Emergency departments strained by patients better seen elsewhere

Washington -- Hospital emergency departments are being overburdened with uninsured patients partly because these patients are unaware of primary care services available in their communities, says a new report from the Urgent Matters program at George Washington University.

Researchers with Urgent Matters, which is funded by the Robert Wood Johnson Foundation, found that severely restricted access to specialty care and mental health services and almost nonexistent dental care are driving many more patients to seek attention in emergency departments.

"When we started this project, we expected to see gaps, but not to see them as large and as prevalent as they were," said the program's director, Bruce Siegel, MD, MPH.

One-fifth of patients coming to the ED did not have conditions requiring emergency care, and another one-fifth had urgent conditions that could have been treated in a primary care setting, the report shows.

"In reality, the emergency department serves as the safety net for the safety net," said Marsha Regenstein, PhD, the report's author. "For some patients, it's their only source of care and the only option for timely care."

Uninsured and Medicaid patients in some communities might have to wait six months or more for an appointment with a specialist. But if they go to an ED, they get all their needs met in one place at any time.

"The convenience of the emergency department really offsets the long waits that are associated with it," Dr. Regenstein said.

Patients also often perceive emergency departments as providing the highest-quality care available. They are increasingly using ED services during normal business hours, when primary care services are readily available elsewhere.

Other factors are straining the safety net as well.

"As the need for safety-net services grows, the ability and willingness of governments to support these services diminishes," Dr. Regenstein said.

Communities that had worked to better integrate services available through their safety-net resources were able to improve use of community-based primary care services by uninsured patients, the researchers said.