Close to half of the 1.4 million outpatient visits to Connecticut emergency rooms in 2009 were for non-urgent care that could have been provided through, or avoided by, treatment in a primary care setting, according to a new report by the state Office of Health Care Access [OHCA].
The December 2010 report by OHCA shows that only about 10 percent of the outpatient, or “non-admit” visits made to hospital emergency departments in 2009 were unavoidable or not preventable. Injuries accounted for another 27 percent of visits, with psychiatric and drug or alcohol-related problems accounting for 5 percent. The bulk of the remaining visits, or 47 percent of cases, were for non-urgent care or “not true emergencies” that would require emergency department [ED] treatment, the report found.
Those findings raise questions about access to primary care, especially in urban areas, where residents utilized ED services at almost twice the state’s overall rate.
“Hospital EDs act as a safety net for those people who have no other access to care,” the report says. “Nearly 50 percent of the persons that visited an ED [as outpatients] received care that was non-emergent. Over 50 percent of the visits were by persons living in an urban setting and during daytime hours.
“These potentially avoidable visits may have been attended to by a primary care provider in a setting such as a community health center, a private physician’s office or an urgent care center.”
The report found that Connecticut saw an overall increase of 9.8 percent in emergency room visits from 2006 to 2009. In 2009, cities that make up the state’s “urban core” – i.e., Bridgeport, New Haven, Waterbury, New Britain, Hartford and New London – utilized emergency departments at a rate of 694 visits per 1,000 population, almost twice the state’s rate of 382 visits per 1,000.
“Generally, residents of urban [core and periphery] or rural towns were more likely to use EDs for non-urgent care than those from suburban or wealthy towns,” OHCA said. “People visit the ED for many reasons, e.g., car accidents, influenza, and lacerations requiring suturing. But people also use the ED for non-urgent care, i.e., not true emergencies… Depending on town group, 38 percent to 53 percent of the ED visits were non-urgent and may have been appropriately treated by a lower level of care.”
The report found that the percent of visits covered by commercial insurance had declined slightly since 2006, as Medicaid-covered visits increased.
“Residents of urban core towns with federal or state government sponsored health care coverage may be using EDs for treatment instead of visiting primary health care facilities,” the report says.
In addition, the percentage of non-emergency visits was higher during the 9 a.m. to 5 p.m. time period than during either the 5 p.m. to midnight or the midnight to 9 a.m. time periods.
Nationally, annual ED visits have mushroomed in the last 10 years – a trend that led the Institute of Medicine in 2007 to describe emergency care in the U.S. as reaching a “breaking point.”
On a per capita basis, ED utilization grew from 342 visits per 1,000 U.S. residents in 1996, to 405 visits in 2006. Despite the increase in ED utilization, the number of U.S. hospitals operating EDs has declined from more than 5,000 in 1991 to fewer than 4,000, according to reports.