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Vol. LXVI, No. 19
September 12, 2014
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The Changing Role of Hospital Emergency Rooms

We know to call 911 if someone might be having a heart attack, stroke or other life-threatening emergency. But these days, hospital emergency rooms are increasingly handling much more than medical emergencies.

Each year, 1 in 5 American adults makes at least one visit to the emergency department (ED), according to the Centers for Disease Control and Prevention. Yet of the more than 120 million annual visits to U.S. emergency rooms, relatively few are life-threatening cases. The CDC estimates that nearly 80 percent of adults visit the ED because they lack access to other options at the time.

Dr. Jeremy Brown
Dr. Jeremy Brown

“Many people are using the ED for evaluation of medical questions; sometimes they simply can’t get to see their primary care doctor or their primary care doctor cannot provide the level of tests and services that are needed,” said Dr. Jeremy Brown, director of NIH’s Office of Emergency Care Research, within NIGMS.

A 2013 RAND report titled “The Evolving Role of Emergency Departments in the United States” found that most patients in nonemergency situations visited the ED because they were referred by a doctor, believed the condition was serious or didn’t think they had any alternative.

“I think the ED provides this critical safety net that people can use 24 hours a day, 7 days a week, 365 days a year,” said Brown. “It does an excellent job of taking care of both the emergency issues and also people’s chronic issues that can’t be taken care of elsewhere.”

EDs have come to handle a wide range of medical needs, from the unplanned—an injury or a bout of pneumonia—to the planned, such as a diagnostic test. The ED has become an important place of care for patients who don’t have a medical home or who can’t use their primary care doctor because the office is closed at the time or the office cannot solely provide for all of their needs, said Brown.

In fact, more people are admitted to the hospital through the ED than any other way. Excluding women who come in to give birth, most people who end up in the hospital first arrived through the ED. According to the RAND report, in 2009, for example, apart from childbirth, admissions from EDs accounted for about half of all inpatient hospital admissions in the United States. So the emergency room (ER) essentially has become the front door to the hospital.

“We tend to think of the ER as either people who don’t need to be there or are there for something severe like a gunshot wound or stopped heart. Neither of these two extremes represent most ER cases,” said Brown. “Some are life-threatening emergencies but the vast majority of people drive there and leave by themselves.”

The ED can refill a prescription or evaluate pain you’ve had for months or treat an asthma attack, but it shouldn’t be a substitute for preventive care. “The ER can handle if you run out of blood pressure medicine or if your blood pressure has gotten worse,” he said, “but the real place to have your BP controlled is not in the ER but with your primary care doctor and scheduled visits.”

While other NIH institutes focus on a certain disease, organ or population, Brown’s office focuses on a specific time of need—emergency care—a discipline that reaches across all health conditions, organs and populations. The office, which has a coordinating role across NIH, also focuses on discerning the needs of vulnerable populations who use the ED because they have nowhere else to go.

“We must think of the ED in a bigger way,” says Brown. “The ED provides emergency care and also the backup ability to do some of what the health care system can do, but when patients can’t get to it. The ED is a rapid diagnostic unit, treating patients in their moment of crisis.”


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