emergency room hospital visits

When to Visit the ER

Unsure when to visit the ER? Learn about common signs and symptoms that indicate you should seek emergency care.

This article is based on reporting that features expert sources.

Getty Images

It's 2 a.m., and you wake up with a terrible pain in your lower back . It's 5 p.m. on a Sunday afternoon, and you suddenly feel extremely nauseous. It's 9 a.m. on a Wednesday morning, and the cough that's been bothering you suddenly seems to take a turn for the worse. What should you do?

Depending on the severity of the problem and your overall health, the answer to that question may be to head to the emergency room – a unit within your local hospital that handles all manner of emergent medical issues.

“ER providers are able to very quickly assess and treat sudden, serious and often life-threatening health issues,” explains Dr. Sameer Amin, chief medical officer with L.A. Care Health Plan, the largest publicly operated health plan in the country that serves nearly 2.9 million members.

The ER, also known as the emergency department, is open 24/7 and can handle a wide range of illnesses, including physical and psychiatric issues, adds Patrick Cassell, patient care administration, emergency services, with Orlando Health in Florida.

Some ERs are Level 1 trauma centers that can handle “very high-level stuff,” he explains, while others, such as those in a community hospital or more rural settings, might need to transfer patients to a larger facility. These transfers happen when the acuity (severity) of the need exceeds the hospital's capacity to care for the patient on-site.

Common Reasons to Visit the ER

So, what constitutes an emergency?

“For us, an emergency is what the patient thinks is an emergency,” Cassell says. “It’s something that we don’t get judge-y about.”

According to a report from the Healthcare Cost and Utilization Project at the Agency for Healthcare Research and Quality, in 2018 (the most recent year data was available), U.S. residents made 143.5 million emergency room visits. Circulatory and digestive system conditions were the most common reasons for an emergency room visit, and 14% of those seen in the ER were admitted to the hospital .

Some common reasons to visit the ER include:

• Chest pains .
• Shortness of breath or difficulty breathing.
• Abdominal pain, which may be a sign of appendicitis , bowel obstruction, food poisoning or ulcers .
• Uncontrollable nausea or vomiting.
• COVID-19, influenza and other respiratory infections .
• Severe headaches .
• Weakness or numbness.
• Complications during pregnancy .
• Injuries, such as broken bones, sprains, cuts or open wounds.
• Urinary tract infections .
• Dizziness, hallucinations and fainting .
• Mental health disorders or suicide attempts.
• Substance use disorders.
• Back pain .
• Skin infections, rashes or lesions on the skin.
• Foreign object stuck inside the body.
• Tooth aches .

When to Seek Urgent Care Instead of the ER

If you're questioning where to seek care, you should opt for the emergency room if you might have a potentially serious condition or are in severe pain, advises Dr. Brian Lee, medical director of the Emergency Care Center at Providence St. Joseph Hospital in Orange, California.

However, if you’re having a medical issue that’s not a full-blown emergency, but your primary care provider can’t get you in for an appointment, that’s a good time to head to an urgent care provider.

“Urgent care clinics are best equipped for a less dire level of care,” Amin explains. “They fill the gaps when the health concern will not require a hospital stay but still needs immediate treatment.”

Deciding between the ER and urgent care also depends on your medical history, notes Dr. Christopher E. San Miguel, clinical assistant professor of emergency medicine with the Ohio State University Wexner Medical Center in Columbus. For example, most people with a cough and a low-grade fever can be treated at an urgent care clinic without difficulty.

“If, however, you have a history of a lung transplant, you should probably be seen for your cough and fever at an ED,” he recommends.

Because urgent care centers typically offer less robust interventions than what you’d find at the emergency room, they can’t help in all situations. They can, however, refer you to a local ER if you do require more intensive care. They also tend to have a lower deductible than the ER, “and if you’re paying out of pocket, urgent cares can be cheaper than an emergency department typically,” Cassell says.

Cost of Urgent Care vs. ER

On the cost front, San Miguel says there are a few factors to be aware of, particularly if funds are an issue.

“Urgent cares are like any other outpatient health care office – they can require payment up front and decline to see patients who are unable to pay,” San Miguel explains.

