Emergency rooms have always been important places for people with serious health problems. But in the last 20 years, the kinds of visits to ERs have changed a lot. Charles Begley, a professor at the University of Texas School of Public Health, says this change shows how people now get healthcare differently. Many people use the emergency room as their main way to get care, even when their problems are not urgent.
Research in Harris County, Houston, shows this clearly. About 40% of patients in busy emergency rooms do not need urgent care. They have conditions that a primary care doctor could treat, or they could go to outpatient clinics for help. Also, 61.5% of patients using Harris Health System’s ERs have no insurance or very little money, so the ER is their only healthcare option.
These numbers show that emergency services, fire departments, and hospitals are under stress. Ambulances cost at least $1,000 per trip and many take patients who don’t really need emergency transport. Going to the ER usually costs another $1,500 or more. This makes healthcare more expensive for communities and taxpayers.
In Houston, 911 gets nearly seven times as many medical calls as fire calls. Many of these calls are for patients who don’t have emergencies. Alden Speer, a firefighter EMT at Houston Fire Department Station 46, says the number of non-emergency calls is probably even higher than 40%. This causes problems because ambulances take patients who might be treated somewhere else.
Ambulance No. 46, one of Houston’s busiest, made 5,154 trips to the hospital last year. This heavy workload makes it hard to keep ambulances ready for real emergencies like heart attacks or serious injuries. Dr. David Persse, who leads Emergency Medical Services for Houston Fire Department, calls the current system “unsustainable” because too many patients use emergency care when they don’t need it.
This situation causes many problems. Emergency rooms get crowded, which means longer waits and less space for real emergencies. Healthcare workers get tired and frustrated, as Dr. Kenneth Margolis has said about the high number of non-urgent patients.
To face these problems, Houston’s Fire Department started the Emergency TeleHealth and Navigation (ETHAN) program in December 2017. ETHAN tries to cut down unnecessary ER visits by letting first responders talk with doctors through video during 911 calls.
When EMTs arrive, they check the patient’s condition. If it doesn’t look like an emergency, a doctor can join the call through video and decide what to do next. Instead of always sending an ambulance and going to the ER, the program can set up doctor’s visits and provide other transportation, usually a taxi paid for by the city.
ETHAN has made a big difference. Out of about 1,000 calls, 45% of patients went by cab instead of ambulance. Another 35% got care instructions at home or were sent to clinics. Only 20% needed emergency transport and ER care. By lowering ambulance use and ER visits, the program saved Houston almost $1 million.
ETHAN shows a new way to meet healthcare needs properly while keeping emergency services ready for real crises. Dr. Michael Gonzalez, ETHAN’s director, says the key question today is, “Can we safely decide who needs emergency care?” The program uses both traditional emergency help and new technology for evaluating patients remotely.
Part of the problem with emergency services is how people think about them. Many people see 911 calls and ER visits as the easiest or only way to get medical help, especially if they don’t have insurance or a regular doctor. The Emergency Medical Treatment and Labor Act (EMTALA), a law from 1986, says hospitals must check every patient who comes in, no matter if they can pay or not. This sometimes causes people to rely on ERs for regular care.
This way of thinking puts more pressure on hospitals and lowers the care quality for patients with real emergencies. Experts like Dr. Persse and Mr. Speer warn about this growing problem. They say it is important to create other ways to treat non-urgent cases safely outside of ERs.
Using artificial intelligence (AI) and automated systems in emergency care and hospitals could make checking patients and using resources better and faster.
Programs like ETHAN use telemedicine to let doctors check patients from a distance. AI can help by studying symptoms, medical history, and local health information to decide how urgent a case is right away. AI can put calls in order, suggest the right transportation, and recommend where patients should go. This helps emergency workers and hospital staff manage their work better.
AI-powered front-office systems, like those from some companies, can handle patient calls and messages easily. Instead of crowding 911 or hospital desks, AI directs people to the right caregivers. AI can also schedule appointments automatically. This cuts down paper work and helps patients get to the right doctor or clinic, which can stop unnecessary ER visits.
Tracking patients after their first visit is very important, like in ETHAN. AI can send reminders for doctor visits, nurse checks at home, or medicine schedules. These systems help keep patients healthy and reduce chances they come back to the ER with avoidable problems.
Healthcare managers can use AI data tools to see how patients come and go, find patterns of non-emergency ER visits, and plan resources better. Knowing when and where non-urgent ER visits happen helps plan health programs and expanding telehealth services.
For IT workers and managers, using these technologies fits with the goal of cutting costs and improving patient care in emergencies.
Programs like ETHAN give important ideas to healthcare managers trying to reduce ER crowding. Medical practice leaders can work with local emergency services, use telehealth, and add AI call systems to make patient flow smoother.
Clinic and health network owners should reach out to teach patients about when to use the ER and promote other care options. This helps community health and lowers wasteful healthcare spending.
IT managers are key to setting up telehealth systems and AI automation. Making sure emergency services, hospital records, and outpatient providers connect well creates a healthcare network that talks to each other. This helps decisions happen faster in emergencies.
Investing in technology, using data-driven plans, and working with the community can help solve the big issue of non-emergency ER visits, especially in big cities like Houston.
It is clear that many people who go to the ER do not need urgent care. This changes how emergency services must work and pushes healthcare teams to find better solutions. Programs like ETHAN show it is possible to sort patients better and lower costs while improving patient experiences.
By using AI for front-office work, smart triage, and follow-up, healthcare providers and managers can handle these challenges more accurately and quickly. Changing how people think about emergency care, along with using new technology, is an important step to build a better emergency care system in the United States.
ETHAN, or Emergency TeleHealth and Navigation, aims to reduce avoidable emergency room visits by allowing first responders to consult with an emergency physician via telemedicine at the scene, assessing if the situation is truly an emergency.
The program has saved the city around $1 million by prioritizing non-emergency care, allowing less expensive transportation options like cabs instead of costly ambulance rides for patients who do not require emergency services.
Studies indicate that approximately 40% of patients visiting Houston’s ERs do not need emergency care and could be treated by primary care physicians or clinics.
If a patient is deemed not to have an emergency, the ETHAN doctor can schedule a non-emergency appointment and arrange for city-paid cab transport instead of an ambulance.
Since launching, the ETHAN program has resulted in about 1,000 calls, with 20% leading to emergency room visits, 45% transported by cab, and 35% receiving care instructions at home.
The program struggles with a shortage of doctors available for telemedicine consultations, and it is unavailable after 10 p.m., which limits its capacity during night hours.
Many patients now use 911 calls to access emergency rooms rather than as a last resort, leading to congested ERs with many non-urgent cases.
The idea stemmed from the recognition of a broken system where emergency rooms were becoming the primary care avenue for many non-urgent health issues.
Patients are contacted by public health nurses or counselors for follow-up home visits, ensuring they have a doctor and keeping their scheduled appointments.
Funding comes from a provision of the Affordable Care Act that supports programs utilizing technology to deliver more efficient and cost-effective healthcare.
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