There's the headline again!! "Patient Load Increases at Emergency Rooms." Although this article was in our local newspaper in Louisville, Kentucky, the situation is prevalent across the U.S. The CDC (2002) reports that there were 89.8 million visits to hospital ERs in 1998 and in 2002 that number had risen to 110.2 million-a 20% increase. During the same period the number of ERs in the U.S. decreased by nearly 15%.

The CDC attributes the increases in part to population growth and an increase in older adults, who tend to visit ERs more often than younger people. Our local article pointed out that in Kentucky increasing numbers of uninsured are using the ER for primary care while the insured are seeking care there to avoid deductibles and co-pays from physicians and clinics.

Obviously the reasons for these phenomena are complex and require examining the problem from various vantage points. Community-based clinics are underfunded and filled to overflowing so the ill have to go somewhere. You need only watch ER on TV every week to see that a majority of their patients are seen for primary care, non-emergent problems and exacerbations of one or more chronic diseases. The costs for all this is astronomical.

Analyzing the ER problems in your local community is crticially important for home health clinicians and agencies. Even though the statistics and the press rarely cover the role home care has in reducing these emergent visits, CMS is addressing this issue head on through the Quality Initiatives. In recent recommendations by the National Quality Forum, 29 publicly reported measures (18 more than the current 11) were presented for review. Of these new measures, three were relative to emergent care were added.

Decreasing the amount of emergent care and hospital admissions, which usually go through the ED, should be a priority to every clinician and home care organization. The CDC reports that abdominal pain, chest pain, and fever were the most common principal reasons for visits. However, approximately 30% of ER patients had elevated blood pressure, and roughly one in four patients received medications during their visit. Webster's Dictionary defines symbiosis in two ways:

* the intimate living together of two dissimilar organisms in a mutually beneficial relationship; especially: MUTUALISM, and

* a cooperative relationship (as between two persons or groups).

To meet our quality objectives, save money, help our patients live their best life possible, and to show the value home care brings to the ER crisis, home care needs to work in symbiosis with our ER colleagues and organizations. Please share with me ways you've developed beneficial relationships that impact positively on your emergent care rates. I'll share your stories with your colleagues in future editorials.

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