ER patient loads vary widely

By LEE BOWMAN
Monday, December 04, 2006
Not all ERs are like "ER."

While some hospital emergency departments are constantly busy, a new survey of emergency rooms around the country found that a third are treating on average less than one patient an hour.

A team of researchers based at Massachusetts General Hospital in Boston compiled a database on nearly 4,900 hospitals around the country in the first stage of a process that may eventually produce a national classification system for ERs.

"Our results suggest that emergency departments are quite different from one another and that we may need to consider a variety of approaches to ensure access to emergency care for all Americans," said Ashley Sullivan, lead author of the report published Monday in the Annals of Emergency Medicine and an emergency medicine researcher at Massachusetts General.

The new database is a project of the Emergency Medicine Network, a consortium of researchers at 180 medical centers focusing on public health issues.

To obtain an accurate, comprehensive listing of all emergency departments in the United States, the team combined material from two existing, but conflicting, databases from 2001, and did additional surveys to characterize the workload of all ERs that were open 24 hours a day, seven days a week, accessible to the general public and not limited to a particular specialty.

The database showed that a third of emergency departments have fewer than 8,760 visits a year, an average of less than one patient an hour. Those 1,535 hospitals, virtually all in rural areas and concentrated in the Midwest and West, accounted for only about 6 percent of all visits.

Higher-volume facilities had an average of 28,000 patients a year, but only about 28 percent of those were in a non-urban setting.

"We were struck by the different visit volume of the average U.S. ED (emergency department), which sees about 16,000 patients per year, compared to the (academic medical center) sites where future emergency physicians are trained, with average volumes of 49,000 visits a year," said Dr. Carlos Camargo Jr., director of the network and senior author of the report.

"We need to confirm that we are giving our emergency-medicine residents the best training for future work in these smaller EDs," Camargo added. "We also may want to re-examine other pathways to ensure continued emergency care in smaller EDs, which face many challenges in the recruitment and retention of physicians."

States with the highest emergency-department-visit rates were West Virginia, Mississippi and Washington, D.C.

By region, patient visits per capita were highest in the South and lowest in the West. Those differences probably reflect factors such as patients' need for "safety net" medical services, the availability of primary-care physicians in the community and the challenge of traveling long distances to reach the nearest emergency department, the researchers said.

Sullivan said further surveys are needed to examine other characteristics of emergency departments "to better understand the landscape of emergency medicine in the U.S.," and suggested that the government should adopt a system to categorize the level of care offered in emergency departments similar to the level 1, 2 and 3 scale already in use for hospital trauma centers.

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