I was rounding in a hospital in rural Colorado and met a woman who had heart failure and very low blood pressure. She was immediately admitted to the hospital, and many days were spent doing expensive tests. Over the course of her admission, it was found that she had been prescribed the same class of medication twice (a beta-blocker) by two different doctors and had been taking both prescriptions. She was discharged from the hospital and luckily did well, but it highlights how gaps in the medical system can cause unnecessary emergency room visits.
The number of emergency room visits has grown in the United States over time, with 13.3% of the population in 2017 experiencing one emergency room visit (1). The costs for these visits can be significant, with the average cost of emergency room visit roughly $530 (2). Because it is estimated that 13-27% of emergency room visits within the United States are unnecessary, the amount of medical expenditure that is essentially ‘wasted’ was recently calculated to be $47B dollars (3).
Top avoidable emergency room visits include:
- Upper respiratory infections – besides pneumonia or other rarer causes of respiratory illness, most respiratory infections are viral and can be treated with supportive therapy and rest. If a patient is worried, having access to a primary care doctor that can see them immediately is important.
- Lower back pain – back pain is extremely common in patients with approximately 8% of adults experiencing lower back pain. Although there are some life threatening causes of back pain, the majority can be addressed with outpatient therapies including rest, physical therapy, and over the counter medications.
- Abdominal pain – there are multiple causes of abdominal pain and patients with worsening abdominal pain should be evaluated in the emergency room, however being a good primary care provider should be able to diagnose benign causes including constipation, irritable bowel syndrome, and stomach viruses.
- Urinary tract infection – although these infections require antibiotics, diagnosis and treatment are readily available at primary care offices.
As noted by the Centers for Medicare and Medicaid Services (CMS), one of the most common causes of unnecessary emergency room visits is due to a lack of established primary care doctor. It is important for patients to establish themselves with a good primary care physician who can easily see and treat patients. By improving the quality of care at home and access to healthcare for patients, we can keep patients safe, healthy, and at home.
Bethany Doran, MD, MPH, is the CEO of Enabled Health, a virtual clinic that works with a patients’ established primary care doctors and serves as a safety net for patients with chronic disease when they can’t get an immediate appointment. Enabled Health recently won an award through the MetLife foundation and Village Capital to be able to help monitor patients’ vitals in their home and prevent costly emergency visits.