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ER visits on the rise and flu isn't the only reason

Ocala, FL - January 31, 2013
Published in Ocala Star Banner on Thursday, January 31, 2013 at 6:56 p.m.

Marion County emergency rooms are becoming more crowded as a growing number of patients head to those facilities instead of primary care offices.

The increase reflects a national trend as sick "people fall through the cracks," experts say. They either don't have primary care physicians, their doctors don't have enough time to see all their patients, or their offices are closed, said Dr. Frank Fraunfelter, medical director of emergency services at Munroe Regional Medical Center.

"(The surge in ER traffic) is putting a tremendous strain on area hospitals," he said.

Munroe's combined emergency department visits (those at Munroe's adult ER, TimberRidge and Munroe's new children's ER) have increased nearly 12 percent during the hospital's first fiscal quarter.

From October through December 2011, Munroe's emergency services saw 24,800 patients. During the same period in 2012, that increased to 27,710 patients.

Some of that increase can be attributed to Munroe's new children's ER, which wasn't online in late 2011. A recent surge of flu patients also is partly responsible, Fraunfelter said.

Marion also has an aging population with associated illnesses that often need emergency medical treatment, he said.

Also contributing to rising ER visits is the growing number of mental-health patients, said Vickie Sullivan, Munroe's director of Emergency Services.

During 2011, mental health patients brought to Munroe's ERs stayed for an average of eight hours and 25 minutes. During December 2012, mental health patients complaining of physical problems remained at Munroe facilities an average of 18 hours and 31 minutes.

Sullivan said this increased time makes it difficult for ERS to operate efficiently and often creates a patient backlog.

Ocala Health Systems, which includes Ocala Regional Medical Center and West Marion Community Hospital, also has seen an increase in ER traffic, said Dr. Art Osberg, Ocala Health's chief medical officer.

The West Marion ER saw a 9 percent hike during the past year, Osberg said. And while Ocala Regional's traffic remained about the same, its patients were generally more sick than during previous years, he said. Combined, the two facilities see about 100 ER patients daily.

Osberg doesn't think the most recent spikes are solely attributable to the flu.

Marion County Health Department data also show patients with flu-like symptoms on the decline while ER visits are trending up.

"It's not (just) a local story", Fraunfelter said of ER stresses. He described the rising number of ER visits as "symptoms of a broken process."

A 2009 Centers For Disease Control and Prevention report showed that the number of emergency room visits nationally increased 43 percent from about 94.9 million during 1997 to about 136.1 million in 2008.

Osberg said Marion County several years ago expanded emergency room capacity and that hospitals were better able handle the rising tide of visits. "But I think it's catching up with us again," he said.

The CDC reported that during 2007:

Medicaid patients were more likely to have reported multiple ER visits than people with private insurance, as well as the uninsured.

As family income increased, the likelihood of a family member having visited an ER decreased. Income differences were more pronounced than those based on age, race or ethnicity.

Non-Hispanic black people were more likely to have reported one or more ER visits in a 12-month period than non-Hispanic whites or Hispanics.

In 2007, 10 percent of ER visits by people younger than 65 were considered non-urgent.

Most emergency room doctors predict the problem of rising emergency room visits will only get worse, according to a 2011 American College of Emergency Physicians report. Nearly 90 percent of ER doctors surveyed said health care reforms won't stem the tide.

Emergency visits have increased at twice the rate of the U.S. population, said Dr. Sandra Schneider, former president of the American College of Emergency Physicians, in the report.

The ER visit increase comes "at the same time hundreds of emergency departments have closed. The new health care reform law does not address these problems, and with the elderly population and more emergency departments forced to shut down, this crisis will only get worse," she said.

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