Californians increasingly visiting hospital ERs for non-injury care

Californians are increasingly likely to visit an emergency room for complex medical problems, research shows

Californians are increasingly likely to visit a hospital emergency room for complex medical problems rather than an injury, according to new research.

Although hospital emergency departments, or EDs, were once known as "accident rooms," a review of all non-federal hospital emergency rooms in California from 2005 to 2011 found that injury-related visits have declined over that time period, according to a study published Monday in the journal Health Affairs.

"As the rising number of ED visits and the stagnant supply of ED and critical care beds in California hospitals contribute to ED crowding, it is worth noting that rising visit rates for trauma are not major contributors to this effect," wrote Dr. Renee Hsia, a professor in the Department of Emergency Medicine at UC San Francisco, and her colleagues.

Overall, emergency room visits due to injury fell nearly 1% while visits brought on by complex medical issues such as gastrointestinal disease and mental illness rose by more than 13%, the researchers found. 

The fastest growing non-injury diagnoses in California hospital emergency rooms included nervous system disorders, gastrointestinal disease, abdominal pain and other ill-defined conditions.

The authors said their findings point to the changing nature of hospital emergency departments.

"California EDs are providing increasing amounts of care for complex emergencies related to chronic conditions, infections, and even non-specific symptoms," the authors wrote. "This trend reflects both changes in the population disease burden and the ED's more central role in healthcare compared to its original charge to treat injured patients and provide charity care."

Although the rate of non-injury related diagnoses outpaced injury visits for uninsured patients, Medicaid patients and those with private health insurance, this was not the case for older patients receiving Medicare. For this group, the rate of injury visits equaled non-injury visits.

"This could reflect an increasing incidence of injury among the elderly as a result of a variety of factors, including increasingly active lifestyles or increasing severity of injury, resulting in the need for growing amounts of emergency care," authors wrote.

Researchers also found that the rate of growth in mental health conditions was significant among the uninsured, Medicare beneficiaries and the privately insured.

This trend, authors wrote, may require increased presence of mental health professionals and services in the emergency room.

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