Emergency departments, however, are compelled by federal law – the Emergency Medical Treatment & Labor Act, which was enacted in 1986 – to see patients and assess them for “life- or limb-threatening illness and injuries regardless of their ability to pay,” he says.

While this means that the ER must see you, they can “decline to treat non-life-threatening problems once they determine that they are non-life-threatening,” San Miguel adds.

You won’t be charged a fee upfront to be seen in the emergency room, but the hospital can and will bill you after you’ve been discharged.

When you accept treatment at the emergency department, “you’re still ultimately accepting responsibility for the bill ,” San Miguel points out. “And because of the nature of providing a 24-hour service that is prepared to handle any emergency, the cost of care in the ED is much higher than the cost in an urgent care.”

If you find yourself in a situation where you’ve received emergency care but are unable to pay, you should call the billing office as soon as possible to talk about your options.

“Often the bill will be reduced and you’ll be placed on a reasonable payment plan,” San Miguel says.

For any non-urgent or ongoing health concerns, visit with your primary care provider, Amin adds.

“It’s always better to have longstanding issues taken care of in a calm and collected manner during normal business hours,” he explains.

How Long Is the Wait at an ER?

Before you arrive, consider that you could be in for a long wait, depending on the type of problem you’re having and the situation inside the ER.

“We don’t operate on a first-come, first-served basis. It’s based on how sick you are,” Cassell explains.

For instance, he says, patients with more severe illnesses, such as a suspected heart attack or stroke , will take precedence over less severe problems, such as a sprain or an earache .

Even though you may walk in and find an empty waiting room and assume you’ll be seen quickly, there could be all sorts of activity going on behind the scenes. Especially in larger ERs, ambulances may be arriving with sick patients or the ER may already be very busy with sicker patients. You will get the same triage if you come by ambulance or walk in to the ER.

So rest assured that if you are very sick, you will get brought back immediately if you walk into ER. Similarly, if you take an ambulance for broken toe, it wont get you in sooner. You will likely be placed in waiting room if ER full.

San Miguel adds, “The best thing you can do is to let the triage/registration team know if there has been a change in your symptoms while you are waiting. For instance, if your chest pain is getting worse or if you are now having trouble breathing, this should prompt the team to reassess you and make sure you are triaged appropriately.”

What Should You Do While You're Waiting to Be Seen?

While you’re waiting, Amin recommends considering what the provider will ask you, such as:

• When did symptoms start?
• How long have they been going on for? Have they changed in severity or frequency?
• Are symptoms related to a health issue you’re being treated for?
• What triggered your visit to the ER today?

You should also bring a list of your medications, health conditions and history, such as chronic conditions and previous surgeries. It's also a good idea to have the names of the providers on your care team, including your primary care doctor and any specialist. Having this information at the ready is especially helpful if you’re headed to an ER that’s outside of the health system you typically use.

“It’s immensely valuable if patients are able to provide us with an accurate history of their medical problems and current medications,” San Miguel notes. “Unfortunately, not all electronic health systems communicate with each other, and in the middle of the night, it can be impossible to request records from another hospital.”

What Happens When You See an ER Provider

When you are brought in to see a provider, the initial aim of the interaction is to assess what’s going on and make sure you’re stabilized.

For some patients, a "big point of frustration is the need to tell their symptoms to more than one person," San Miguel says. "It seems like we’re quite unorganized and not communicating with each other, but in reality, we just know that the patients themselves are the best source of information about their own symptoms.”

As the physician, San Miguel always reads the notes that come from the initial intake, “but I want to confirm the details directly with you.”

While you will receive some care on the spot, most of your treatment will take place elsewhere, Cassel adds.

“With the exception of putting in stitches to fix a cut, the emergency department is not in and of itself a definitive care spot. Definitive care takes place outside of the ED,” he says.

This means that once the care team determines what’s going on and what care you need, you’ll either be admitted to the hospital for more intensive treatment or sent home with care instructions and a plan for additional follow-up if necessary.

