Otolaryngology in the ED

Dr. McGowan also noted that we live in a society that is often unwilling to wait for results, and EDs have a streamlined system to obtain diagnostic studies. “Patients may have to wait to be seen, but they don’t have to wait weeks for an appointment or to get an imaging study or laboratory result,” she said.

Hearing loss is not well-evaluated in the ED, because no audiologic facility exists there and, typically, not even a tuning fork is available. —Sujana S. Chandrasekhar, MD

Reducing Non-Urgent Visits

Despite overcrowding and non-emergent visits, emergency physicians wouldn’t want to discourage patients from coming to the ED. “The American College of Emergency Physicians states that if a prudent layperson could reasonably be concerned that an emergency exists, they deserve the right to be seen in the ED and have that visit covered by their health insurance as an emergency department visit,” Dr. McGowan said.

That being said, “Increased access to primary care after hours and on weekends decreases the number of patients seeking care in the ED,” Dr. McGowan said. “While urgent care centers can be a great option, they are staffed with physicians from various backgrounds, and many are not trained in emergency medicine.”

Dr. Chandrasekhar believes that educating primary care providers as well as patients on what constitutes a true otolaryngology emergency could help lower the number of non-urgent visits to the ED. The AAO-HNSF does this by including ED representation on pertinent clinical practice guidelines (CPGs). “Of 16 CPGs in publication or in development at the AAO-HNSF, four (i.e., sudden hearing loss, Bell’s palsy, benign paroxysmal positional vertigo, and evaluation of the neck mass in adults) have an emergency physician on the guideline development group (GDG),” she reports. “Every member of the GDG has an equal voice and equal writing responsibilities for each CPG.”

The AAO-HNSF also partners with the American Board of Internal Medicine Foundation to participate in its Choosing Wisely campaign, which promotes conversations among clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. “This helps them to be able to fully participate in their healthcare decisions,” Dr. Chandrasekhar said.

Despite the low number of patients using the ED for true otologic emergencies, emergency physicians feel that it is their duty to accommodate all patients. While there are ways to deter ED visits, such as education and increasing access to primary care, some emergent cases do indeed exist.