Hospitals Adapt ERs To Meet Patient Demand For Routine Care
Updated : March 10, 2016, 6:51 PM ET
Published : March 10, 2016, 4:01 PM ET
Abe Aboraya - NPR
When it's time for medical care, where do you go? The doctor's office? An
urgent care clinic? Or the nearest hospital?
As many as 1 in 3 Americans sought care in an ER in the past two years,
according to a recent poll by NPR, the Robert Wood Johnson Foundation and the
Harvard T. H. Chan School of Public Health. That relatively high frequency may
be a matter of convenience, even though many in the poll also report frustration
with the cost and quality of care they received in an ER.
Skipper Beck, for instance, who lives in Holiday, Fla., near Tampa, wasn't
crazy about the care he got. As he remembers it, he was having a great Friday,
playing beach football on Florida's Gulf Coast, when he hurt himself.
"I hit someone a little too hard, a little bit too low," says Beck, who is 36
years old.
By that evening, Beck couldn't rotate his shoulder. It was painful to lift
any weight, he says. He thought maybe he'd dislocated the shoulder, fractured
it, or maybe torn something. So, late that night, he headed to the ER.
The medical staff ran tests, put him in a sling and sent him on his way – 4
1/2 hours later. "Honesty I felt like cattle," he says. "Kind of 'get me in, get
me out.' "
Beck thinks the cost for his ER visit was unreasonable, and he felt like the
doctors didn't care about him. In fact, about a quarter of the people NPR polled
in Florida say the ER care they got was fair or poor, and only a third say it
was excellent.
The relatively high cost and no-frills treatment in traditional emergency
departments may be because most ERs are designed to treat life or death
emergencies — gunshots, a heart attack, a bad car accident.
But 47 percent of recent patients in the U.S. say they seek care in an ER for
non-urgent reasons. They go because it's convenient, says, Robert Blendon, a
professor of health policy and political analysis at Harvard's T.H. Chan School
of Public Health.
Many (28 percent) say their main reason for choosing an ER for treatment,
instead of a doctor's office, urgent care facility or community health clinic
was because the other facilities weren't open, or the poll respondent couldn't
get an appointment. About 3 percent nationally — and 8 percent in Florida — say
they mainly chose an ER for treatment because the other facilities were too far
away.
"Almost a third of people in Florida have used an ER in the last two years,"
Blendon says.
Many people assume that the only patients who choose an ER for care that's
not an emergency are poor and uninsured, and don't have a regular
doctor. But Blendon says that's an oversimplification: In fact, more than 80
percent of Floridians polled who used an ER are covered by health insurance.
What can be done to shift more of the non-urgent cases out of the ER?
It would help, Blendon says, if the medical world were more responsive to the
problem. For instance, more community doctors could hold some office hours on
evenings or weekends, so they could potentially see a patient like Skipper Beck
late on a Friday, or see patients on short notice when they're sick.
"I'm hoping we'll change a bit of the discussion," he says. "You have to have
a place to go, and the hours have to reflect the life of people."
But ERs are important to hospital revenue, and people seek help there for
many reasons. So some hospitals are trying to make the ER experience more
convenient for patients. Some emergency departments now allow patients to
schedule appointments, for instance. And others modify their care and facilities
to attract a particular subset of the community — such as the parents of sick or
hurt children.
Delilah Torres, whose 10-year-old son, Ryan, has Down syndrome, appreciates
that sort of special attention to kids.
"There were many times, many times in the past when I waited before taking
Ryan to the emergency room because I knew how stressful it is to sit at the
waiting room for hours," she says.
A few weeks ago, Torres had a very different experience at Nemours
Children's Hospital in Orlando, Fla. When she and her son arrived in the ER,
she says, the staff brought Ryan into a special room, with soothing music and
toys, and talked to his mother about what upsets him.
Torres says Ryan is strong, and four nurses are usually needed to draw blood
from him, or put in an IV line.
"This time was the first time it actually only took two nurses to put a line
in Ryan," she says.
The Nemours Children's Hospital, in central Florida, is just a few years old.
Its waiting room is painted in bright colors, and has round, plushy cubby holes
cut into the wall for fun seating for the kids. Free slushies are available in
the ER.
Cara Harwell, a nurse practitioner there, points out a sign that says REACH:
Respecting Each Awesome Child Here.
"We want the parents to self-identify that they have a child with autism or a
similar condition, like a sensory processing disorder or a mental health
disorder," Harwell says.
That friendly approach in the ER will help the hospital's "patient
satisfaction scores," she says. Funding is partly tied to performance in those
rankings, and hospital officials are studying how it affects other aspects of
care.
"Before we even put our hands on them, if we can know what the child likes
and doesn't like, we can prevent them from becoming ... agitated [and from
hurting] themselves or someone else," Harwell says. "We can also reduce the use
of sedatives or restraints."
Of course, hospitals have yet another motivation to improve a patient's
experience of the ER visit: A well-run emergency room can be profitable, and
parents like Delilah Torres will drive 30 minutes past another hospital to get
to one that better meets her needs.