Why patients are flooding the ER—and what’s driving the surge?

In the United States, emergency rooms see nearly 140 million visits every year.^[] Americans visit the ER for all sorts of issues, from mild injuries and illnesses to life-threatening complications. 

A new report has found that a significant number of patients could have avoided the emergency room by visiting their primary care physician (PCP) instead. According to the findings, which were shared by the Canadian Institute for Health Information (CIHI), roughly 15% of ER visits to Canadian emergency rooms could have been handled by a PCP—and over half of these visits were for conditions that could have been treated via telehealth.^[]

Jared L. Ross, MD, a board-certified emergency medicine physician and assistant professor at the University of Missouri, suspects that this percentage is even higher—at least in the United States.

The causes for these visits vary, depending on the time of year, geographic location, and patient population, according to Dr. Ross. That said, there are certain health issues that, year after year, account for most ER visits. Here are five of them. 

Abdominal pain

Abdominal pain is frequently cited as the top complaint in ER rooms around the world. Recent estimates suggest that these symptoms account for roughly 5% to 10% of all ER visits.^[] 

According to James Lyons, MD, an emergency room doctor and medical consultant at Synergy Houses, the reasons for abdominal pain may range from mild gastrointestinal issues to more urgent conditions like appendicitis or gallbladder problems. They may also be related to a severe condition such as an aortic aneurysm or ectopic pregnancy, research shows.^[]

Traumatic injuries

“Injuries, like fractures or deep cuts, often come from falls or accidents and need immediate attention to prevent complications or ensure proper healing,” Dr. Lyons says.

Seasonal sickness

Upper respiratory symptoms tend to spike during the winter. As seasonal diseases like influenza, COVID, and respiratory syncytial virus spread, more people show up at the ER with coughs, congestion, and fevers. Data from the Department of Health and Human Services shows that people frequently present with an upper respiratory infection, acute pharyngitis, and streptococcal pharyngitis.^[]

Chest pain

Finally, people experiencing chest pain and shortness of breath are often sent to the ER by their primary care physician, Dr. Lyons notes. According to the American Heart Association, chest pain accounts for over 6.5 million ER visits every year.^[]

Chest pain is always taken seriously in the ER, as it can be a sign of a life-threatening health issue such as a heart attack or pulmonary embolism—or it may be related to a minor problem such as acid reflux or a muscle strain.

The fastest-growing cause of ER visits? Mental health issues

The fastest-growing cause of ER visits? Mental health issues. These issues typically include mood disorders, such as anxiety, along with suicidal ideation and drug overdoses, according to research from the Centers for Disease Control and Prevention.^[]

For patients without health insurance, the ER can be an appealing option. “The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 does not allow ERs to ask for payment prior to a patient visit, even if it isn’t an emergency,” Dr. Ross notes. 

In addition, ER departments are accessible around-the-clock, unlike primary care offices and some urgent care clinics. “This strains emergency services, leading to longer wait times and making prioritizing life-threatening cases harder,” says James Lyons, MD, an emergency room doctor and medical consultant at Synergy Houses.