Introduction
Emergency medicine involves the care of patients who suffer from traumatic injuries or other serious symptoms of illness. The patients require effective health services that are available in the healthcare setting on 24 hours basis. The government of the United States requires that the emergency department should provide health care services to patient with or without payment. However, a significant number of victims who visit the emergency rooms do not require the level of services provided. In a place like Maryland, patients who have non-emergency needs account for about 60% of the total visits to the emergency rooms. Due to an increase in the number of Americans who are not insured, the government policies contribute to overcrowding in the emergency departments.
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"Utilization of U.S Emergency Room Visits".
Purpose of Study
The emergency department is a crucial component of the healthcare system in the United States to cater to the emergent needs of the population. Various policy makers have questioned the ability of the United States to handle the increasing demands in healthcare departments (Levas et.al, 2014). This study will be important to reveal the contributing factors to the overutilization of healthcare facilities in the United States. In most instances, the overcrowding in emergency departments compromises the safety of patients and the overall health of the public. This research will be important in revealing the underlying causes of overcrowding and potential remedies for the crisis.
Review of Literature
A number of factors result in the increased use of emergency departments in the United States and the overall healthcare needs. First, the homeless population in the country use the emergency departments on a frequent basis. According to a research carried out by Ku et.al, (2010), the homeless individual make up about 76% of the total visits to the emergency departments in comparison to other individuals in the United States. Besides, most of the population who seek medical assistance are the elderly who have more health complications (Stang et.al, 2015). Besides, most of the patients arrived in the healthcare settings using an ambulance and they were either diagnosed of having an issue in substance abuse or psychiatric in comparison to others.
Ku et.al, (2010) further argues that a significant population of the individuals who seek for medical assistance do not have health insurance and have more substance abuse diagnoses in comparison to non-homeless individuals. The rising number of individuals who visit emergency departments needs an introduction of new policies to change the situation. In the years between 2007 and 2008, homelessness has increased by 12% in the cities based in the United States despite the efforts of the government to provide housing. According to an assessment of the Housing and Urban Development, Ku et.al, (2010) revealed that about 767, 000 become homeless on annual basis and the individuals are likely to have several health complications and chronic health problems. Similarly, the homeless population is more likely to abuse drugs and develop mental illness, therefore, increasing their vulnerability to illness for being subjected to trauma.
In a close analysis carried out among the homeless by (Yarmohammadian et.al, 2016), it is evident they are often uninsured and face other hindrances in accessing medical care. The efforts to look for food, shelter, and security supersede the need of accessing medical attention among the disadvantaged population (Lo et.al, 2014). Consequently, the homeless individuals will be more likely to make use of the Emergency Departments (EDS) for either non-emergent or routine medical needs. Practically, the homeless persons are more likely to visit emergency departments in comparison to non-homeless persons resulting to overcrowding in the emergency rooms (Cha et.al, 2016). However, the transient nature of the homeless individuals makes it complicated to characterize the population and the research that have been carried out is limited to cities and hospitals. There is the need to develop an accurate impact of homelessness on EDS. The prerequisite would provide a well-informed development of policy for a reduction of costs associated with ED.
The aging population in America increases the demand for the services in emergency departments and hospitalizations. According to a research carried out by Di Somma et.al, (2015), the frequency of visits to the emergency departments in the United States is increasing in comparison to the growth in population. The emergency departments are significant to address any emergency cases although they account for non-emergent care of patients. The healthcare department of the United Sates has released a statement describing the emergency care to be at its breaking point (Latham & Ackroyd-Stolarz, 2014). The overcrowding results in ineffective and unsafe care threatening the lives of many residents in America.
According to census records, the main threat that leads to the crisis in the emergency department in the United States is the increasing number of persons who are above 65 years. Legramante et.al, (2016) argues that the increased demand of for health care needs among the population acts as a driving force to the demands of healthcare departments. In the coming years, research analyst predicts for a further growth of the aging population and the number of visits to the emergency departments among the group might also increase. It is, therefore, evident that aging population might have catastrophic effects to overcrowding.