For example, if you are having a heart attack , you’ll be admitted to an inpatient unit in the hospital for more testing and stabilization. If you’ve come in for an earache, you’ll probably be given a prescription and sent home. You'll then use those medications and recover with instructions to follow up with your primary care provider as soon as they can see you.

Lee underscores that “emergency and urgent care is not complete care. It is an acute intervention that addresses specific issues that often require further attention in the ambulatory office setting.”

Lastly, remember that the providers you’re working with are doing their best to look after you in a timely, helpful fashion. The ER staff understand you have been waiting, but they have no control over how many patients show up at once. If a surge of patients show up in an hour, the ER doesn't have the ability to suddenly bring on more staff. This happens more frequently than people realize.

Cassell says that the people who staff the emergency department are there “because we love it. We are task-focused, and we’re often very busy going from place to place, but we really do care.”

Keep in mind that the ER is not generally a calm place and the patient experience will be different from what you might get if you’re admitted in the hospital.

What to Pack in Your Hospital Bag

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our  editorial guidelines .

Amin is chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S.

Cassell is patient care administrator, emergency services, with Orlando Health in Florida.

Lee is medical director of the Emergency Care Center at Providence St. Joseph Hospital in Orange, California.

San Miguel is clinical assistant professor of emergency medicine with the Ohio State University Wexner Medical Center in Columbus.

Tags: health , patients , patient advice , hospitals

Most Popular

Patient Advice

health disclaimer »

Disclaimer and a note about your health ».

Your Health

A guide to nutrition and wellness from the health team at U.S. News & World Report.

You May Also Like

How to find the best spinal surgeon.

Elaine K. Howley May 6, 2024

Finding the Best Orthopedic Surgeon

Elaine K. Howley May 3, 2024

Does Medicare Cover Ozempic?

Paul Wynn May 2, 2024

Is Mifepristone Safe?

Payton Sy May 1, 2024

Health Screening Tests Women Should Have

Angela Haupt and Gretel Schueller May 1, 2024

Doctors That Women Should See

Vanessa Caceres and Gretel Schueller May 1, 2024

How to Find the Best OB-GYN for You

Elaine K. Howley and Gretel Schueller May 1, 2024

Early Miscarriage Symptoms

Claire Wolters April 30, 2024

11 Tips for Your First Mammogram

Elaine K. Howley April 29, 2024

Osteoporosis, Osteoarthritis, Osteopenia

Payton Sy April 29, 2024

What to expect at the ER: A guide to navigating the emergency room

• Your ER experience and wait time will depend on the severity of your condition. 
• Reasons to go to the ER might be excessive bleeding, a high fever, a seizure, or chest pains. 
• If you need to see a doctor immediately, but it's not an emergency, urgent-care is another option. 

When you or a loved one arrives at an emergency room (ER) in the US, you should expect to have a nurse briefly assess you shortly after arrival. The nurse will determine the severity of your condition, which will determine your wait time. If you're in serious condition, you may be brought by paramedics or EMTs and be taken directly to a trauma ward, or seen by a doctor immediately depending on your condition. 

People in the ER are treated in order of how sick they are, says Eric Chu , MD, an emergency medicine physician at the University of Connecticut School of Medicine.

"For example, if you are brought in after having a cardiac arrest, you will be taken to the resuscitation bay where you will be seen immediately. In other cases, you may walk into the waiting room, be assessed by a nurse, and then depending on your acuity, have to wait until a room is open for you," says Chu. 

Average wait times in the ER can range from 25 to 50 minutes , depending on how busy the hospital is. "I think the biggest factor on how long it'll take to be seen in the ER is where you live and which hospital you go to. I have seen patients wait six hours just to be put into a room. It also depends on what time and which day you go. Mondays are notorious for being the busiest day of the week and the weekends are usually the least," says Chu. 

Here are some instances when you might need to go to an ER, and what you can expect once you're there. 

What to expect at the ER

When you arrive at the ER, a trained emergency nurse will assess your condition and determine the urgency of your situation; this process is referred to as " triage ."

While you're waiting to see a doctor, you may be x-rayed, given medications for your symptoms, or be asked to provide blood or other samples, according to Chu. 

