More than 3,000 people walked into Tri-City emergency rooms in 2011 seeking attention not for heart attacks or broken bones, but for cough and cold symptoms -- symptoms that are better fit for a family doctor or an urgent care center than an emergency room.
Local health officials say that use of emergency rooms for health concerns that aren't actually emergencies is one of the biggest and most costly issues facing the health care system.
And local citizens have identified it as one of their top five concerns about health care in an ongoing community health assessment survey.
The problem is so costly that the state has threatened to stop paying hospitals to care for people who come in with non-emergency problems unless the numbers come down.
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So a team of Tri-City hospitals, clinics, doctors, health insurance providers, fire departments, educators and the United Way are working together to figure out how to direct patients not experiencing emergencies to more appropriate venues for treatment.
They don't want to stop people with true emergencies -- chest pain or stroke symptoms, for example -- from coming into emergency rooms for treatment, but they do want to get those people with cough and cold symptoms, or chronic illnesses requiring ongoing management, connected to primary care doctors where they'll get more cost-effective treatment.
"This is not about keeping people away (from the ER)," said Richland Fire Chief Grant Baynes. "It is about getting them to the right place."
The fire departments fit into the picture because they provide ambulance and paramedic services when someone calls 911.
About 80 percent of calls dispatched to Tri-City fire departments are medical, and about two-thirds result in the person being taken to the hospital by ambulance.
But often those calls aren't true emergencies, Baynes said.
"We will get things like, 'My finger hurts. I didn't do anything to it. I just woke up today and it hurt,' " he said.
Pasco Fire Chief Bob Gear said his department sometimes gets calls from people who drive to a hospital, see a wait to get into an emergency room, and call an ambulance from the hospital parking lot because they know it'll get them in.
"Many of these frequent users of the ER recognize that the fastest way in is on an ambulance gurney," Gear said.
Contrary to what might be expected, frequent emergency room users aren't always the uninsured or low-income people on Medicaid.
The Kennewick Public Hospital District Board heard during a presentation Thursday on emergency room use that about 40 percent of Medicaid clients visited an emergency room during the past year. About 18 percent of people with private insurance used an ER.
Susan Campbell, a nursing instructor at Washington State University Tri-Cities, told the Herald that the team was surprised to learn when it started collecting data that a number of people who have commercial health insurance are frequent users of emergency rooms for non-emergency needs.
"It may simply be convenience," Campbell said.
Baynes noted that local urgent care centers close before 9 p.m., and many ambulance calls come later. He speculated that people may be calling for ambulances or visiting emergency rooms because there's no other option during certain hours.
"I'm not sure why they don't go earlier. Maybe they think the ER is better," he said.
Carol Moser, director of the Benton Franklin Community Health Alliance, said another factor may be an insufficient number of primary care physicians in the two counties.
According to health rankings released by the state earlier this year, Benton County has one primary care doctor for every 911 residents, while Franklin County has one for every 1,702. The state average is one primary care doctor for every 736 residents, while the national benchmark is one for every 631 residents.
Campbell said part of the solution is re-thinking what it means to have access to health care.
"In the future, we can't think of health access as just a doctor's office," she said.
Substance abuse also is an issue as people come into emergency rooms seeking prescriptions for narcotic pain drugs. To combat that problem, KGH, Kadlec Regional Medical Center in Richland and Lourdes Medical Center in Pasco are collaborating on a program paid for through a grant by the Centers for Disease Control to track prescription drug addicts who go from hospital to hospital looking for narcotics.
Local hospitals also are participating -- along with every hospital in the state -- in a program with the state to apply seven strategies designed to reduce unnecessary emergency room visits.
The strategies include participating in an electronic case management network that allows emergency rooms to identify frequent users and formulate a care plan along with a primary care doctor to ensure they get consistent care to help reduce their emergency rooms visits.
The hospitals, along with the local team, also are working on a community education component that includes a brochure outlining when to go to a doctor's office versus an urgent care clinic or an emergency room, and a card with phone numbers and addresses for local clinics and urgent care centers.
Moser said the team is working on getting the brochure and card distributed to Tri-Citians in their utility bills.
"Just getting the message out to the community is a start," Moser said.