Stopping the ER Mentality

Julie Shenkman
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The American health care system is trying to reform itself to maintain quality care and services without enormous costs associated with good care. Rising medical costs are why Congress passed the Affordable Care Act in 2010. However, even with required health insurance, emergency room visits continue to create a dilemma in the United States.

Dr. Edwin Leap, an emergency physician with 21 years of experience, writes in a blog post that doctors, nurses and primary care physicians have a certain mentality that sends patients to the emergency room first, even if that doesn't necessarily make sense. The reasons for this paradigm are numerous.

The beginning of this goes back to a law passed when Ronald Reagan was president. The Emergency Medical Treatment and Active Labor Act, or EMTALA, stipulates that no one can be turned away for emergency medical treatment for any circumstances. The law states health care agencies cannot deny someone access to emergency room care because of economic circumstances. The mandate did not not add any budgets to hospitals to help alleviate the load.

Since then, doctors tell discharged patients to come back to the emergency room if anything changes in their post-stay care. If a wound re-opens, someone's pain increases or anything seems abnormal, the person checks in with the ER. The statistics behind the push to render emergency care continue to show more and more ER visits.

As of 2012, the latest year for which data is available, the Centers for Disease Control reports there were 136.3 million trips to the ER. That comes out to 44.5 visits for every 100 people in the United States. Of those visits, 16.1 million, or 11.9 percent, led to admission into a hospital. The sheer number of visits to more than 5,000 ER facilities in America shows only part of the story. states that the New England Health Institute believes that 56 percent of emergency room visits were totally avoidable. Patients with several medical maladies, such as sprains, broken bones, abdominal pain, bronchitis and treatments requiring x-rays, should go to an urgent care facility instead of an ER. However, many people favor the convenience of an ER versus urgent care.

The cost differences between urgent care and the ER are astounding. An average ER visit can cost an individual more than $1,200 versus just $150 for a co-pay at urgent care. In the entire United States, patients can cumulatively save $18 billion per year simply by going to an urgent care facility instead of the ER.

The cost factor doesn't take into account overworked staff, waiting times in the ER when patients first arrive and the tension already present in the situation. The ER may have additional forms for patients to fill out as someone waits for treatment.

The overburdened and limited system needs to have some relief before it breaks. Emergency room facilities have some of the best doctors on staff in the United States, but the system in place must change so that patients do not receive unnecessarily expensive care.

Photo courtesy of imagerymajestic at


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  • Barbara I.
    Barbara I.

    I came into the ER with severe lower back pain and blood pressure 171/112. The triage nurse just assumed it was not that urgent because people with bruises and minor injuries was seen before me. I was in so much pain that I stood on my feet the whole five hours crying. They just gave me a pain pill and referred me to my primary care. No testing was done. Everyone shouldn't pay because of their work overload. Can't handle the job, quit.

  • Renee H.
    Renee H.

    The ER visits could possibly be eliminated if they re-established urgent care departments, after hours 6-12 Monday through Sunday. If a patient needed more medical attention they could be triaged to the ER department.

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