Upward Trend for ER Visits Levels Off

After a continuous climb since 1996 ended in a record-setting year for visits to the Froedtert & Medical College emergency room in 2002, the numbers appear to have held steady in 2003.

The National Center for Health Statistics last year reported a 14% increase in US emergency room cases between 1997 and 2000. NCHS attributed part of the jump to the growing number of people who have the highest rate of emergency room use: those age 75 or older. Nationally and locally, more automobile crashes have also been reported as contributing to the spike in ER visits the past two years.

"The numbers here jumped significantly between 2000 and 2001, and 2002 was even higher," said Daniel J. DeBehnke, MD, Medical College of Wisconsin Professor of Emergency Medicine and Director of Clinical Services.

"We had a big jump of about 5,000 patients in 2001," said Dr. DeBehnke. "That went up another 2,000 in 2002. For 2003 we're about even with last year, so we've leveled off at between 47,000 to 48,000 visits. It's general emergency department utilization, not anything that we can pinpoint that says it's a particular complaint. It's not trauma - shootings and stabbings and the like. That type of trauma stayed relatively stable."

More Minor Complaints, Fewer Rooms
Dr. DeBehnke agreed that demographics are playing some role in the upward trend in terms of general volume, but also noted that emergency rooms are now providing care that used to be provided elsewhere to people of all ages.

"Most people believe that it's based upon individuals' ability to access their physicians," said Dr. DeBehnke. "It's more convenient to access the emergency department. Physicians have office hours that aren't convenient for working people. It's easier at 7:00 at night, after you've been at work all day, to come to the emergency department for your sore throat or those sorts of things instead of getting into your doctor's office. The same is true on the weekends. Our urgent care area, which sees minor complaints, sees about 10,000 of those 47,000 patients each year, and they're only open 12 hours a day."

While the 75-plus age group may be more prone to heart attacks and relatively severe injuries from falls and other mishaps, Dr. DeBehnke said that there is no evidence from his department that shows that seniors are placing a disproportionate burden on the emergency room.

"As the population is aging, obviously you're seeing more older individuals," said Dr. DeBehnke. "Some of that rise in overall volume is related to the elderly, but it's not a significant increase. You can't say that of this three or five or seven percent increase we saw that the majority of it is from the elderly. It's a global, across-the-board use of the emergency department."

NCHS also reported a reduction in the number of emergency rooms nationwide, placing added stress on the health care system in general and on individual emergency medicine practitioners.

To address those problems at Froedtert, Dr. DeBehnke said, "We need a bigger emergency department." He added that plans are now being considered to increase the number of emergency department beds from 29 to as many as 55 and to continue increases in emergency medical staffing levels.

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.