"You will be seen by a doctor, physician assistant, or nurse practitioner when you are moved to a room. Treatment or further tests may be done at this time. Consultants, including cardiologists, nephrologists, or neurologists, may also be involved in your care, if required. Then, depending on how sick you are, you may be discharged or admitted to the hospital," says Chu.

When should you go to the ER?

As the name suggests, an ER is essentially for emergencies that could be fatal or cause permanent disability. 

You may also need to go to the ER if you or a loved one have been in an accident or have experienced trauma and require immediate attention.

On the other hand, if you're feeling unwell and need to see a doctor immediately, but it's not an emergency, you can go to your primary care doctor if they have a same-day opening or go to an urgent-care clinic . 

Many urgent care clinics are open every day, and you can get treated faster and for a substantially lower cost than at an ER. If your symptoms are mild and you can wait a day, you can also visit your primary care physician during clinic hours.

What to bring to the ER

If possible, you should try to gather some essentials before you go to the ER, to help the ER physicians understand your medical history and any allergies you might have.  

"Things that are helpful to bring to the ER include your home medication list, the names of your doctors, any paperwork from recent hospital or doctors' visits, and your insurance information (if you have insurance). For example, if you had a recent heart attack, it may be helpful to bring the paperwork from that admission and what medications you have been taking," says Chu. 

You should also try and take a trusted family member or friend along with you to help with paperwork and answer any of the physician's questions, if you are too ill to do so yourself. 

If you're not going to the ER under acute circumstances, Chu recommends bringing a book or a phone charger, since you could be waiting a long time. 

What is the cost of an ER visit?

The cost of your ER visit will depend on the tests conducted, medication and treatment provided, and your health insurance coverage, says Chu. This can vary from hospital to hospital. "One hospital may charge you $30 for a medicine while another may charge you $300," he says. This variation in cost can be due to several factors . For example, larger hospitals, teaching hospitals, or hospitals that provide highly specialized services may charge considerably higher fees.

The average cost of an ER visit is around $1,500 . Sprains, which are among the top causes for ER visits, could cost around $1,100, whereas treating a kidney stone could cost around $3,500. If you have insurance, it may help cover some of this cost, depending on your insurance plan.

Whether your ER visit is covered by insurance can depend on several factors, including whether the hospital or provider are included in the insurance provider's network, says Chu. 

"It can also depend on whether your insurance covers certain costs, like an ambulance ride, for example. An ambulance ride that is not covered by insurance can be quite expensive," says Chu. Ambulance rides can range between $224 and $2,204 per transport. 

Insider's takeaway

You may need to visit the ER for life-threatening situations. The course of your visit can vary quite a bit depending on your condition. While ERs provide necessary and oftentimes lifesaving services, they can involve long wait times and expensive bills, making urgent care or your primary care provider a better option if the situation isn't an emergency. 

Related stories from Health Reference:

• How hypertension, heart disease, and stroke are related
• What causes high blood pressure and how to know if you have hypertension
• How to lower blood pressure with a heart-healthy diet and exercise
• 7 of the most dangerous things that put you at risk of a heart attack
• What is a good resting heart rate, for adults and kids

• Main content

10 Symptoms That Warrant A Trip To The ER

It can be hard to tell when your best bet is to rush to the emergency room.

When you wake up in the middle of the night with an alarming symptom—maybe it's a high fever or splitting headache—it's hard to know whether to rush to the emergency room or not. You don't want to overact, but you definitely don't want to underreact either. So how do you know when that stomach pain needs to be treated ASAP or if that numb feeling can wait until morning to deal with? We spoke to Ryan Stanton, MD, a board-certified emergency physician and spokesman for the American College of Emergency Physicians to find out.

While you may be used to an occasional headache from stress or one too many drinks, certain types of headaches can be cause for more concern. The three most common—and not dangerous—types of headaches are tension, cluster, and migraines , but "there are a couple of characteristics we look for as emergency doctors that tip us off that a headache is more than the average headache," explains Stanton.

