Where should “acute care” problems be treated?

The September issue of Health Affairs published a research article that examined how patients use acute care services. The study analyzed 354 million visits to health care facilities or providers for acute care between 2001 and 2004. Twenty-eight percent of the visits were handled by hospital emergency departments, 22 percent by family/general practitioners, 20 percent by nonprimary care specialists, 10 percent by general internists, and seven percent by hospital outpatient departments. The uninsured received greater than half of their acute care in emergency departments, and most of that occurred on weekends or after-hours on weekdays. The two commonest complaints were abdominal pain and chest pain.

By definition, shouldn’t “acute care” problems be addressed within the context of acute care? If you or a relative had chest pain, would you send them to your primary care physician’s office? I hope not; you’d call 911 and send them to the closest emergency room for evaluation of an acute myocardial infarction. If you or a relative had severe abdominal pain, would you send them to your primary care physician’s office? No, in fact not; you’d send them to the closest emergency room for evaluation and an ultrasound or CT scan, if appropriate.

I agree that our emergency departments are overwhelmed with patients coming in with conditions that could possibly be easily treated in a primary care office or clinic. However, chest pain, severe abdominal pain, fractures, and severe lacerations, to call a number of, require the eye of experts who’ve the experience and resources to treat this stuff which might be clearly “acute care” issues.