If you’ve ever been admitted to an emergency room or accompanied a family member there, it’s probably not a fond memory. Medical emergencies are frightening, exhausting, and costly. While emergency room visits should be rare, a new study has found that too many people who are treated in an ER return for emergency care within a month of the initial visit.

Repeat ER visits aren’t good for anyone. Whenever possible, consumers should use urgent care centers or call their primary care physicians for medical conditions that are not true emergencies. But according to a report from the Robert Wood Johnson Foundation, hospital readmissions for Medicare patients alone cost about $26 billion a year, $17 billion of which is avoidable.  Now health officials are turning their attention to why so many patients return to the ER for a second or even third visit.

Researchers at the University of California, San Francisco, looked at hospital statistics in six states over several years. They found that 8.2 percent of patients returned to an ER for additional care within three days of the first visit. About one-third of those visits occurred at a different institution than the ER they first visited. Of the various reasons why people returned, almost one-quarter of the patients sought care for a skin infection. Revisits cost more than the initial visit, according to the data.

Another study, published in 2013 by the Robert Wood Johnson Foundation, found that readmission to hospitals in general (not just emergency rooms) is a huge problem, especially for older patients. The Centers for Medicare & Medicaid Services determined that avoidable readmissions are one of the biggest problems in healthcare today, and they’ve even begun to penalize hospitals with high readmission rates for patients with pneumonia or heart complications.

It’s not clear why some patients return for more care. It could be that they are asked to return for a follow-up visit, that they are just not getting adequate care during the first visit, or they do not following discharge instructions properly. The Robert Woods Johnson report says that while some readmissions are expected or necessary, “many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn’t understand, and not taking medications or getting the necessary follow-up care.”

Patients can take steps to counteract this problem, however. In addition to making wise choices about when an ER visit is needed, patients can be their own advocate by being sure they understand their care and follow-up instructions clearly.

When to Use the Emergency Room

Hospital Emergency RoomWhen you need sudden medical care, think first about how serious the problem is and determine if the appropriate action is a phone call to your family doctor, a visit to an urgent care clinic, or an immediate trip to the ER.

Signs of an Emergency:

If a person or unborn child is facing death or permanent disability, go to the emergency room.

If you cannot wait to be seen, call 911 for immediate assistance. Cases when it’s necessary to take quick action include:

  • A person has stopped breathing or is choking
  • A head injury along with loss of consciousness or confusion
  • A neck or spine injury, especially if mobility and sensation are affected
  • An electric shock or lightning strike
  • A second-degree burn larger than three inches or third-degree burn
  • A seizure that lasts longer than five minutes, is followed by another seizure, or has an out-of-the-ordinary recovery (pain, trouble breathing)

With the following conditions, go to the emergency department. (Call 911 if you cannot transport yourself or cannot wait to be seen).

  • Trouble breathing
  • Loss of consciousness or the ability to see, speak, walk, or move
  • Severe pain or pressure in the chest
  • Arm or jaw pain
  • Abnormally bad headache, especially with quick onset
  • Weakness or drooping that appears on one side of the body
  • Persistent dizziness or weakness
  • Smoke or poisonous fume inhalation
  • Sudden confusion
  • Any deep wound or injury that causes heavy bleeding
  • A suspected broken bone that causes loss of movement, especially if the bone is visible outside the skin
  • Coughing or vomit that contains blood
  • Any severe pain
  • Allergic reaction that includes hives, swelling, or trouble breathing
  • A high fever accompanied by a headache and stiff neck, or high fever that over-the-counter medicine does not reduce
  • Persistent vomiting or diarrhea
  • Ingestion of poison or an overdose of drug or alcohol
  • Suicidal thoughts

Consider using an urgent care center if:

  • Your problem does not threaten your life or have the potential to cause disability, but you are concerned and cannot see your doctor in time.
  • You are experiencing a common illness (cold, flu, earache, headache, sore throat, fever, rash) or minor injury (sprain, cut, burn, broken bone, back pain, eye injury) that is not listed above as requiring emergency care.

Before leaving the hospital:

To avoid a repeat visit to the hospital or hospital emergency room, make sure you have a thorough discharge plan from your caregiver and have discussed your transition to home. Here are some tips from the Robert Wood Johnson Foundation report Care About Your Care that can help patients take steps to avoid being readmitted.

  • Don’t be afraid to ask questions until you understand fully.
  • Repeat instructions you are given so doctors and nurses can correct any misunderstandings.
  • Ensure you have a written, specific discharge plan before leaving the hospital.
  • Make sure your doctors have complete and correct information about any medication you are currently taking. Follow instructions for medication to the letter.
  • Schedule and attend follow-up appointments as directed, bringing medications and discharge instructions with you.
  • Know which symptoms mean you need to return for treatment. Have a plan for who to call or where to go during the day, at night, and on weekends.

References

Sources

Duseja, R., Bardach, N.S., Lin, G.A., Yazdany, J., Dean, M.L., Clay, T.H. . . . Dudley, R.A. (2015, June 2). Revisit rates and associated costs after an emergency department encounter: A multistate analysis. [Abstract]. Annals of Internal Medicine, 162, 750-756. doi:10.7326/M14-1616

Retrieved from: http://annals.org/article.aspx?articleid=2299853

U.S. National Library of Medicine. (2014, Oct. 27). When to use the emergency room – Adult.

Retrieved from:

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000593.htm

Robert Wood Johnson Foundation. (2013, Feb.). How to avoid being readmitted to the hospital.

http://www.rwjf.org/en/library/research/2013/01/how-to-avoid-being-readmitted-to-the-hospital.html

Robert Wood Johnson Foundation. (2013, Feb.). The revolving door: A report on U.S. hospital readmissions.

Retrieved from: http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404178

Robert Wood Johnson Foundation. (2013, Feb.). Care about your care discharge checklist & care transition plan.

Retrieved from:

http://www.rwjf.org/en/library/research/2013/01/care-about-your-care-discharge-checklist—care-transition-plan.html

Clancy, C. (2008, Aug. 19). How to use hospital emergency rooms wisely. Agency for Healthcare Research and Quality Archive.

Retrieved from: http://archive.ahrq.gov/news/columns/navigating-the-health-care-system/081908.html

Centers for Disease Control and Prevention. (2015, Oct. 13). Seizure first aid.

Retrieved from: http://www.cdc.gov/epilepsy/basics/first-aid.htm

Crozer-Keystone Health System. (2015, July 15). When to go to the emergency department for a burn.

Retrieved from: http://www.crozerkeystone.org/news/press-releases/2015/july/when-to-go-to-the-emergency-department-for-a-burn/

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