Emergency department visits are on the rise according to a survey conducted by the American College of Emergency Physicians (ACEP). The ACEP collected responses from more than 1,800 emergency room physicians, and 46% of those respondents say they have seen an increase in emergency patient volumes since January 1, 2014. This is a curious result considering the Affordable Care Act’s healthcare coverage mandate went into effect at the start of this calendar year. Increasing the number of insured Americans was supposed to provide citizens better access to primary care services and decrease their reliance on the ED. However, healthcare coverage is no longer the only barrier between patients and primary care providers. The United States has a shortage of primary care physicians, and there are not enough providers to meet the exceeding demand for primary care services. Many providers are not accepting new patients, and most are not accepting new Medicaid patients. Without access to primary care, Medicaid patients have few options other than the ED. Prior to the ACA, studies showed that Medicaid patients were among the most frequent ED users. Increasing Medicaid enrollment could actually have the reverse effect on ED volume because patients who are newly covered may be more likely to use the ED now that they have some sort of coverage. A hospital executive told The Courier Journal that many of the newly insured patients who are coming to the ED have non-emergent conditions that could be better treated at a lower level of care. A possible solution to the increase in ED patients, particularly those with non-emergent conditions, could be establishing a fast track unit in the ED. Fast track units treat patients with minor conditions that might otherwise be managed in a primary care setting, such as minor viral infections, superficial wounds, minor allergic reactions, broken bones, animal bites, and minor burns. Even before the ACA, it was estimated that 60%-80% of patients who present to the ED do so for non-emergent or even minor health problems. Non-physician providers such as nurse practitioners and physician assistants typically staff fast track units. In fact, an Australian study that found ED patient flow improved when nurse practitioners were utilized to see non-emergent cases because it allowed physicians to focus on more complex cases. Here at Barton Associates, our team has placed emergency medicine nurse practitioners and physician assistants in several fast-track units. If you are an ED manager looking for fast track coverage, or an NP or PA looking for a locum tenens assignment in a fast track unit, contact us today!