EDs shrinking: Some "diversions" aren't that amusing

DemFrom CT called my attention to a May 26, 2005 Press Release from CDC that should give us pause as we stare into the face of a possible influenza pandemic. Here's an excerpt:

Visits to U.S. Emergency Departments at All-Time High; Number of Departments Shrinking

Visits to the nations emergency departments (EDs) reached a record high of nearly 114 million in 2003, but the number of EDs decreased by 14 percent from 1993 to 2003, according to a new report released today by the Centers for Disease Control and Prevention (CDC).

The report attributes the rise in ED visits to increased use by adults, especially those 65 years old and over. Among people aged 65-74, the ED visit rate was more than five times higher for those residing in a nursing home or other institution compared with those not living in an institutionalized setting.

The report also finds that Medicaid patients were four times (81 visits per 100 people) more likely to seek treatment in from an ED than those with private insurance (22 visits per 100 people.)

Emergency departments are a safety net and often the place of first resort for health care for Americas poor and uninsured, said Linda McCaig of CDCs National Center for Health Statistics and the reports lead author. This annual study of the nations emergency departments is part of a series of surveys of health care in the United States and provides current information for the development of policies and programs designed to meet Americas health care needs.

Other findings in the report include:

• From 1993 through 2003, the number of ED visits increased 26 percent from 90.3 million visits in 1993 to 114 million in 2003. The U.S. population rose 12.3 percent during this period, and the 65-and-over population rose 9.6 percent.
  
  
• The average waiting time to see a physician was 46.5 minutes, the same as it was in 2000. The wait time was unchanged despite increased visits. EDs have implemented a number of efficiencies, including fast track units, which may have kept the wait time constant. On average, patients spent 3.2 hours in the ED, which includes time with the physician as well as other clinical services.

Influenza is characterized by sudden onset. In an influenza epidemic, the Emergency Department (ED) will be the first place people will think of going or be taken to (can't get an appointment with your doctor until next February?). In many cities EDs are already on "diversion" (they shunt cases elsewhere). What will happen if the case load goes up by a mere 20% (not a rhetorical question)?