Head to the ER if...  the pain is intense and sudden. "Is it the worst headache of your life? Did it come on suddenly like you were struck by lightning or hit in the head with a hammer?" says Stanton. "These are the two major questions we will ask to gauge the risk for a potentially deadly cause of headache known as subarachnoid hemorrhage." A headache is also worrisome if it is accompanied by a fever, neck pain, or stiffness and a rash, which could signal meningitis.

Abdominal Pain

From tummy aches to belly bloat, abdominal pain is the number one non-injury reason for adult emergency room visits, according to the National Hospital Ambulatory Medical Care Survey. The pain can be caused by a number of factors from gas or a pulled muscle to the stomach flu or more serious conditions like appendicitis or urinary tract infections. 

Head to the ER if... you're experiencing intense localized pain, especially in the right lower part of your abdomen or your right upper region, explains Stanton, as this could hint at an issue with your appendix or gallbladder that may require immediate surgery. Other concerning symptoms are abdominal pain accompanied by an inability to keep down any food or fluids; blood in the stool; or a severe and sudden onset of the pain.

With heart attacks as the number one killer for both American men and women, it's no surprise that sudden chest pain can be scary and is one of the leading causes of emergency room visits for adults. "Heart attacks are at the top of the list due to their frequency and potential risk," says Stanton. 

Head to the ER if... you are experiencing chest pain along with shortness of breath, decreased activity tolerance, sweating, or pain that radiates to the neck, jaw, or arms—especially if your age or family history puts you at a higher risk for heart attacks. "This is not a time for the walk-in or urgent care clinic," says Stanton. "They will just take a look and send you to the ER since they don't have the ability to deal with cardiac-related issues."

Infection can run the spectrum from a simple infected skin wound to serious forms such as kidney infections. The vast majority of infections are viral, which means they won't respond to antibiotics and can be treated at home with over-the-counter symptom management until the virus passes. The key then is to look at the severity of the symptoms. "The more severe infections are sepsis (infection throughout the body), pneumonia , meningitis, and infections in people who have weakened immune systems," says Stanton.

Head to the ER... based on the severity of your symptoms. "You want to show up at the ER if there are any concerns, such as confusion, lethargy, low blood pressure , or inability to tolerate any oral fluids," says Stanton. "These may suggest a more sinister infection or may just need a little emergency room TLC, such as medications to help with symptom management, fluids, or possibly antibiotics, to turn the corner."

Blood in your stool or urine

Blood shouldn't ever be found in your stool or urine, so even if your symptoms don't require a trip to the ER, it's important to make an appointment with your physician as soon as possible to determine the source and decide on a treatment plan. "Blood in the urine is usually caused by some kind of infection such as a urinary tract or kidney infection or kidney stones," says Stanton. "When it comes to stool, it's often benign, but it can be the sign of something very dangerous." The number one cause is hemorrhoids followed by fissures, infections, inflammation, ulcers, or cancer. If you have a little blood with no other symptoms, make an appointment to talk with your doctor. 

Head to the ER if... you have large amounts of blood in your stool or urine, or if you have blood in your stool or urine in addition to other symptoms such as a fever, rash or fatigue, intense pain, or evidence of a blockage.

Difficulty Breathing

"Shortness of breath is one of the most common emergency department presentations," says Stanton. The most common causes are asthma, Chronic Obstructive Pulmonary Disease ( COPD ) from smoking or infections such as pneumonia. When it comes to shortness of breath, it's pretty straightforward, says Stanton. "If you can't breathe, get to the ER."

Head to the ER ... always.

Cuts, Bumps & Falls

Whether it's a knife accident chopping veggies for dinner or a misstep off the deck stairs, many cuts, bumps, and bruises can be handled at home with ice or a home first aid kit supplies.

Head to the ER if... what's supposed to be on the inside is on the outside, or what's supposed to be on the outside is on the inside, says Stanton. If you can see muscle, tendons, or bone, it requires more than just a BandAid. "It's important to get these addressed because they are fraught with potential secondary complications from infection to loss of function and ischemia [reduced blood flow]," warns Stanton.

While not pleasant, vomiting is a common symptom that can be caused by various conditions, most often viral gastroenteritis ("stomach flu") or food poisoning. Usually, vomiting can be managed with home care and a check-in with your primary care doctor.

