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Misuse of Emergency Rooms Takes Its Toll on Docs

< Jun. 15, 2011 > -- Doctors who treat emergency patients are getting burned out by the work - primarily because so many patients use the ER for non-emergencies.

A new survey of ER doctors by the American College of Emergency Physicians (ACEP) found that some people return to the ER again and again - up to 40 times a year. Nearly all the doctors who responded to the survey said they saw frequent users.

More than two-thirds of the doctors said something needed to be done about the problem, but less than a third said that their hospitals had taken any steps to address it.

"What we found is that emergency department doctors recognize that this is a problem and are asking for help," says lead author Jennifer Peltzer-Jones, Psy.D., R.N., at Henry Ford Hospital in Detroit.

Most felt burned out

The researchers surveyed more than 1,000 ACEP members and 500 hospital physician residents, staff members, and former employees between July and October 2010. Of those who responded, 82 percent said they felt burned out to some degree from having to cope with patients who used the ER multiple times for non-urgent conditions or problems.

Aspects of burnout included feeling emotionally exhausted, treating patients with an increasingly depersonalized eye, and/or a plummeting sense of personal accomplishment on the job.

Variety of reasons

Why do people use the ER for non-emergencies? It's not always a lack of insurance that drives them to do this, the researchers found. Those who use the ER frequently may be struggling with a chronic condition yet don't have a regular health care provider. Others may end up at the ER because of homelessness, a lack of transportation to reach a doctor's office, substance abuse issues, or psychiatric illness.

Yet the ER is not the best place to get treatment for a chronic condition, says Marshall Morgan, M.D., at Ronald Reagan UCLA Medical Center in Los Angeles. These patients "take up a lot of staff time and are a huge cost to a hospital that will often not get reimbursed," he says. "But I don't know of very many places that have done an effective job at coping with the problem."

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What to Expect at the ER

If you go to a hospital emergency room (ER), be aware that patients are treated in order by the severity of their injury or illness. If you arrive by ambulance or are unconscious, you will be immediately taken to a bed for treatment. If someone drives you to the ER, you will stay in the waiting room until the staff determines your condition. A nurse will take your temperature, heart rate, and blood pressure, check your symptoms and find out your medical history. In the exam area, a doctor will examine you and may order tests. If you are seriously ill, you may be admitted to the hospital. If you are sent home, the ER doctor will discuss your diagnosis and treatment plan.

How do you know when an illness or condition is serious enough for the ER? Here are warning signs of a medical emergency:

  • Chest pain that lasts at least two minutes

  • Uncontrolled bleeding

  • Sudden or severe pain

  • Coughing or vomiting blood

  • Difficulty breathing, shortness of breath

  • Sudden dizziness, weakness, or change in vision

  • Severe or persistent vomiting or diarrhea

  • Change in mental status such as confusion

Always talk with your health care provider to find out more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

Agency for Healthcare Research and Quality – How to Use Hospital Emergency Rooms Wisely

American College of Emergency Physicians Foundation – About Emergencies

CDC - Injury, Violence, and Safety