Mallappallil M et al. (2005) Excessive use of emergency room care by hemodialysis patients. Dialysis & Transplantation 34: 542–549

Excessive use of emergency care for minor afflictions is common among hemodialysis patients, according to data from a US inner-city hospital. The authors of a retrospective analysis of these data published in Dialysis & Transplantation call for a concerted effort to limit emergency room attendance to urgent cases only.

Mallappallil et al. examined the records from 181 visits by 141 adult hemodialysis patients to the emergency department of one of the main teaching hospitals in New York City. Despite 23% of these visits being a result of direct referral from a dialysis facility, more than 90% of patients were discharged in less than 24 hours. The predominant diagnoses during the 33-month study period were mild gastrointestinal disorders and musculoskeletal pain. Most interventions could have been administered by outpatient services. Nephrology consults were ordered in 25% of cases; only eight patients were hospitalized.

Interestingly, the cost of emergency room care is not included in the US$14 billion estimate of annual MEDICARE expenditure on end-stage renal disease (ESRD). The average $822 spent on each non-emergent visit to emergency services (calculated in the study presented here) is an obvious target for cost-cutting. Making such savings will, however, require a shift in perception of the role of emergency room care in management of ESRD, by both patients and dialysis center staff. Education programs have been successful in other chronic disease populations, and should be initiated in the ESRD setting.