Head to the ER if... there is blood in the vomit, significant stomach pain, or dark green bilious vomit which could suggest bowel obstruction. Another important factor with vomiting is dehydration. "If you are unable to keep anything down, you will need to get medication or treatments to help you stay hydrated," explains Stanton. "Young children can become dehydrated rather quickly, but most healthy adults can go several days before significant dehydration becomes an issue."

"Rarely is a fever anything other than an indication that you are ill," Stanton explains. It's actually a healthy sign that your body is responding to an infection. The concern then is not with the fever itself, but with what infection is causing the fever. Don't hesitate to treat it with over-the-counter medicines such as ibuprofen. 

Head to the ER if... a fever is accompanied by extreme lethargy or there are other symptoms of infection present. Most concerning to Stanton are "fevers in kids with lethargy, fevers in adults with altered mental status, and fevers with headache and neck pain ."

Loss Of Function

Numbness in your legs, slack facial muscles, a loss of bowel control—if a certain body part or body function stops working suddenly or over time, it's worth finding out why. 

Head to the ER... always, recommends Stanton. "Whether it is due to a trauma or just develops over time, any loss of function requires immediate evaluation." The two most common causes are physical trauma and stroke, both of which are serious and require medical attention. "When something is not working, don't try to 'sleep it off'," advises Stanton. "If it doesn't work, there is a reason, and we need to see if we can diagnose, reverse, or prevent ongoing problems."

The bottom line for any symptom: If you truly can't decide what to do, it's better to be safe than sorry. "Any time you have a concern or emergency, it's always better to get checked than to wait until the problem escalates," recommends Stanton.

Other things to consider

While not symptoms, per say, according to the National Institutes of Health , you should always head to the ER if you:

• Inhaled smoke or poisonous fumes
• Consumed a toxic substance or overdosed on a medication or drug
• Possibly broke a bone 
• Are having seizures
• Suffered a serious burn
• Had a severe allergic reaction and are have trouble breathing, swelling, or hives
• Are having suicidal thoughts 

Weird Health Symptoms

8 Signs of a Blood Clot You Should Never Ignore

Your Hormones May Be Why You Can’t Lose Belly Fat

13 Reasons Your Legs Keep Cramping at Night

12 Reasons You Have Swollen Fingers

10 Signs of Acid Reflux Everyone Should Know

Everything You Should Know About Hemorrhoids

8 Things Your Body Hair Says About Your Health

Should I Worry About My Eyes Acting Weird?

How Can I Tell if I Have Nerve Damage?

How to Get Rid of Gas, Pain, and Bloating Fast

9 Lung Cancer Symptoms You Should Never Ignore

QuickStats : Emergency Department Visit Rates,* , † by Age Group — United States, 2019–2020

Weekly / October 21, 2022 / 71(42);1350

Views: Views equals page views plus PDF downloads

* Based on a sample of visits to emergency departments in noninstitutional general and short-stay hospitals, excluding federal, military, and Veterans Administration hospitals, located in 50 states and the District of Columbia. Visit rates are based on sets of estimates of the U.S. civilian, noninstitutionalized population developed by the Population Division of the U.S. Census Bureau and reflect the population as of July 1 of each year.

† With 95% CIs indicated by error bars.

The emergency department (ED) visit rate for infants aged <1 year declined by nearly one half from 123 visits per 100 infants during 2019 to 68 during 2020. The ED visit rate for children and adolescents aged 1–17 years also decreased from 43 to 29 visits per 100 persons during the same period. Decreases among adults aged 18–44 (47 to 43 per 100 adults), 45–74 (41 to 39), and ≥75 years (66 to 63) from 2019 to 2020 were not statistically significant. ED visit rates were highest for infants aged <1 year followed by adults aged ≥75 years.

Source : National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2019–2020.

Reported by : Christopher Cairns, MPH, [email protected] , 301-458-4186; Jill J. Ashman, PhD.

