According to various researchers – Uscher-Pines, Pines, Kellermann, Gillen, Mehrotra (2013), and Moskop, (2010) – the number of Americans visiting the hospital has immensely increased over the years. For instance, Pitts et al. (2008), as cited by Moskop (2010) indicates that above 100 million patients visit the hospitals today in the United States. According to Moskop (2010) and Uscher-Pines et al. (2013), the rise in the number of patients visiting the hospitals has consequently led to emergency departments becoming a major source of healthcare for these patients across the United States. Moskop (2010) explains that emergency departments (EDs) are to provide for fast and prompt medical treatment for very urgent and emergent health problems. However, over the years, patients have resorted to seeking for EDs for various health purposes, some which are not emergent nor urgent. According to a survey dubbed “ National Hospital Ambulatory Medical Care Survey” presented by National Centre for Health Statistics (2008), there are almost 22% and 13% semi-urgent and urgent cases dealt with in EDs respectively. Only about 5% of the cases were triage and neede3d immediate medical attention. Uscher-Pines et al. (2013) add that most studies point that about 30% of the ED visits in the United States are non-urgent.
Use of EDs for non-urgent medical problems have become under strict opposition from most medical practitioners and lawmakers. Some researchers; Northington, Brice, and Zou (2005) and Carret, Fassa, and Domingues (2009) indicates that use of EDs for non-emergent medical problems is uncalled for and more disadvantageous. Northington et al. (2005) explain that visiting of the EDs instead of other care sites, for instance, retail clinics, for non-urgent medical issues can lead to overspending on healthcare, unnecessary wastage of time on testing and treatment, and missed chances to promote good relationships with most important and primary physicians. Carret et al. (2009) say that by the year 2009 a study had projected saving of about $5 billion annually if the non-urgent medical conditions were cared for in the retail clinics. Carret et al. also says that in cases where urgent cares were open the amount saved still applies. Over the years; however, most emergency physicians working in the hospitals have strived to implement practices that discourage non-urgent visits (Uscher-Pines et al., 2013). Uscher-Pines et al say that some of the practices that have been put in place to discourage non-urgent medical conditions in the EDs include higher co-payments, encouraging PCPs, and patient education about the use of EDs. Despite all these steps to discourage use of EDs for non-urgent medical conditions, the use of the EDs has continued to rise and still expected to rise. The question is why. Uscher-Pines et al. (2013) look at the possible reasons why people prefer EDs. The common explanation as indicated by Uscher-Pines et al. (2013) is that most patients prefer EDs because of the possibility that prior interventions had not adequately addressed the issues. This forces the patients to see an alternative in the EDs (Guttman, Zimmerman, & Nelson, 2003). This paper looks into the reasons why hospitals EDs are used for non-urgent medical conditions and the possible consequences.
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Various researchers have presented studies that point to various reasons as to why hospital emergency departments are in most cases used for non-urgent medical conditions by the masses. However, some of the common reasons are based on income, insurance, social support, the perception of severity, convenience, cost, and previous healthcare experience. Most of the people of low income have been found to prefer the use of EDs irrespective of whether the medical condition is urgent or non-urgent. Mortensen (2010) indicates that most of the uninsured patients prefer ED services. Mortensen says that uninsured patients are likely to visit ED compared to HMO and Medicaid patients. Sesser et al. (1991) and Petersen et al. (1998) says that social support also plays a major role in the use of Hospital EDs for non-urgent medical conditions (cited by Uscher-Pine et al. 2013). One of the major social support that played a role in the visit of the EDs is marital status. Most of the single people prefer the EDs (Uscher-pine et al., 2013). According to Cunningham, Clancy, Cohen, and Wilets (1995) health status also plays a vital role in the visitation of the EDs. Cunningham et al. indicates that persons with poor health prefer visiting EDs.
