Reducing ER Visits in Washington, D.C.

Emergency rooms in Washington, D.C. regularly receive high national rankings, but they have some of the longest emergency room wait times and highest admission rates in the nation. The Kaiser Family Foundation reports that the District also suffers from a shortage of primary care physicians (PCPs) , with only half of the need met.

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Nationwide, the average wait time in the ER before a patient even sees a doctor is 28 minutes. But in D.C., the average wait time is 46 minutes, as shown by the graphic below. (Please note that this data doesn’t account for the total average time spent in the emergency room — which can be much, much longer.)

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Very recent data from MEP Health indicates, however, that even these factors may be improving. A monthly utilization report from December 2013 reveals that area acute care centers had just over 40,000 visits that month, down 8 percent from the previous year. Overall, visits declined nearly 2 percent for the last two months. Low-income patients in particular often turn to emergency rooms because they do not have access to a PCP who can provide preventive care or treatment for less acute ailments. In addition, many patients with low socioeconomic status prefer hospital care because they perceive hospitals to be more affordable and convenient and of higher quality than PCPs, according toa study published in Health Affairs.

Boosting the number of PCPs and nurse practitioners (who often help fill the void left by a shortage of PCPs) could help alleviate crowding at emergency rooms  and free up acute care centers to focus on cases that are true emergencies. Other viable approaches include expanding access to walk-in clinics and improving awareness about preventative health measures individuals can take to improve their health.

Improving Health Care Outcomes

Fortunately, area residents and students have plenty of local organizations working to provide alternatives to the ER and improve health care outcomes. Here’s a look at several of these organizations.

  • Capital City Area Health Education Center: This D.C.-area nonprofit strives to educate health care professionals and improve health service options to residents through community-based partnerships such the DC Pink Divas (a patient navigation and training program around breast cancer), Kids 2 Health Careers and its Clinical Placement Clearinghouse. Together, the organization’s programs serve more than 5,000 D.C. residents each year.
  • Community of Hope: Serving the low-income and homeless adults and children of D.C. is Community of Hope’s mission. The organization has three health care locations across D.C. that provide compassionate services such as dental exams and birthing and behavioral health services regardless of the patient’s ability to pay.
  • DC CARE: Persons who are HIV-positive turn to DC CARE for supportive services such as emergency financial assistance and help enrolling in health insurance coverage. DC CARE also trains subject matter experts in HIV-related topics.
  • DC Health Link: Established by the Health Benefit Exchange Authority, DC Health Link is the District’s health insurance marketplace for individuals, families and small businesses. DC Health Link has also chosen 35 area groups to receive grants totaling $6.4 million for assisting with enrollment. Expanding access to health insurance gives patients more options than showing up at the emergency room for treatment.
  • DC Health Matters: DC Health Matters is a one-stop resource where professionals and community members can learn about local health resources and best practices and find demographic and other data.
  • DC Healthy Families: This website allows families to compare health plans, choose a health plan and doctor, find local meetings to learn about health care plan options and more.
  • DC Primary Care Association : This nonprofit health action and advocacy organization works to improve D.C. residents’ access to primary health care services. The organization has worked to fulfill this mission by building community health centers, creating policies that support access and fostering a community of people to help navigate the health care system.
  • District of Columbia Health Care Association: DCHCA is an information and education resource that provides members with continuing education and updates on applicable policies and legislation. It also works to educate legislators, government officials and consumers about issues facing the health care industry, working to create better access for all.
  • Health Leads: Opened at the Children’s National Medical Center in 2001, Health Leads works with D.C. families to connect them with healthy resources. Doctors, nurses and social workers refer patients to Health Leads. The organization recruits and trains local college students to volunteer as Health Leads Advocates.
  • La Clinica del Pueblo: This nonprofit serves D.C.’s Latino and immigrant population, providing culturally appropriate health services such as interpreters, mental health services, medical referrals, substance abuse services and more to those who need it most.
  • Mary’s Center: This federally qualified health center provides health care and other services to families and individuals whose needs often go unmet, notably immigrants. Health care services include pediatric, adolescent and adult care, prenatal care, dental treatment and community outreach.
  • MBI Health Services: MBI offers a free-standing mental health clinic, mental health rehabilitation services and support for patients with developmental disabilities. It also provides health care professional staffing for institutions and individuals.
  • MedStar PromptCare: MedStar PromptCare can treat most injuries or illnesses without an appointment and provides an alternative to the emergency room when a PCP’s office is closed or the patient has a minor injury and doesn’t want to wait in the ER.
  • MetroHealth: This nonprofit community-based organization provides integrated medical health care to the underserved with a focus on awareness and promotion of treatment services for persons who are HIV-positive. It also provides nutritional counseling and urgent and sick visits.
  • Northwest Nurse Practitioner Associates: NNPA provides complete primary care services. When it opened in 2004, it was the only nurse practitioner owned and operated practice in D.C.
  • Peer Health Exchange : Peer Health Exchange empowers teenagers to make healthy decisions by training college students to teach health in public high schools that don’t have health education. GW students have participated in Peer Health Exchange’s program, along with students from many other college and universities.
  • Planned Parenthood of Metropolitan Washington, DC, Inc.  PPMW operates five health centers in the D.C. metro area, providing reproductive health services, teen pregnancy prevention programs, HIV/AIDS testing and counseling, and more.
  • Summit Health Institute for Research and Education Inc.: This community organization’s mission focuses on preventing obesity by encouraging D.C. residents to increase physical activity and take charge of their health. Wellness Circles help those with chronic ailments like diabetes or hypertension learn to manage their treatment and prevent complications.
  • Whitman-Walker Clinic: This community health center serves greater Washington’s urban community, particularly those in the LGBT or HIV-positive communities. Services include primary care medicine, nutrition services, STD screenings and more.
  • Young Invincibles: Young Invincibles works to mobilize 18- to 34-year-olds around important issues such as health care access, entrepreneurship and jobs access.

Many of these health care organizations help increase access by working directly with communities that might otherwise turn to the ER, taking the burden off of emergency rooms and providing more effective alternatives. As organizations work to address long wait times and overcrowding in the ER, health care leaders will play a key role in implementing lasting solutions.

Know of another organization helping to improve health care outcomes and curb ER visits in Washington, D.C.? Tell us in the comments!