ERs cut back as patient loads rise

Emergency room visits increased 20 percent in the past decade, while the number of emergency departments shrunk 15 percent.

The finding, from a Centers for Disease Control and Prevention survey released Wednesday, is the latest illustration of an overtaxed ER system facing a crisis, experts say.

A nursing shortage, cuts in reimbursement, an aging population and a lack of inner city and rural primary care doctors are leading hospitals to turn away ambulances, make patients wait in hallways and delay care.

The crunch is tightening as the threat of terrorism and diseases such as SARS loom, adding increased urgency to the need for ER capacity.

"It's a problem that becomes a crisis when ambulances get diverted and patients have to travel longer distances to get the care they need," said David Shactman, a senior research associate at Brandeis University in Boston.

Arizona's Tuscon Medical Center said last month it will close July 1, and the only top-level trauma center in Detroit may shut down this summer.

Atlanta's sole Level 1 facility, Grady Memorial Hospital, faces ER crowding and a $20 million budget deficit that could lead to a reduction in services, said Dr. Arthur Kellermann, head of emergency medicine at Grady.

There were 107.5 million emergency room visits nationwide in 2001, up from 89.8 million visits in 1992, the CDC said. Most of the increase began in 1997, when managed care companies stopped requiring approval prior for ER visits and federal officials forced hospitals that accept Medicare to take all patients.

The U.S. population grew nearly 12 percent during the decade. The increase in people age 75 or older -- who go to emergency rooms 60 percent more than average -- accounts for much of the boost in ER usage, said CDC health scientist Linda McCaig.

But the CDC also found that parents often bring children to ERs in the evening, possibly because they can't make appointments with primary care doctors during the day, McCaig said.

A lack of physicians in inner cities and rural areas leads many patients to seek ER care, Shactman said. A Commonwealth Fund study found that 75 percent of visits to New York City emergency rooms were for conditions that weren't emergencies or could have been treated in primary care clinics.

The CDC said there were 3,872 ERs in the country's 6,000 hospitals in 2001, down from 4,530 in 1992.

Some emergency departments expanded, so there may have been less than a 15 percent drop in ER beds. A recent California Healthcare Foundation study found that the number of emergency room beds increased 19 percent in the state during the 1990s, while the number of emergency departments dropped 10 percent.

But hospitals across the country have fewer inpatient beds for longer-term care. This stems from mergers and downsizing forced by budget cuts and increased expenses from the nursing shortage, a growing uninsured population and other factors, Kellermann said.

Grady operates 796 of its 1,035 licensed beds. That leads to backlogs of emergency room patients waiting to be admitted and more demands on ER staff, Kellermann said.

Emergency room crowding led two of three hospitals to turn away ambulances at some point in 2001, the U.S. General Accounting Office says.

Up to eight Atlanta hospitals have diverted ambulances at the same time, Kellermann said.

Possible solutions include more primary care clinics in underserved areas and a return of some penalties for unnecessary trips to the ER, Shactman said.

Hospitals also could open more inpatient beds, he said. And instead of doing most routine surgeries on certain days, they could spread out the procedures throughout the week and on evenings so operating rooms and intensive care units are better prepared for sudden bursts of ER activity.

But Kellermann said much of the answer must come in increased government funding.

"The situation is alarming and has been for some time," he said. "It's unconscionable that we're not coming to terms with the Achilles' heal of our health care system."

Something missing in this article?

Hush! If we're all real quiet then maybe no one will notice what's going on.

But Kellermann said much of the answer must come in increased government funding.

Heaven forbid that we should control the tide of illegal immigrants who use our ER's as their "family doctors."

Yes ---in many parts of the country now, the non-paying patients are outnumbering the insured patients. Already here only 32% of the population bothers with private insurance, 34% has Medicaid or Medicare and 34% don't even have that ---but everyone is equally "entitled" to the same health care ----even if they just came over from Mexico.

No doubt this article is not going to mention the fact that the 12% increase in population comes from immigration.

During this same period, didn't our congress vote to let 200,000 h1b visas into this country every year? Didn't they close their eyes to the 1500 illegals coming into our country daily? What about the Russians, Somolies, ME, and other immigrants coming into our countries? After they get here, they then bring their extended families.

Now they are telling us that we have a nursing shortage and ERs are closing for lack of pay? DUH!

Most all of this has been done under the leadership of the Republican Congress.

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