Apart from the above-mentioned reasons for use of the ED for non-urgent medical conditions, some of the most common reasons include previous health experience, as earlier mentioned by Uscher-pines et al (2013), perceived severity, and cost. According to Han et al. (2003), cited by Uscher-Pines et al. (2013), and Cunningham et al. (1995) previous health experience have been cited by many searchers as a cause to the use of EDs for the non-urgent medical conditions. According to Han et al (2003), most patients feel that some retail clinics do not actually address their medical conditions appropriately. In fact, most patients feel that hospital EDs are better when dealing with their medical conditions. These patients do not consider whether the medical issue is non-urgent or not. Perceived severity, according to Gill et al. (1996) and Baker et al. (1995) is one of the few common reason as to why most patients with non-urgent medical conditions visit hospital EDs (Cited by Uscher-Pines et al. (2013). Most patients in the United States perceive their medical conditions as urgent (Moskop, 2010). Finally, according to McConnell et al. (2007) cost is also a serious factor why hospital EDs are used for non-urgent medical conditions (cited by Moskop, 2010). According to Northington et al. (2005), 42% of patients visit ED because of the payment flexibility. Most of the ED services do not require payment at the time of treatment (Uscher-pine et al., 2013). As much as people prefer visiting the ED for non-urgent medical conditions, there has been a concern about the possible consequences by various researchers.
According to Derlet et al (2000) and Moskop et al. (2008); as cited by Moskop et al. (2010), the major problems that are associated with non-urgent ER visits of the EDs include overcrowding, the high cost of care, and low-quality care. According to Butun and Hemingway (2017), the past three decades have seen the overcrowding of the EDs with patients waiting on many occasions. This according to Moskop (2010) has resulted in the decreased protection of the patient confidentiality and recommended privacy. According to Derlet et al. (2008), cited by Moskop (2010), overcrowding has even led to impaired evaluations and treatments of the patients. Moskop (2010) indicates that patients with minor medical problems might take longer time in the waiting line in a crowded ED than in uncrowded one; however, the issue is that their treatment and evaluation take shorter time and could be done in clinics. This ends up creating overcrowding which could be prevented.
According to Berger (2010) (cited by Moskop (2010), high-cost of care is another possible consequence of non-urgent visits of ED. Coulehan (2009) says that even diagnosis has become expensive because of the increased number of people visiting the ED. Coulehan, for instance, visits an ED to determine the cost of Shingles which he finds to be resulting in about $9,000 bill. According to Moskop (2010), the reputation of the ED services has resulted in expensive services since most people also prefer the service.
Finally, Moskop (2010) indicates that the most critical negative consequence of the non-urgent visit of the ED is the reduced quality of care. Moskop cites a physician named Seay Tim who says that “ the ER’s a bad place to get your primary care”. According to Greene (2007), cited by Moskop (2010), ED care has been noted to contribute to low-quality care in non-urgent medical condition cases. Moskop explains that this is because the patients are strangers to one another and the encounter is usually a one-time thing. Moskop (2010) explains that ED doesn’t provide for follow-ups hence lack of continuity of care.
References
Butun, A., & Hemingway, P. (2017). A qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with a minor illness: International emergency nursing .
Carret, M. L. V., Fassa, A. C. G., & Domingues, M. R. (2009). Inappropriate use of emergency services: a systematic review of prevalence and associated factors. Cadernos de Saúde Pública , 25 (1), 7-28.
Cunningham, P. J., Clancy, C. M., Cohen, J. W., & Wilets, M. (1995). The use of hospital emergency departments for nonurgent health problems: a national perspective. Medical Care Research and Review , 52 (4), 453-474.
Guttman, N., Zimmerman, D. R., & Nelson, M. S. (2003). The many faces of access: reasons for medically nonurgent emergency department visits. Journal of Health Politics, Policy, and Law , 28 (6), 1089-1120.
Mortensen, K. (2010). Copayments did not reduce Medicaid enrollees’ nonemergency use of emergency departments. Health Affairs , 29 (9), 1643-1650.
Moskop, J. C. (2010). Nonurgent Care in the Emergency Department—Bane or Boon?. Virtual Mentor , 12 (6), 476.
National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary Tables. 2008
Northington, W. E., Brice, J. H., & Zou, B. (2005). Use of an emergency department by nonurgent patients: The American journal of emergency medicine , 23 (2), 131-137.
Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013). Deciding to visit the emergency department for non-urgent conditions: a systematic review of the literature. The American journal of managed care , 19 (1), 47.
