Most ER patients do not need emergency care

PHOTO: Mailiis Ollino

People turned to the emergency rooms of Estonian hospitals a total of 462,000 times last year. Only 5 percent of ER patients had life-threatening conditions, while most – 57 percent – did not need emergency medical assistance, a recent National Audit Office study found.

Those 57 percent included cases where people turned to the ER with hiccups, blocked ears, sweating or ingrown nails. Some people wanted to renew their prescriptions or take a pregnancy test or simply said they did not wish to bother their family doctor.

Such visits meant that the severity of the condition of one-fifth of people who came to the ER was not assessed in time, while in one-tenth of cases, people did not get to see doctors inside the prescribed time limit. Some had life-threatening or potentially life-threatening conditions.

Family doctor before ER

Auditor General Janar Holm said that the people are not to blame. “People want help and go where they can get it – it is perfectly normal.” The problem is with family and specialist medicine, Holm said. The quality and availability of family medical care is uneven, while specialist medicine is suffering from queues, incomplete IT solutions and poor awareness of patients.

Audit director Mart Vain said that people should first and foremost be helped by family doctors. This would help curb ER queues caused by overload and save money – treating simple conditions is on average four times more expensive in the ER than in the family medicine system. ER is made more expensive by specialist doctors and additional tests and procedures.

Head of ER at Pärnu Hospital Merike Lepa said that the reason people prefer the emergency room to family doctors is that tests are all done in the same place which saves them from having to run around town. The staff at the Pärnu Hospital feel that the original concept of ER has become muddled.

The audit concludes that almost half of people who turned to the ER last year could just as well have visited their family doctor.

It is noteworthy that nearly 60 percent of patients complaining of mild conditions turn to the ER during the workday, when family medicine centers are open.

“I’ve been on call [at the ER] during the president’s anniversary of the republic reception, and the waiting room was empty. People started trickling in once the reception ended. That alone shows their conditions are not emergencies, head of the hospital’s quality service Teele Orgse said.

Availability of family medical care is uneven. “The main reason why patients turn to the ER is poor availability of family medicine, said audit director Vain. No fewer than 40 percent of people who turned to the ER with minor conditions said their family physician was unavailable.

Family doctors are not obligated to see people after working hours. Data from the audit office suggests only 9 percent of family practitioners make out-of-hours visits. Six counties do not have any after hours service. “Family doctors are working based on capacity, not necessity. At the same time, we know that around half of the population would like to visit their family doctor after 6 p.m.,” Vain said.

Europe’s longest queues

The audit discovered that family doctors are not interested in keeping their patients from turning to the ER. Mart Vain said that in some cases it is just the opposite. “Having someone else treat the patient helps the family physician save time and to some extent also money,” he explained. Representatives of 11 hospitals said that some family doctors send patients to the ER also when it is not strictly necessary.

The audit showed that 21 percent of patients return to the ER inside a year, whereas 10 percent have the same medical conditions as before. Information on whether patients have visited the ER and when does not reach family doctors. The latter would need to open several PDF files in the health information database to access this information. “A family doctor who has 2,000 people on their practice list just doesn’t have the time,” Vain said.

Poor availability also characterizes specialist care. While treatment queues have become shorter over the years, they are still the longest in Europe. “There are cases where people are forced to wait in line for months. This situation adds to the likelihood of people turning to the ER. People either get sick of waiting and take the easy way out or have their health deteriorate,” Vain explained.

He said that treating patients at the ER is the most expensive option. ER treatments cost a total of €153 million last year in a situation where the entire family medicine system took €114 million.

Last year’s 462,000 ER visits mean that 13 percent more people decided in favor of that solution than in 2010.

ER patients numbered around 300,000 or every fourth person in Estonia. There are 19 emergency rooms in Estonia.