Healthcare News & Insights

New role of ED: Treating chronic conditions

While much has been made of curbing unnecessary visits to the emergency department, the rise in ED visits for certain conditions may indicate another trend, one that’ll change how hospitals care for patients: The ED may become a hub for patients with multiple complex chronic conditions. 

ThinkstockPhotos-179059648Typically, the ED’s meant for people who’ve experienced sudden illness or traumatic injury, such as a concussion from a car accident.

But many people are using the ED for non-traditional reasons, and it’s not just the “superutilizers” who are doing so.

Shift in visits

A new study from Health Affairs examines ED visits to all hospitals in California from 2005 to 2011. According to a news release about the study, ED visits in the state decreased overall during that time period – likely due to changes brought about by healthcare reform encouraging patients to seek other options for non-emergency conditions.

But despite the general decline in ED use, visits due to non-injury-related diagnoses rose over 13%. The medical conditions that rose the most in patients visiting the ED: nervous system disorders, diseases of the gastrointestinal system and symptoms of abdominal pain.

Younger patients (those aged 5-44 in the study) had more of these non-injury diagnoses than older patients (45 and up). In older patients, injuries are still a significant reason for visiting the ED, with falls topping the list for more senior patients.

And another category of diagnoses that’s becoming more common in all types of patients who visit the ED, including privately insured, uninsured and Medicare beneficiaries, are those related to mental illnesses.

Future of ED use

Looking at this data, researchers concluded that the role of the ED is changing. While there’s still a significant portion of cases involving acute injury and illness, more patients are visiting the ED because of the exacerbation of an existing chronic condition, whether it’s a physical condition or a mental illness.

That means that ED physicians are dealing with a patient mix that has more complex illnesses. So along with treating their chief complaint, clinicians may have to address other co-morbidities and health issues to help the patient fully recover. They may also have to help the patient arrange follow-up care with specialists after he or she is discharged from the facility.

In essence, EDs may end up taking on a role similar to that of a primary care physician in some cases, particularly if a patient has an illness that’s difficult to control and returns to the ED several times because of the sudden onset of serious symptoms.

Does this mean that hospitals will be able to take a page from primary care providers and start billing payors for giving care management services to patients? With prevention becoming more important in healthcare delivery nowadays, it could very well be possible.

In the meantime, hospitals’ best bet for helping these patients is to build relationships with primary care providers and other specialists to improve continuity of care. That may help patients keep these chronic conditions under better control themselves – and visit the ED less often.

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