Suggested citation for this article: QuickStats : Emergency Department Visit Rates, by Age Group — United States, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:1350. DOI: http://dx.doi.org/10.15585/mmwr.mm7142a5 .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Hospital and Emergency Services

Goal: prevent hospital visits and improve emergency department and hospital care..

Every year in the United States, there are about 36 million hospital stays. 1   Healthy People 2030 focuses on reducing preventable hospital visits and improving hospital care, including follow-up services.

In the emergency department, timely care is critical for improving health outcomes. People staying in the hospital also need high-quality care to reduce their risk of having complications or developing infections. And many people need follow-up care once they leave the hospital.

Many hospital stays and emergency department visits are preventable. Strategies to connect people to a primary care provider, promote healthy behaviors, and create safe environments are key to reducing hospital visits.

Objective Status

Learn more about objective types

Related Objectives

The following is a sample of objectives related to this topic. Some objectives may include population data.

Hospital and Emergency Services — General

• Chronic Kidney Disease

Drug and Alcohol Use

• Health Care Access and Quality
• Health Care-Associated Infections

Heart Disease and Stroke

Infectious disease, injury prevention, older adults, pregnancy and childbirth, respiratory disease, violence prevention, other topics you may be interested in.

Weiss, A.J., & Elixhauser, A. (2014). Overview of Hospital Stays in the United States, 2012. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf  [PDF - 209 KB]

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

Tips for navigating an emergency department visit: Who you’ll see, what to ask and why it matters

MD (Internal Medicine Resident) & PhD candidate (Focus on Geriatrics), Dalhousie University

Professor of Geriatric Medicine, Dalhousie University

Disclosure statement

Jasmine Mah is an Internal Medicine resident with Nova Scotia Health and receives scholarships supporting her PhD research from the Department of Medicine at Dalhousie University, Dalhousie Medical Research Foundation, Dr. Patrick Madore Foundation, Alzheimer Society of Nova Scotia and the Pierre Elliott Trudeau Foundation. She is part of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations ( www.ccna-ccnv.ca ). The affiliations/funders had no input into any aspect of this subject or article.

Melissa Andrew has received funding from Sanofi, GSK, Merck, Pfizer, Seqirus, Public Health Agency of Canada, Canadian Institutes of Health Research, and the Canadian Frailty Network, unrelated to the present article. She serves as a member of the Alzheimer Society of Nova Scotia Board of Directors and is part of the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations ( www.ccna-ccnv.ca ).

Dalhousie University provides funding as a founding partner of The Conversation CA.

Dalhousie University provides funding as a member of The Conversation CA-FR.

View all partners

The emergency department (ED) can be a stressful and confusing place for individuals who are sick or injured. During the pandemic, with many hospitals not permitting friends or family to accompany ED patients, being alone may exacerbate the uncertainty, fear and anxiety patients may experience about things like waiting times, undergoing tests or medical prognoses.

Research shows that almost half of all patients leave the hospital with a poor understanding of their ED visit . As doctors who see the consequences of poor communication, let us break down what is going on in the ED and give you the knowledge and tools to empower you to have a smoother experience.

The emergency department explained

In the ED, some patients arrive by themselves (or get dropped off by family), some disembark from an ambulance and some are transferred from other hospitals. To decide the order of patient care, clinicians use a decision-making tool called the Canadian Emergency Department Triage and Acuity Scale (CTAS). The CTAS is used instead of a first-come, first-served system.

The CTAS sorts patients based on severity of the illness or injury. A score of 1 suggests an imminent risk of dying or severe disability within minutes without treatment (for example, serious car accident or stroke). A score of 5 suggests that the outcome of the medical issue will not change whether treatment is delivered now or in a few hours.

A patient’s movement around the ED, from waiting location to treatment room to investigation area, is based on the presenting illness and CTAS. Patients wait for the room with the best resources for their condition. For example, a plaster room is the best place to make a cast for a broken ankle, but does not have the heart monitor equipment for diagnosing or treating a heart attack.

These factors help explain why certain patients seem to leave the waiting room faster than others.