Haywood et.al, (2013) argues that African Americans are more likely than other races to access medical care through the emergency department resulting to overcrowding. Similarly, the individuals are more likely to be uninsured and lack basic healthcare providers. In addition, the blacks lack enough resources to seek medical attention, which result in the use of emergency departments as the only alternative (Puumala et.al, 2016). Consequently, the overuse of health services results to overcrowding of the healthcare facilities.
Research Questions
What are the demographic characteristics of the frequent users of emergency departments in the United States?
What interventions can be used to prevent the frequent utilization of emergency departments to avoid overcrowding?
What are the best remedies to improve the quality of care in emergency departments and reduce medical costs?
Methodology
To determine the social factors that result to the overutilization of healthcare facilities, the methodology of the study was based on quantifying the number of visits that would be recorded if the age structure of the population changed with other factors remaining constant. I obtained subgroups in the population to assess the rates of visits to National Hospitality Ambulatory Medical Care. I used a random sampling among all the non-federal emergency visits in America. I obtained information about the age structure and racial composition from the Census Bureau having the blacks more likely to visit emergency departments than the whites.
I used the year 2014 as the baseline and as a determination to the use of emergency departments for each age structure and race. Afterward, I applied the rates of visits to the number of people expected to exist in future. The main measure of outcome was the ratio of an increase in emergency visits to the total population growth. The hypothesis in the research was that the ratio would be greater than 1 as an indicator that demand for emergency services from the elderly would cause the rate of visits to emergency rooms to increase in comparison to the population size.
Next, I predicted the number of emergency cases to the admissions to hospitals through an application to the rates observed in the year 1993-2009 to the frequency of visits predicted in future. In addition, I estimated the total number of hours that patients would spend in the emergency rooms as it was predicted that elderly have more complications, thus, spend more time in care delivery. In the analyses of the gathered information, I used excel in carrying out the analyses. In our analyses of the factors that lead to overutilization of healthcare facilities, it was clear that the elderly and people from minority races account for the largest number of visits to the emergency departments. The elderly develops more complication in the advancement of age and contributes to an increase in the total number of visits to the emergency rooms.
Limitations
The main limitation of this research was its scope in that the study could only estimate visits to the emergency departments by age having all other factors being equal. In addition, the observation to the research is limited to the hospitalization that results from emergency cases and fails to consider the hospitalizations that do not result from ED. The projections from Census could also not be accurate being a limit to the study.
In conclusion, emergency departments for a crucial component of the healthcare system of the United States. However, a number of factors result in increased demand for health care and overcrowding of the departments. As a result, the situation in hospitals compromises the quality of care delivery to the patients, which requires remedies to reduce the burden on nurses. In the United States, policymakers have to work in collaboration with the government and health practitioners to improve efficiency in the process of care delivery.
- Cha, W. C., Ahn, K. O., Shin, S. D., Park, J. H., & Cho, J. S. (2016). Emergency department crowding disparity: a nationwide cross-sectional study. Journal of Korean Medical Science, 31(8), 1331-1336.
- Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015). Overcrowding in emergency department: an international issue. Internal and emergency medicine, 10(2), 171-175.
- Ku, B. S., Scott, K. C., Kertesz, S. G., & Pitts, S. R. (2010). Factors associated with the use of urban emergency departments by the US homeless population. Public Health Reports, 125(3), 398-405.
- Haywood, C., Tanabe, P., Naik, R., Beach, M. C., & Lanzkron, S. (2013). The impact of race and disease on sickle cell patient wait times in the emergency department. The American journal of emergency medicine, 31(4), 651-656.
- Legramante, J. M., Morciano, L., Lucaroni, F., Gilardi, F., Caredda, E., Pesaresi, A., … & Di Lecce, V. N. (2016). Frequent Use of Emergency Departments by the Elderly Population When Continuing Care Is Not Well Established. PloS one, 11(12), e0165939.
