5.06.2008

Why is My ER So Busy?

We all know that ERs are busy these days, but is this due to the 43+ million uninsured getting healthcare the only place that can't turn them away? Not according to the most recent survey. As reported in the NYTimes, the actual number of uninsured patients is declining visiting our ERs is declining even as the percentage of uninsured increases nationwide. Of course that's not exactly good news.


The 26 percent increase in the number of visits in the period was
largely caused by an increase in the number of people with private
doctors who sought emergency room care. The authors suggest several reasons, among them an aging population,
a growing number of time-sensitive medical treatments that can be
performed only in an E.R., complications from medical and surgical
treatments and the difficulty of obtaining a timely appointment with a
private physician.

That jibes with what we see in our ER. A lack of general practitioners to care for an increasing elderly population has caused a logjam at the clinics and the ER is the only pressure outlet. When I triage, many of my patients tell me they tried to get an appointment to see their doctor but couldn't get in for three weeks. That's fine for a checkup, but for an acute illness it is totally unworkable. They get sicker, their CHF gets worse and they come to the ER. In fact our clinic tells patients to come to the ER if they insist they need to be sooner.

Right now there are three urgent care centers -- no appointment walk in clinics -- opening up across the river in Oregon. I'm curious to see what the competition will do to traffic in our ER. Certainly, urgent care makes a lot more sense for runny noses.

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