become a mantra among emergency department physicians: "Insurance coverage does not equal access." Health care reforms signed into law last year will increase the number of insured people, but not in great numbers until 2014.


Frequently, Rosenau said, primary care doctors refer their patients directly to the emergency department, defying the myth that people simply choose it over a family doctor. The survey supports Rosenau here too, with the finding that 97 percent of doctors reported seeing patients referred to their emergency departments by other doctors every day.

Age and obesity also have contributed to the increase, he said. As patients live longer, they may have multiple health issues, which can make emergency visits more frequent and more complicated. Likewise, obese patients frequently have diabetes, high blood pressure and other ailments that prompt them to seek help, he noted.

The numbers are up virtually across the board at Lehigh Valley Health Network's three emergency departments. In 2008, the network's hospitals in Allentown, Bethlehem and Salisbury Township had 143,834 patients come through its emergency rooms. Just two years later, the overall number is up by 20,000 patients, including 76,300 at LVH-Cedar Crest -- a 20 percent increase.

And that doesn't include the first children's emergency department, which opened several weeks ago at LVH-Cedar Crest. There, doctors are seeing 30 to 40 patients a day, Rosenau said.

"Volumes are higher than expected," he said.

At St. Luke's Hospital & Health Network, patient usage of the emergency departments also is up significantly, particularly at its Allentown hospital. That emergency department will see an estimated 47,386 patients this year, a jump of nearly 39 percent since 2007, said Dr. Will Sotack, medical director.

The hospital more than doubled its emergency room beds since 2008, but even that space is being maxed out, Sotack said.

Patients have been reporting with the "typical emergency room mix" of people with chest pain, fractured bones, breathing problems and accident victims, Sotack said.

Representatives at Sacred Heart Hospital in Allentown and Easton Hospital declined to specify emergency department use at their facilities, but said the trend at both places also is on the rise. Valerie Downing, vice president of marketing and public relations at Sacred Heart, said emergency department use in March was among their busiest "in years." Rosenau and Sotack agreed that emergency departments face another threat: a growing shortage of primary care doctors. Having an adequate supply of primary care doctors helps out emergency departments by getting people to care for their diseases before the problems become acute. "On the back end, it should save money because ... they'll be treated sooner," Rosenau said.

The American College of Emergency Room Physicians says emergency care costs less than 3 percent of the nation's $2.1 trillion health care tab. Considering that emergency departments are usually open all day and often treat critically ill people, emergency care is a bargain, the organization says, citing a study in the New England Journal of Medicine.

Sotack emphasized that the hospitals have clinics that individuals can visit, sometimes without a strict time appointment. Clinics provide a place where people can get the follow-up care that may be required after a trip to the emergency department. They also accept Medicaid patients, he said.

But for even the best-insured, most health-conscious individual, a visit to the emergency department is virtually inevitable at some point.

"It's not a failure to use the emergency room," Rosenau said. "No matter what you do, there will always be unexpected events." [email protected] 610 778-2259 To see more of The Morning Call, or to subscribe to the newspaper, go to http://www.mcall.com. Copyright (c) 2011, The Morning Call, Allentown, Pa.

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