For the past several years, descriptions of the healthcare system in the United States have included phrases like “serious emergency department overcrowding,” “unraveling safety net,” and “emergency medicine in crisis.” Articles have described many of the causes: closures of hospital emergency rooms, nursing shortages, individual’s lack of health insurance, and the need to comply with various government regulations, to name a few.
Whatever the reasons, the steadily increasing need for acute and emergency care services in this country has resulted in overcrowded emergency rooms in nearly every metropolitan region and many suburban and rural areas, as well. Many experts feel that the overcrowding is having a negative impact on patient care. Most patients who have to wait several hours to be seen by a doctor probably feel the same way. Fortunately, the results of a recent comprehensive study reveal one of several potential solutions to the crisis
Looking toward the future, it is unlikely that people will change their preferences for receiving prompt care for injuries, illnesses, and medical needs which arise suddenly. Moreover, many adults and children with anxiety-provoking or uncomfortable problems – even if they aren’t emergencies – cannot and should not have to wait for future appointments. For a variety of reasons – including convenience and a sense of superior care – many people chose the emergency rooms at their local hospitals to provide these services. But with so many people seeking care, the crisis mounts. And adding new emergency rooms is not possible, for the same reasons that so many of them are having to close. Luckily, there is another way to increase the ability of the healthcare system to meet the increased demand.
At the heart of one potential solution are the results of a recent study sponsored by the prestigious Robert Wood Johnson Foundation. The Urgent Matters study found that up to 40% of those who go to an emergency room for medical care – those with lower levels of injury or illness – could be cared for in a clinic or doctor’s office. If those patients could be redirected from the emergency room, then they would get their medical care more quickly and conveniently, and leave the emergency room better able to care for patients with a higher level of illness or injury. The problem, of course, is getting an appointment – one of the main reasons that a person might go to the emergency room in the first place.
Enter the Urgent Care Medicine solution. Urgent care medicine is the care of any patient of any age who has an immediate but non-emergent medical need. Urgent care clinics are equipped to care for patients with such problems as: cough, allergy symptoms, mild to moderate asthma, fever, many infections (sinus, ear, respiratory, skin, bladder, kidney, intestinal), rashes, wounds, sprains, simple fractures, abdominal pain, and headaches.
The “walk-in” basis of urgent care clinics is convenient for patients. The waiting times and overall treatment times are, on average, significantly less than that for similar evaluation and treatment in the emergency room. Because there are no hospital facility charges and the professional fees are lower, the cost of similar care and treatment is lower in the urgent care clinic than in the emergency room. Typically, the fees are low enough that uninsured patients can afford to pay for the care they need. Using urgent care clinics for the treatment of these common problems is therefore more efficient – a greater number of patients with needs at this level can be seen per unit of time – and economical. Another advantage is that urgent care clinics – each able to care for 70 patients a day or more – can be built much more quickly and economically than emergency rooms, to meet rising demand.
In many communities, urgent care clinics are already filling the acute-care void, giving patients an option to waiting for appointments with their physicians or using the emergency room. Urgent care facilities are typically open 6-7 days per week and have extended hours (e.g. 8am-8pm) compared with typical doctors’ offices. Patients are utilizing urgent care clinics more and more and are learning that they provide valuable services. Along with emergency rooms, they have become part of the medical “safety net” upon which people are increasingly relying if they don’t have personal physicians or can’t wait or chose not to wait for regularly scheduled appointments.
Because it is a new discipline, physicians from many specialties practice urgent care medicine. In fact, currently, over 20,000 physicians practice in over 10,000 urgent care medicine facilities nationwide. In response to the trend, in 1997 a group of concerned Orlando physicians formed an organization now called the America Academy of Urgent Care Medicine (AAUCM). Their goal is to ensure quality and excellence among practitioners of urgent care medicine. Members of AAUCM are working with the American Medical Association, university hospitals, and other groups to have the new specialty recognized and to develop training programs for new physicians. AAUCM recommends that all physicians in the specialty complete the certification process provided by the American Board of Urgent Care Medicine to demonstrate their proficiency and dedication. The Board uses techniques that meet or exceed those utilized by other medical specialty boards – including an application process, review of any malpractice cases, review of patient care records, and a written examination.
While there is no doubt that patients with critical illnesses or injuries are best cared for in the emergency room, urgent care medicine is an option for many. As Dr. Franz Ritucci, president of AAUCM urges, “Anyone who is severely ill or injured or unsure about whether a life-threatening condition is present, should call ‘911’. However, if you or a family member have a medical problem of mild to moderate severity and desire immediate care, your local urgent care medicine clinic is there to help you.” Dr. Ritucci and the AAUCM feel that making the investment in training urgent care medicine specialists and developing ways to integrate urgent care clinics into healthcare systems will help meet the rising demand that is currently stressing this nation’s healthcare resources. He adds, “The Academy’s ultimate goal is to improve the quality of urgent care medicine practice on a continuous basis, so that patients and other physicians can continue to rely on that portion of America’s ‘health-care safety-net’ which urgent care medicine provides.”
References
1. Derlet, R.W. and J.R. Richards “Overcrowding in the Nation’s Emergency Departments: Complex Causes and Disturbing Effects” Annals of Emergency Medicine 2000:35(1):63.
2. Solberg, L. I. et al. “Emergency Department Crowding: Consensus Development of Potential Measures” Annals of Emergency Medicine 2003;42(6):824.
3. Derlet, R.W. “Overcrowding in Emergency Departments: Increased Demand and Decreased Capacity. Annals of Emergency Medicine 2002;39(4):430.
4. Booth, B. “Is this trip really necessary? Emergency departments face overcrowding” American Medical News 8 Sept 2003. Available online at: http://www.ama-assn.org/amednews/2003/09/08/prsa0908.htm.
5. McCraig, L et al. National Hospital Ambulatory Medical Care Survey: 2002 Emergency Department Summary 18 March 2004. Available online at http://www.cdc.gov/nchs/data/ad/ad340.pdf.
6. Derlet, R.W., et al. “Frequent Overcrowding in U.S. Emergency Departments” Academic Emergency Medicine 2002;8:151
7. The George Washington University Medical Center, School of Public Health and Health Services, Department of Health Policy. “Walking a Tightrope, The State of the Safety net on Ten U.S. Communities”. May 2004. Available online at: http://www.urgentmatters.org/about/sna_reports.htm.
8. Hawryluk, M. “California emergency departments close after hemorrhaging money” American Medical News 24/31 March 2003. Available online at: http://www.ama-assn.org/amednews/2003/03/24/gvsd0324.htm.
9. “Improving Access to Emergency Departments: Costs, Trends, and Solutions.” A Blue Cross and Blue Shield Association Analysis. 2003 Available online at: http://bcbshealthissues.com/relatives/100042.pdf.
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