ER Visits, Crowding up, but Imaging Not to Blame

From 2001 to 2008, emergency department visits climbed faster than population growth by a factor of 60, according to a study published in the Annals of Emergency Medicine this week—and although advanced imaging was a big factor in ER crowding, its significance was outweighed by that of standard clinical procedures. Combing seven years of data from the National Hospital Ambulatory Medical Care Surveys, researchers determined that “more common throughput factors, such as the use of intravenous fluids and blood tests, the performance of any clinical procedure, and the mention of two or more medications” had a greater impact on a patient’s length of stay in the emergency department. “The general trend toward greater treatment intensity may reflect, in part, increasing numbers of older adults with complex medical problems but probably also represents an increasingly interventionist practice style,” the study reads. “This might in turn be attributed to striving for higher quality of care, financial incentives that reward higher intensity of services, or ‘defensive medicine.’” The study blames “practice intensity” as the chief driver of hospital occupancy, and warns that such burdens, if sustained, could soon become an insurmountable hurdle for the healthcare system at large. As ER visits climbed nearly 2 percent annually, crowding (as measured in terms of mean occupancy) rose 3 percent annually.