What You Should Know About Your ER

The American College of Emergency Physicians grades U.S emergency medical care at a D+.
The American College of Emergency Physicians grades U.S emergency medical care at a D+.

By: Darria Long Gillespie, MD, MBA

If you have an emergency, you assume that your 911 services and ER will be ready to take care of you, right?

Maybe not. The American College of Emergency Physicians (ACEP) released their "2014 Emergency Medicine Report Card" and the U.S. as a whole got a grade that you wouldn't bring home to Mom -- a D+. One important distinction -- this was NOT a grade of ERs and ER doctors, but instead an evaluation of how well the country supports emergency care.

When you need to go to the ER, having a good ER doctor is crucial. But just as crucial is the state and federal "infrastructure" needed to maintain emergency rooms for true emergencies. As an ER doctor, I can and do treat the elderly lady sick with pneumonia because she was unable to get a vaccine, or the man whose leg infection became severe because he was unable to see an outpatient doctor. I also see the pedestrian struck by a vehicle at an unsafe intersection -- an accident that could have been prevented if the intersection had been repaired. But the reality is, ER doctors and providers only have so much capacity to make up for bad systems and are now working in one of the hardest environments ever for providing ER care. According to this report, the systems have only gotten worse since 2009, when it was last released.

Related: 7 flu vaccine myths that can make you sick

In evaluating the states, the ACEP measured a total of 136 variables that affect how many people need the ER (demand) and how many needed resources are available to take care of them (supply). These included the number of ERs and ER doctors, the number of inpatient beds, the number of hospital closures, use of electronic medical records, state efforts to prevent injuries, accidents and traffic fatalities, distracted driver reform and even how well the state prepares for mass disasters.

How did your state rate? See the full report at emreport.org.

So, what accounts for the problems?

1. Not enough doctors -- especially ER doctors, neurosurgeons, orthopedists, hand surgeons and ear, nose and throat doctors. The end result? If you need a hand surgeon after a nasty bike accident and there's no specialist on call, you'll need to be transferred to a hospital where a hand specialist can be found - and that takes time.

2. Too many patients. While it's true that patients with no insurance have had no choice but to go to the ER for any kind of health care, guess what? Even people with private insurance are sent to the ER. In fact, four in five patients who contacted their primary care physicians were told to "go to the ER" to receive complex workups and admissions for acutely ill patients, according to a RAND study in 2013. In addition, the expansion of Medicaid under the Affordable Care Act to more of the poor and uninsured has meant more ER visits for the newly covered. A recent study out of Oregon showed that gaining Medicaid coverage increased a person's use of the ER by 40%. That makes for one crowded waiting room.

3. Disaster UN-preparedness. Having been in Boston during the marathon bombings last spring, I saw the life-saving impact of a well-funded, well-trained emergency system. On that day, we saw that having a robust EMS system to communicate with doctors and triage the patients meant the difference between life and death.

Related: How To Prepare Your Family for a Disaster

4. High accident rates and low vaccination rates. In either case, this means more patients will need to be seen in the ER. My home state of Georgia has one of the lowest rates for flu and pneumonia vaccination in older adults (meaning fewer visits). Georgia also has the third lowest rate of alcohol-related traffic fatalities, but some of the highest rates of bicyclist and pedestrian fatalities in the nation.

5. Hospital closures. Cuts in government funding caused 19 more hospitals to close in 2011, taking ERs with them.

In spite of the country's overall poor grade, the one thing you can count on is the dedication, top quality and work of those ER doctors, nurses and staff in the trenches every day. But no matter how great the players, a system without adequate federal/state support can develop weaknesses. For something as integral as our emergency care -- that's not something that any of us can afford.

What can you do to make sure that you and your family have care when you need it?

1. Make a point of going to the same hospital whenever you need an ER. That way the healthcare providers have a better chance of accessing your records and reaching your doctor.

2. If you have a specialist that you've seen before, call his or her office first if you have a related emergency. You'll either get fitted in for an appointment or you'll be directed to the appropriate ER. This is much better than just going to the ER and hoping your doctor is on call.

3. Know your town's heart attack centers. If you or, more likely, a parent has a heart problem and all ERs are the same distance from your location, consider heading to that ER.

Related: Do This to Avoid Medication Errors in the Hospital

4. Prepare for potential public emergencies. If you're attending a big event and meeting up with loved ones, plan a secondary spot at least half a mile away from your primary one. At the Boston Marathon last year, families planned to meet at the finishing line - but then the bombing happened and people scrambled to find each other.

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