JustCare

Tag: Emergency room

  • With limited options, one in three people visit the ER every two years

    With limited options, one in three people visit the ER every two years

    A recent Robert Wood Johnson Foundation, NPR, Harvard School of Public Health poll reveals that one in three people in this country visited the ER in the last two years. And, it’s often not because they have an emergency. It’s rather because we don’t offer them a viable alternative.

    Almost half of all patients who received emergency care say they did not do so because they had an emergency. People often choose the ER because they can’t find a doctor to see, and it’s a convenient solution. Either they can’t schedule an appointment quickly enough. Or, the medical facility they use is not open when they need it.

    For the most part, hospital emergency rooms are generally set up to treat emergencies, not routine care. Many people who end up in the ER report low satisfaction with both the cost and quality of their care. Long waits for treatment are the norm.

    Why shouldn’t hospitals be able to treat all comers in a satisfactory way and at a reasonable cost?

    Here’s some advice about hospital care from Just Care:

  • Paramedics help people avoid emergency rooms

    Paramedics help people avoid emergency rooms

    A new initiative is underway around the country to use firefighter paramedics to keep people out of hospitals and direct them to appropriate primary care or other services. And, it’s working! With support from the California Health Foundation, firefighter paramedics in the Golden State are being trained to identify individuals who use hospital emergency rooms frequently for non-emergency situations and, instead, pay them regular visits. The goal is to get them needed care so that they don’t call 911 or need to use the emergency room. The paramedics call on them in their homes and connect them to regular doctors or other services that can keep their health on track.

    In California, with authorization from the State Emergency Services Medical Authority, 13 jurisdictions are participating in this pilot program. Some of the programs focus on people who have just been discharged from hospitals. Others treat “frequent flyers” who are thought to use emergency rooms more than necessary.

    Conventional paramedics typically spend about 20 minutes talking with the 911 callers in their homes and another 20 minutes taking them to the hospital. Instead, community paramedics partner with people in need of care and create a plan with them so they get access to the services they need most that can help them better care for themselves. Not surprisingly, their clients want this help and are willing participants.

    The paramedics drop by to visit patients and work with them to achieve their goals, including checking their blood pressure, ensuring they take their prescription drugs,  and undertaking bio-psycho-social assessments of their situations. If appropriate, the paramedics may refer them to a social worker, arrange for home-delivered meals, connect them to local agencies that treat substance abuse disorders.

    In short, these paramedics show they care. As a result, these patients have had fewer hospital visits and a better quality of life.  For more information, click here. To learn more about the high number of older adults living alone, elder orphans, for whom these services can be life-saving, click here.

  • Emergency room closures are hurting patient care

    Emergency room closures are hurting patient care

    In the 13 years between 1996 and 2009, the number of emergency rooms has dropped more than 6 percent to 4,594, while emergency department (ED) visits have increased by 50 percent to 136.1 million from 90.3 million.  And, a new Health Affairs study shows that these ED closures has led to an increase in the number of people admitted to an emergency room who die; specifically, people whose nearby emergency room has closed are at higher risk of death.

    In short, ED closures have hurt the quality of care at nearby emergency rooms.  Many of the emergency rooms that have closed had served low-income vulnerable communities, people likely to be Black, Hispanic and female, have Medicaid, be uninsured and in poor health. Patients from communities whose EDs have closed often have travel further to get to an emergency room. The nearby EDs who have taken on more patients as a result of ED closures have been operating over capacity, requiring patients to wait longer for treatment and demanding more of their already busy staff.

    The study reveals a five percent greater likelihood of patient death in hospitals affected by ED closures than at other hospitals. Patients who had heart attacks, stroke and sepsis had a 15 percent greater likelihood of death than patients at hospitals unaffected by ED closures. Patients admitted with asthma or COPD did not have a greater risk of death.

    Emergency rooms are required to take all comers. They cannot turn a patient away for any reason.  Back in 2007, the Institute of Medicine described Emergency Departments as “at a breaking point.” And, more have closed since then. The study suggests a closer look at whether we need more Emergency Departments in vulnerable communities and incentives that would keep more Emergency Departments from closing, including higher payment rates.  The authors further suggest that “it may be time to reassess the extent to which market forces are allowed to dictate ED closures and access.”

    The study looked at more than 16 million ED admissions but only at Emergency Department closures in California. About 12 percent of the US population lives in California, but it is demographically different from the rest of the country, with a much smaller Black population and a much higher non-White population.

    Click here for tips on how to choose your emergency room, and here for how to keep your emergency care costs down.  Click here for how to plan for a hospital visit, particular an emergency visit.