Why Go To An Emergency Room?

Dr. ALlen Weiss, MD, MBA, FACP, FACR

by Allen Weiss, MD, MBA, FACP, FACR
President, NCH Healthcare System

July 13, 2006 - During the summer months emergency rooms (ERs) face many minor emergencies associated with families on vacation and children at play. These needs are superimposed on the year-round demands created by major accidents, illnesses, and unplanned personal medical disasters. We all need to be able to use ERs for what they are intended—namely, emergencies.

Across the United States today, overcrowding and over-utilization are huge and growing problems. These trends not only cause delays but also yield higher costs which we all ultimately share. ERs are also misused by patients without insurance or the means to pay because all ERs must accept and stabilize all patients regardless of the ability to pay. Consequently, many people come to the ER for routine care at all hours knowing they will not be coerced to pay at the time of the visit. Collier County has an estimated 45,000 people without insurance or the ability to pay.

Estimates of people unnecessarily treated in an ER range from 26% to over 60%. Commonly, people with minor problems such as colds, ear aches, and small cuts come to an ER, wait hours, get charged high fees, and do not receive the satisfaction of continuity of care. What can we all do to help ourselves and each other avoid these problems while still having the security that the ER is ready, willing and able to care for the “real” ER patient?

First, establish a relationship with a physician. Having access to a regular health care provider by phone or in person obviates the need for many unnecessary ER visits while secondarily providing reassurance to the patient. Minor concerns may be easily addressed over the phone or by scheduling an appointment in the near future as an outpatient or office patient.

Additionally, Collier has many “walk in” clinics which have met a growing need for tourists, seasonal residents, and other patients without a “medical home.” These caregivers specialize in the most common ailments yet have the diagnostic acumen to recognize more serious problems needing referral to specialists or in-patient care.

Furthermore, patients who are uninsured or under-insured have many high quality alternatives including the Neighborhood Health Clinic, Senior Friendship Center, Healthy Kids, Physicians’ Led Access Network (PLAN) and Community Health Services Inc (CHSI). These community resources care for tens of thousands including expectant mothers, babies, school-aged children, and workers whose employers cannot afford insurance.

Collier’s healthcare is excellent as evidenced by both the HealthGrades and Solucient recent accolades to the NCH System for top 5% overall clinical quality for the past two years and top 100 most improved hospitals from 1999 to 2004. Yet, our county is not unique in suffering from the problems of appropriate ER care. We need to share responsibility for not over-utilizing the ER but rather developing a “medical home” before an emergency exists.

Dr. Allen Weiss is President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.