All posts tagged mental-health

Only 3.3% of emergency room visits are ‘avoidable,’ study says – Healthcare Finance News

Only 3.3 percent of emergency room visits are avoidable, according to a study published Thursday in the International Journal for Quality in Health Care.

This is because those visits deemed ‘avoidable’ involve mental health or dental care, issues with which the ER is generally not equipped to deal, according to the study published in the peer-reviewed journal.

[Also: Medicaid expansion results in more emergency room trips; fewer patients uninsured]

The study shows that despite the health insurance industry’s campaign about avoidable ER visits, most patients in the emergency room belong there, said American College of Emergency Physicians President Becky Parker, MD.

The ‘avoidable’ emergency department visits are defined as visits in which patients did not require any diagnostic or screening services, procedures, or medications, and were discharged home.

“Most patients who are in the emergency department belong there and insurers should cover those visits,” Parker said. “The myths about ‘unnecessary’ ER visits are just that myths.”

The study analyzed data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011.

The most common ‘avoidable’ ER visits in the study included cases in which patients were discharged with alcohol- and mood-related disorders, or with dental conditions.

The study showed that 10.4 percent of visits by patients diagnosed with alcohol-related disorders, 16.9 percent for mood-related disorders and 4.9 percent for dental-related conditions, were ‘avoidable.’

While these visits were deemed avoidable, the majority of patients with these conditions still required some form of diagnostic or treatment service, said the study’s authors.

“We found that many of the common conditions of ‘avoidable’ emergency department visits involved mental health and dental problems, which ERs are generally ill-equipped to treat,” said lead study author Renee Hsia, MD, of the Department of Emergency Medicine at the University of California, San Francisco. “This suggests a lack of access to healthcare rather than intentional inappropriate use is driving many of these ‘avoidable’ visits. These patients come to the ER because they need help and literally have no place else to go.”

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Only 3.3% of emergency room visits are ‘avoidable,’ study says – Healthcare Finance News


Influx of seniors challenge emergency room system – Thousand Oaks Acorn

The number of older people in emergency rooms is expected to increase significantly over the next 30 years, doubling in the case of those older than 65 and potentially tripling among those over 85.

Our healthcare system is in critically short supply of primary care physicians and geriatric specialists to treat seniors. As a result, many seniors end up in emergency rooms rather than being treated in the community.

The emergency room can be an overwhelming place for seniors, as they must enter an unfamiliar environment, field rapid-fire questions, then experience fear and anxiety about the diagnosis that awaits.

Are our emergency rooms prepared for this significant growth in senior patients? The answer might be no, unless we heed a call to arms in the following critical areas.

Mental health

Nationwide, more than half of the people with mental illness go untreated, according to Mental Health America. Many seniors with mental illness dont realize they have it because they are dealing with multiple medical issues.

Their challenges are rarely purely psychiatric, and consequently, its hard in the ER to receive prompt comprehensive care for their mental illness.

Two hospital studies conducted from 2007 to 2010 found that the number of patients age 65 and older coming to the ER with mental health issues such as dementia, Alzheimers and depression increased nearly 21 percent. A lack of awareness among the general population about the mental illnesses facing seniors leads to older patients often ending up in the ER when a crisis occurs.

Drug side effects

An increasing number of older people are arriving at the ER as a result of side effects or adverse reactions to the prescription drugs they are taking.

According to Centers for Disease Control and Prevention, 35 percent of ER visits due to adverse events from prescription medications in 2013-14 were by adults age 65 years and older, compared with 26 percent in 2005-06. Among that group, seniors made up 44 percent of those who required hospitalization as a result of the drugs adverse effects.

Blood thinners, antibiotics and diabetes agents were involved in almost half of the prescription-drug-related visits.

In our fragmented healthcare system, patients are often seen by multiple physicians, each having an incomplete view of the patients drug use. Clinicians often hesitate to discontinue medications because of lack of familiarity with the medication or patient.


Just last week the California Health Report published an article stating that the rate of patients over 65 seeking care at hospital ERs for opioid-related issues in California was second only to Arizona among the 50 states.

Often, older Americans who struggle with opioid addiction have been prescribed the medication to deal with managing pain upon being discharged from the hospital following surgery.

According to the Journal of the American Medical Association, of those who received an opioid prescription, more than 42 percent still had the prescription in place 90 days after they left the hospital.

ER visits often focus on the physical injuries (pain and broken bones from a fall that really was due to the loss of fine motor skillsa result of long-term opioid use) and push the root cause into the background. Because of the stigma, seniors also struggle with admitting drug dependency.

Identifying the caregiver

Almost half of all seniors over the age of 70 live alone today. Who advocates for them and how are these advocates identified in the emergency room?

Seniors enter the ER either from home, an assisted-living facility or, in some cases, from the streets. Frequently they do not have a family caregiver or an individual who is operating as their designated healthcare proxy with them.

The ER can be an overwhelming place, and a second set of ears, eyes and voice can lead to a better set of outcomes. Family caregivers also play critical roles in transitions from hospital to home or other post-acute settings.

As a community, we have an opportunity to work together to educate seniors and caregivers on what to expect when they enter the hospital and to inform hospital staff about the many challenges todays seniors face.

Consider joining Senior Concerns as it hosts a seminar titled Things You Should Know Before Your Next Hospital Stay from 5:30 to 7 p.m. Tues., Sept. 19 at 401 Hodencamp Road, Thousand Oaks. Call (805) 497- 0189 to reserve your seat.

Andrea Gallagher, a certified senior advisor, is president of Senior Concerns, a nonprofit agency serving Ventura and western Los Angeles counties. For more information, visit, and for comments or questions, email

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Influx of seniors challenge emergency room system – Thousand Oaks Acorn