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Glenn D. Braunstein, M.D. Headshot

ER Crisis: Think, Plan, Act to Get Best Emergency Care in Urgent Situations

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After dining on the best tapas of your life and while relaxed and heading home after a hard week, whack! Wham! Your car has been hit. You're in pain, and after a dizzying ambulance ride, you find yourself in an emergency room. How long will you wait? And what kind of situation will you be thrust into?

Know this: emergency room care has reached a crisis stage in Los Angeles and nationwide, especially in big cities where there are many poor and uninsured. A just-published study in the Journal of the American Medical Association reported that the number of urban ERs declined 27 percent in the last decade (to 1,779 from 2,446), even as patient traffic increased. Hospitals that served many poor individuals, were located in highly competitive markets and that were for-profit but had slim margins, were most likely to shut their ERs, according to 18 years of research observation.

For patients, this means that, even in a serious situation when time matters most, you may be diverted to another ER if one nearby is overloaded and has shut temporarily. If you're not confronting a life-threatening situation, you may sit in a waiting area for hours before receiving care. In some LA-area emergency rooms, patient waits exceed 10 hours. Nationally, there were 123.8 million emergency room visits in 2008 (the most recent year for which there is data from the Centers for Disease Control and Prevention) -- an average of 41.4 visits for every 100 people. Only 18 percent of patients who arrived at the ER were seen in fewer than 15 minutes. In California, more than 11 million individuals visited the emergency room in 2009, according to the most recent data from the Office of Statewide Health Planning and Development.

A health care consulting firm says that nationally, the ER wait-time averages around four hours. A recent federal report says that, in 2009, patients who needed to be seen in one to 14 minutes did not get that attention before 37 minutes.

Patient Patients?

It's little wonder that even the most patient people explode with complaints about their ER experiences, even when, ultimately, they are pleased with their medical care and take into account the common-sense reality that the sickest, most injured must be treated first.

What's ailing our ERs? Simply put, they wrongly have become the venue of last resort for too many people for medical treatment. That said, yes, the federal laws requiring these areas to treat patients, regardless, make sense. But for many of us, there are better options, including urgent care or even retail clinics (such as those that are found attached to chain pharmacies). Americans, it seems, simply seek excessive non-emergency treatment in ERs.An estimated 13.7 to 27.1 percent of all emergency room visits could be dealt with well at these alternative sites, studies show. They note that in many situations -- such as when you or a loved one experience strains, fractures or illnesses like sore throats -- urgent care may be a better option, especially considering the waits, stress and exposure to a place full of unhealthier individuals.

In addition, there is a national shortage of primary care physicians, the family-style MDs who grow familiar with their patients and once took care of many of their medical needs, urgent and otherwise, reports the American College of Emergency Physicians. Because many primary care physicians earn less than specialists, med students graduating with upwards of $200,000 in debt often don't pursue a generalist's practice. This means there are fewer primary care doctors and because of this, more patients experience longer delays in securing doctor appointments, which can sometimes take weeks. That leads them simply to visit the ER to wait it out there rather than hold out longer to see a personal physician.

The Cost of Emergency Care

But making ERs the prime point for the provision of medical care has its price -- beyond time lost and personal inconvenience. Emergency rooms have become a leading driver of medical costs overall, as they must be staffed 24/7 with pricey equipment and technology, as well as highly skilled medical personnel trained to handle the most dire and dramatic situations. So if you head to the ER for treatment, it likely will be expensive.

Indeed, according to some estimates, if patients could be persuaded to pursue non-emergency treatment in urgent care centers and retail clinics, the nation could save $4.4 billion annually. And since by law, hospitals must treat any individual who enters an ER - whether insured or not -- many hospitals set high gross charges for such care.

What Can Be Done?

With the national political season upon us, it's confounding to all, I think, that we can talk so much about health, health care and public policy without engaging in the serious, adult discussions the times demand. When it comes to our overwhelmed ERs, certainly there's a thicket of issues to deal with -- from insurance to health care economics, hospitals' operations, how best to care for the poor, the aged, the chronically and mentally ill, and, perhaps, even immigration policy. As voters and taxpayers, we need to get and stay informed and to press policy-makers to fix our ER woes.

As individuals and families, patients can, and should, take steps to keep themselves out of ERs, to avoid unbearable waits and to ensure that those who really need the care most receive it in a timely manner: If you're not in a life-threatening situation, think of alternatives. Can, for example, urgent care or retail clinics deal well with your health issue? (Such spots, it should be noted, will refer you, posthaste, to a hospital if their expert evaluation says your needs exceed their capacities.)

Even before a crisis develops, though, what kind of relationship have you developed with a physician or caregiver, in particular to figure out what's supposed to occur in your health emergencies? Physicians, no matter what the sitcom stereotypes suggest, take calls from their ailing patients, and, especially if they know you, can better advise you on the best care for your needs and situation. They're familiar with your health conditions and medical history, and if you've got chronic conditions, you especially want to build a relationship with your MDs.

I want to put in a special word for my hard-working colleagues who treat babies and young children and help their moms and dads. Parenthood isn't easy. It's learned over time, and it can be human to fret and to delay calling a pediatrician until late, on a weekend or a holiday and even then to cart a child to the ER with a fever or cough. There's growing concern about the number of children seeking non-emergency care in the ER. Work with your pediatrician in advance, establish that rapport so if you need help after hours, you feel comfortable making a timely phone call. That certainly beats spending the wee hours, struggling with a sick child, in a crammed, tumultuous ER waiting room.

If you have older offspring, check into recent national health care changes that let you keep your kids on your insurance in that tween time when they're out of college or university but not yet working at a job with health benefits. It isn't cheap, I know. While the young may think themselves invincible, they're prone to accidents and violence (sadly), and they often delay seeking care until they find themselves in need of urgent or even emergency treatment. They're heavy users of ERs, and if they are uninsured, they may be saddled with a debt for medical care that may be difficult to crawl out from under.

This brings me to my last plea: The medical reasons for why folks typically end up in ERs offer few mysteries and plenty more places for people to take personal, preventative measures, U.S. statistics show. Without dwelling on data, they suggest that further good ways to stay out of emergency care include: frequent checkups if you have a chronic condition, especially to stay on top of heart and lung woes and diabetes; staying away from drinking and driving; getting flu shots; taking care about where and what you eat; and, guys, especially, let's not pretend we can hoist everything with no concern for our backs or kid ourselves about our expertise in dealing properly with risky household matters (using power tools or ladders, handling chemicals or fire). Emergency rooms and departments are serious places for dealing with life-threatening care, and we all should do all we can to stay out of them and let the great experts there do what they must.