Shattering myths about emergency rooms: ”˜Urgent emergents’ and ”˜frequent fliers’

by Jessica Firger
Graduate School of Journalism at CUNY

President Bush made an infamous comment during a speech in Cleveland, Ohio, last year: "The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room."

The president was perhaps repeating what he has heard about emergency rooms, or even read in the papers. The notion that emergency rooms are a hub for health care of the uninsured has been a popular narrative in hospital news coverage for many years. However, a study recently published in the Journal of the American Medical Association revealed that privately insured people use emergency rooms more often than the uninsured do.

According to the Centers for Disease Control and Prevention, only 12 percent of visits to the emergency room are deemed non-emergencies. At Montefiore Medical Center in the Bronx, New York, only 1 percent of patients are "frequent fliers," those who turn to the emergency department for all of their health care needs, according to Lynne Holden, M.D., an attending physician in Montefiore's department of emergency medicine speaking at the Urban Health Journalism Workshop on Oct. 18 in New York City.

"We really are victims of our own success. We're open 24-7," said fellow panelist Michael Carius, M.D., chairman of Norwalk Hospital's department of emergency medicine in Connecticut.

Carius, former president of the American College of Emergency Physicians, said that 90 percent of emergency care facilities are working beyond capacity and one ambulance is diverted every minute, stretching the average emergency department beyond capacity. By 2020 emergency rooms will be short 100,000 physicians and 500,000 nurses.

"Emergency departments are really the canary in the coal mine," Carius explained. How well an emergency department functions is the gauge of a hospital's overall health and productivity. Because of this, emergency departments have become scapegoats for a hospital's failings. The genesis of the emergency room's downfall can be traced to the early 1990s, the heyday of managed care when it was presumed that fewer emergency beds were needed with the new system in place. 

The result is a larger and rapidly aging population who cannot get emergency care when they need it, an increased availability of technology which slows down the emergency department, not enough preventive care, and a shortage of primary care physicians.

As the demand from patients goes up, the supply of resource goes down, which leaves an ever-growing "surge capacity gap," Carius said. In other words, our country's ill-equipped emergency rooms will make it impossible to handle large-scale national catastrophes caused by bioterrorism or natural disasters, a fact made more apparent by the aftermath of 9/11 and Hurricane Katrina.

The solutions, however, need to occur on the micro-level, according to Holden. She suggested increasing fast-track hours to an around-the-clock operation, to bring immediate aid to what she calls "urgent emergents," seriously injured patients or victims of accident or trauma. At Montefiore, Holden said, the emergency department has been able to decrease its "door to needle time" for many of its heart attack patients, meaning the time it takes for some victims to get from the door of the emergency room to a cardiac catheterization has lessened.

Holden also recommended an increase in hours for social services such as domestic violence counseling. But a long-term solution – and most pressing of all – would be for hospitals to increase their efforts in recruiting more "culturally competent" health care providers who are willing to take on the emergency room.