More Than Two-thirds of ER Visits Avoidable, Says Study

by LAS

A recent study by Truven Health Analytics found that 72 percent of emergency room visits were avoidable, and could have been safely treated by a primary care provider. Truven drew upon a database of 24 million patients.

Healthcare situations were broken down into four categories of urgency. Category One is Non-emergent; medical care was not required within 12 hours.

Category Two is Emergent – Primary-Care Treatable; medical care was required within 12 hours but could have safely been delivered in a primary care setting (that is, in a clinic office).

Category Three is Emergent, (preventable or avoidable); this means that the patient needed medical care within 12 hours, for could have been prevented with effective office visits. An example of the latter would be someone who had diabetes or high-blood pressure who was not taking their medication as advised, and suddenly had a sudden event such as a stroke.

Category Four is Emergent (not preventable or avoidable); these are the kinds of events that people normally associate with an ER visit – a child falls out of a tree, someone is a victim of a car accident or shooting, someone is hit by a softball in a game, a homeowner falls off the roof, etc.

Some events were split between two categories, such as “abdominal pain, unspecified site” since there is a 33 percent chance of it being a serious problem requiring emergency treatment and a 67 percent chance of being something that could be looked at in your doctor's office.

The good news that only 6 percent of patients had an event that could have been prevented with proper primary care. That suggests that people are taking existing conditions seriously, taking their medicine, and making sensible lifestyle decisions.

Almost half (42 percent) could have been acceptably treated by their primary care provider. No reason was floated for why patients did not go to their physicians. Possibly they felt they could not get into a treatment room in a timely fashion.

One quarter had serious conditions but did not require treatment within 12 hours. Presumably they could have gotten into their primary care provider within that time, or gone to an urgent care center.

When broken down by age, it was shocking to see that three-quarters of the visits by children age four and under were of a nature that should have been seen in a primary care setting. Whether the parents had health-care coverage for minors was not addressed in this report. But still, these health events should have been seen in a primary care setting by a pediatrician who was familiar with the child's background.

Steering patients to the proper non-ER setting would by itself create huge cost savings for not only insurers but the patients, who presumably would have come up with much larger copays for an ER visit.