Why we must stop abusing Emergency Room services.

1. ER ABUSE
by Carol Judson
for NUR410: Issues & Trends in Nursing
Pennsylvania College of Health Sciences

2. ER Abuse: Introduction
• Common, Persistent Problem
• Highest occurrences: Medicaid patients and
the Uninsured (Gindi, Black, & Cohen, 2016).
• Just yesterday (May 31, 2017) Anthem Blue Cross
Blue Shield of Georgia made the decision that it will
no longer cover Emergency Department visits it
deems unnecessary starting next month (Haefner, 2017).
• Similar policies have been enacted in Missouri
and Kentucky (Haefner, 2017).
• ACA was supposed to address, but actually
increased ER visits (Leonard, 2016).

3. Adults aged 18–64 with at least one visit to the emergency room in the
past year, by number of visits, health insurance coverage status, and
year: United States, 2013 and 2014

4. Patients who say they went to the ER primarily
because they couldn't get care elsewhere.

5. Image retrieved from https://obamacarefacts.com/wp-content/uploads/2015/05/er-visits-obamacare-study.png

6. More Shocking Statistics
• 130.4 million ED visits per year (CDC, 2013).
• 71% of ED visits unnecessary, avoidable (Rodak, 2013).
• 9 out of 10 ER visits in New York hospitals
unnecessary with an est. additional cost of $1.3
billion(MacDonald, 2016).
• Average cost of ER visit: $1049, Average cost of
physician’s office visit: $153; savings: $896 per
visit (Blue Ridge Healthcare, 2016).
• Percentage of adults visiting the ER unchanged
despite the fact that 7.9 million gained insurance
coverage (Gindi, Black & Cohen, 2016; Leonard, 2016).

7. ER Abuse: Impact on Nursing
• Limited number of nurses in the ER
• Shortage of ER nurses (Thompson, 2009)
• Time taken away from true emergencies
• Stressful environment made more so by certain
types of patients (alcohol, drug use/overdose,
psychiatric issues) and the violence they bring
• More than 1 in 4 assaulted over 20 times (Thompson,
2009)
• More than 1 in 5 verbally abused over 200 times
(Thompson, 2009)
• Some even reconsider their careers (Thompson, 2009)

8. ER Abuse: Impact on Healthcare & Society
Serious Economical Impact
• Growing use of U.S. emergency departments
(EDs), cited as a key contributor to rising health
care costs, has become a leading target of health
care reform (Schuur & Venkatesh, 2012).
• Interventions targeting frequent ED users are
likely to effectively decrease ED visits and
improve social outcomes (Moe et al., 2017).
• The majority of studies have shown reduced costs
following implementation of interventions (Moe et
al., 2017).

9. ER Abuse: Impact on Healthcare & Society
Overcrowding, Inability to Address Actual Emergencies
Efficiently and Effectively, Incentivize Reduced ED Use
• Difficult for patients to arrange sick visits with primary care
providers in a timely fashion, because schedules are often full,
afterhours service is unavailable, and many acute problems
are not well suited to office practices lacking basic laboratory
and imaging capabilities (Schuur & Venkatesh, 2012).
• Patient crowding and prolonged wait times lead to
undesirable consequences from irritable patients to
irrevocable harm, more serious problems (Thompson, 2009).
• As reimbursement models shift from providing incentives for
admissions as a hospital’s revenue source to providing
incentives for reducing admissions, EDs will probably reduce
their use of hospital admission (Schuur & Venkatesh, 2012).

10. SMART Objectives in Reducing ER Abuse
• Educate patients and the public as to the appropriate use
of the ER through yearly campaigns involving public
service announcements, billboards, advertisements, and
handouts to those who come to the ER, health clinics, and
especially to those who have Medicaid.
• Have Primary Care Physicians and nurses in their offices
explain proper ER use to patients during regular office
visits, websites and on-line portals, and take-home
literature each year or when appropriate.
• Encourage the use of Urgent Care and Telemedicine when
possible and seek to have payment plans available to
qualified patients as a way to reduce ER visits for financial
reasons.

11. Emphasizing the EMERGENCY in
Emergency Care
• Reveres the Needs of Critical Patients
• Respects the Time of Physicians, Nurses &
Staff
• Recognizes the Limited Resources Available
• Reduces Cost of Care
• Regards All Members of Society
• Reputes the Purpose of the Emergency
Department

12. What else, as nurses, can
you do to help encourage
proper use of the
Emergency Room by your
patients and the general
public?

13. References
Blue Ridge Healthcare. (2016, January 11). Save the ER for a true emergency. The News Herald. Retrieved from
http://www.blueridgehealth.org/in_the_news/pdf-stories/2006-01-11-save-er-true-emergency.pdf
Centers for Disease Control and Prevention (CDC). (2013). Emergency Department Visits. Retrieved from
https://www.cdc.gov/nchs/fastats/emergency-department.htm
Gindi, R. M., Black, L. I., & Cohen, R. A. (2016, February 18). National Health Statistics Report: Reasons for emergency
room use among U.S. adults aged 18–64: National Health Interview Survey, 2013 and 2014. Centers for
Disease Control and Prevention (CDC). (Report No. 90). Retrieved from
https://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf
Haefner, M. (2017). BBS of Georgia to stop covering ED visits it deems unnecessary. Becker’s Hospital Review.
Retrieved from http://www.beckershospitalreview.com/payer-issues/bcbs-of-georgia-to-stop-covering-ed-
visits-it-deems-unnecessary.html
Leonard, K. (2016, February 18). Obamacare has barely made a dent in ER visits: A new report shows plenty of
Americans still received potentially costly care at the emergency room after the law took effect. U.S. News
& World Report. Retrieved from https://www.usnews.com/news/blogs/data-
mine/2016/02/18/obamacare-has-barely-made-a-dent-in-er-visits
MacDonald, I. (2016, April 11). 9 out of 10 New York hospital emergency room visits unnecessary. Retrieved from
http://www.fiercehealthcare.com/healthcare/9-out-10-new-york-hospital-emergency-room-visits-
unnecessary
Moe, J., Kirkland, S. W., Rawe, E., Ospina, B., Vandermeer, B., Campbell, S., & Rowe, B. H. (2017,
January).Effectiveness of interventions to decrease emergency department visits by adult frequent users: A
systematic review. Society for Academic Emergency Medicine, 24 (1), 40-52. doi: 10.1111/acem.13060
Rodak, S. (2013, April 25). Study: 71% of ED visits unnecessary, avoidable. Becker’s Hospital Review. Retrieved from
http://www.beckershospitalreview.com/patient-flow/study-71-of-ed-visits-unnecessary-avoidable.html
Schuur, J. D., & Venkatesh, A. K. (2012, August 12) The growing role of emergency departments in hospital admissions.
The New England Journal of Medicine. 367, 391-3. doi: 10.1056/NEJMp1204431
Thompson, E. (2009, August 5). Slapping your ER nurse? Survey shows abuse. ABC News. Retrieved from
http://abcnews.go.com/Health/MindMoodNews/story?id=8257976