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Study: Primary-Care Traffic Crippling Hospital EDs

Emergency Management Alert, November 29, 2005

Emergency responders don't have to be informed that pressure on hospital emergency departments to provide primary care is further weakening overburdened facilities; however, there is a new study that may shed more light on the trend. Released last week by the Center for Studying Health System Change (CSHSC), the study highlights such problems as poor staffing practices (assigning specialists to provide on-call coverage) and quality-of-care concerns in management of patients with serious mental illness. "Failure to address these growing pressures could compromise access to emergency care for patients and spur already rapidly rising health care costs," says the study, "Rising Pressure: Hospital Emergency Departments as Barometers of the Health Care System," released this month.

Surge in Non-Urgent Visits

Reporting increased use of emergency departments for primary care are hospitals, health-plan and public-sector facilities. Respondents were interviewed during CSHSC's 2005 site visits to 12 nationally representative communities. "Overall," the study says, "the percentage of ED visits for non-urgent or semi-urgent reasons has increased over the past decade." Exacerbated by the ED's 24-7 availability, the problem has intensified during the past two years, the study says, despite the fact that facilities are "not designed or staffed to provide continuous and comprehensive primary care efficiently."

This has prompted a response from some communities are trying novel approaches to improve access to primary care for Medicaid and uninsured patients.

• in Cleveland, a public-private partnership funded by the United Way Vision Council is creating an outreach program to educate residents about primary care services as well as develop a shared electronic medical record across three hospital EDs and the area's three federally qualified community health centers.

• in Seattle, Harborview Medical Center is hiring case managers to connect frequent ED patients with primary care physicians and training the patients in self-management to help prevent avoidable ED visits

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