It’s not news that many people go to their local emergency room for care that could be provided at much lower cost at a doctor’s office or community health center.
Many patients who do this may not have health insurance or a primary care provider. This can be a costly venture, however, and local health providers are striving to educate patients about when a trip to the emergency room is really necessary.
“In general, if the patient feels that their life or limb is threatened, they need to get to the emergency room,” said Dr. Tripp Carter III, medical director of emergency services at Portsmouth Regional Hospital.
“Those with chest pain, difficulty breathing or symptoms of a stroke should definitely go to the emergency department.”
When a patient comes into the emergency department, he or she is “triaged” by medical personnel for severity of symptoms. They are then usually put into an examining room to be seen by a physician.
Carter recommends asking yourself this question: “Do I really think I need the emergency department — or is it just convenient?” If it is not life threatening, a call to the person’s primary care provider may be the best thing to do. Most medical practices have an on-call service for a provider to call back a patient any time when the office is closed. He or she can advise the patient as to whether they need to be seen right away in the emergency department or if it can wait until the patient can be seen at the office.
Portsmouth Regional Hospital has a service called Consult A Nurse, staffed 24/7, which can answer questions about health concerns. The number is (888) 421-1080. This is not to be used in a true emergency like chest pain or severe trauma, when 9-1-1 should be dialed.
While the nurses at Consult-A-Nurse don’t diagnose medical conditions over the phone, they provide answers to health-related questions and offer support and consultation.
Grant Turpin, Portsmouth Regional’s emergency medical services coordinator, added that people can go to the hospital’s Web site, www.portsmouthhospital.com, to find out the current wait for the emergency room. Or, they can text “ER” to 23000.
“It is better to err on the side of caution if the patient is not sure,” Carter said. “During the winter months we do get our fair share of people with sniffles and coughs. But some patients may actually have pneumonia.”
Carter said the emergency room staff sees a lot of patients with dental emergencies. These are patients who usually do not have access to dental care mostly because of having no insurance.
“Often, we refer these patients to Families First,” he said.
The hospital will also refer patients who do not have a primary care provider to Families First Health and Support Center in Portsmouth.
“This is helpful to these patients because we otherwise don’t take adults for dental care unless they are already Families First patients, and we normally have a wait of several weeks for new health center patients to establish care,” said Margie Wachtel, communications director at Families First, a community health center that serves a mostly uninsured and underinsured population. “But patients referred from the emergency room are fast-tracked.”
In fiscal year 2013 (July 2012 through June 2013), a total of 384 patients were referred to Families First from the emergency departments at Portsmouth Regional Hospital and Exeter Hospital.
Exeter Hospital began referring patients in October 2012.
Of these patients, 214 were from Portsmouth Regional and 170 were from Exeter Hospital.
“Not all 384 of these patients actually contacted us and received services at Families First, but they could have,” Wachtel said.
Families First is in the process of educating its patients about when and when not to use the emergency room.
“We know every morning how many of our patients came to the emergency room the day before at Portsmouth Regional,” said Helen Taft, executive director of Families First. “We’ll connect with these patients and have found that most of them have not called here first.” Families First offers an after-hours nursing service 24/7 with a doctor on call. It has also added walk-in appointments on Tuesday and Friday mornings, and same-day appointments for ill patients.
Flyers are placed throughout the clinic reminding patients of these options so they will only go to the emergency room during a true emergency.
“The state of New Hampshire is about to implement Medicaid Care Management, and one of the goals of that is to reduce costs, in part through reducing overuse of the emergency room,” Taft said.
Goodwin Community Health in Somersworth has a similar partnership with Wentworth-Douglass Hospital in Dover in referring emergency room patients to the center. There is an outreach worker on site at the hospital who works Sunday to Thursday from 1 to 9:30 p.m.
“These times were identified as the most needed,” said Janet Atkins, executive director of Goodwin Community Health. She said patients generally present with chronic pain, upper respiratory infections, anxiety, depression, asthma and diabetic complications.
The outreach worker program started in January and Atkins said about 150 patients are referred to the program each month.
“Most of them have no primary care provider, are uninsured or on Medicaid,” she said. “While not all of them end up coming to us, we are able to provide a medical home for many.”
Atkins said of those referred, about 24 percent will become patients at Goodwin.
Goodwin offers walk-in service five mornings a week for medical and dental patients and it stays open a couple of evenings to see patients.
It is trying to change the behavior of patients from automatically using the emergency room and increase the utilization of preventative care.
“We are creating a unique and creative approach by having an outreach worker at the hospital who can schedule a follow-up appointment on the spot,” said Lara Willard, Goodwin’s director of marketing and public relations.