"We, the People..." By Neal E. Flomenbaum, MD, Editor-in-Chief

People sometimes ask if it is safe to be treated in an emergency department or admitted to a hospital in July, when new doctors traditionally start their residencies. In response, I point out that one of the most admirable features of academic emergency medicine is its emphasis on attending supervision, guaranteeing a senior-level physician at the bedside at all times, including July. Our academic colleagues in other specialties also provide an intense level of supervision that makes the “changing of the guard” a safe experience. In fact, we do such a great job of training our new residents and new attendings for their July roles that we have no qualms about turning over the reins to them in August and leaving for vacation until September.

So, in the finest academic tradition, I have found some guest authors for the month of August. In June 2007 the CDC published the “2005 Emergency Department Summary” of data on visits to hospital emergency departments in the United States, and its authors—the people of the United States—have written this month’s editorial, with assistance from Eric Nawas, Richard Niska, and Jianmin Xu of the CDC. (Information from the CDC report, which covers the last full year of data prior to last year’s IOM reports on emergency departments, appears as italicized type preceded by bullets.)

See you in September.

“We sometimes criticize emergency departments for making us endure long waits to receive care. At times ambulances even bypass the nearest emergency department because the hospital is on diversion. But our faith in and appreciation for the care provided in the nation’s EDs is unshaken. In fact, we have even encouraged our friends and relatives to go to EDs for their care…”

• In 2005, more than 115 million people sought care in emergency departments, representing almost 40 visits for every 100 persons in the United States, compared to the 96.5 million visits in 1995 (a 37% increase).

“We like your friends in pre- hospital care too…”
• Almost 18 million patients (15.5%) came to the ED by ambulance.

“And we appreciate all of the other things you do for us as well…”
• Diagnostic and screening services were provided during 71% of visits, procedures at 47% of visits, and medications given or prescribed almost 77% of the time.

“In fact, considering all the care we receive, the waiting time does not seem that unreasonable…”
• Patients spent an average of 56 minutes waiting to see a physician and 3.3 hours for the entire visit. Almost 7 out of 10 patients spent less than 4 hours in the ED.

“Some of us are really sick, some of us have just recently been discharged from the hospital, and only a few of us get tired of waiting and leave…”
• Almost 12% of ED visits resulted in admissions, about 2% of which involved patients discharged from the hospital within the previous seven days, while only about 2% of patients left without being seen by a health care provider.

“We come for a variety of reasons, but mostly for abdominal pain, chest pain, fever, and cough...”
• Reasons for visits given by patients included abdominal pain (6.8%), chest pain (5%), fever (4.4%), and cough (2.9%). The most frequently diagnosed disease categories were injuries and poisonings (24.9%). The most frequent injury mechanisms were unintentional falls (20.8%) and motor vehicle accidents (10.1%).

“We are grateful that you care for all of us regardless of our ability to pay. And although we like all EDs, we especially like those in not-for-profit hospitals…”
• Self-paying patients, patients who were not charged, and charity care accounted for 16.7% of visits, while about half a million visits (0.4%) were by homeless people. More than 72% of ED visits were to voluntary nonprofit hospitals.

“So thanks for all your efforts on our behalf. Keep up the good work. And try to get some more help, if you can.”

Emerg Med 39(8):10, 2007