People in the ED

The people working in the ED include clinicians such as doctors, nurses and social workers, and non-clinical staff such as clerks, porters and housekeepers. The number and types of staff will depend on the size of hospital. Each team member has a defined role and scope of practice, resulting in a roughly predictable sequence in which patients will see each staff member.

A patient entering the ED usually has their information collected by a clerk first, followed by a preliminary assessment by the triage paramedic or nurse. They may then be seen by another professional for a test or procedure like an X-ray. They may be monitored and treated by a nurse through much of this time, and seen by a physician. Before leaving the ED, a social worker or patient navigator may be seen as well.

Sometimes clinicians come and go over time, depending on whether they are waiting for results of tests or responses to treatment, so visits can differ in length. Recognizing the different roles of each employee, and different timelines, can help patients understand the process of diagnosis and treatment.

Why understanding your ED visit matters

To minimize feelings of being overwhelmed, and improve overall quality of care, patients should understand what happens in the ED. Patients may understand their diagnosis, but often have less comprehension of the followup plan . For example, approximately five to 10 per cent of patients do not fill their ED medications as prescribed and many do not follow up with recommended medical appointments .

This is partially due to a lack of understanding of their ED visit, and results in more returns to the ED and greater likelihood of hospitalization, especially for older adults .

Certain factors put patients at higher risk for leaving the ED without sufficient knowledge. These include hearing or vision challenges, cognitive impairment or altered cognition (for example, from intoxication or severe illness), speaking a primary language different than the one spoken in the ED, as well as having difficulty reading or a lack of knowledge about the health-care system or health issues .

What you can do

While the health care system needs to do its part to improve the ED experience and clearly communicate, there are evidence-based strategies that can empower patients in their own care.

• Have a list of your medications, allergies and medical conditions on hand, saved on a phone or in a wallet. It is beneficial to be as prepared as possible. Think about the questions you want to ask: What is the goal of the visit? Who will help you keep track of the recommendations? Preparing in advance can speed up the process and provide information to the health-care team.

For older people, those with mobility or sensory challenges and those who are very unwell, a family member of caregiver may call the hospital and ask to speak to a nurse or doctor to relay or receive this information if their loved one is unable to do so.

On discharge, the patient should ask for clear written instructions. Short, concise and in plain language is preferred over long medical summaries. Written is generally better than verbal instructions .

Repeat the discharge and followup instructions with the nurse or physician to check for accuracy. If the information and next steps are overwhelming, ask to speak to a discharge planning nurse or care navigator who can help smooth the transition from ED to home.

If the patient and/or loved ones see barriers to being able to follow through with a suggested care plan (such as an inability to afford medication, get to a pharmacy or swallow pills), these barriers should be brought to the ED team’s attention. It is better to address these proactively than to leave a condition under-treated.

If you are not feeling better, or are getting worse, return to the ED. Ask about return precautions: symptoms to watch for that should prompt a return to the ED. Going back may give ED staff a chance to see your symptoms at a different stage, which may result in a different course of action.

In terms of what to ask, research has shown that it’s helpful for patients to record a few important points:

• Date of ED visit and main diagnosis
• Medication details (dose, purpose and how long to take)
• Any doctors to follow up with, when and how to contact
• Symptoms that should lead to immediate return to the ED

Being knowledgeable and prepared to self-advocate can not only make the next ED visit easier and less stressful for you or your loved one, but can also help ensure you leave with the information you need.

• Emergency departments
• Health-care system
• Medical test
• Emergency room care
• Medical emergencies

Scheduling Analyst

Assistant Editor - 1 year cadetship

Executive Dean, Faculty of Health

Lecturer/Senior Lecturer, Earth System Science (School of Science)

Sydney Horizon Educators (Identified)

• Find a Doctor
• Patients & Visitors
• ER Wait Times
• For Medical Professionals
• Piedmont MyChart

• Medical Professionals
• Find Doctors
• Find Locations

Receive helpful health tips, health news, recipes and more right to your inbox.

Sign up to receive the Living Real Change Newsletter

What to expect in the emergency department

“The emergency department is an area in the hospital where we can quickly assess patients, make them better, or decide they’re going to need additional testing or management and admit them to the hospital,” says Jeffrey Oyler, M.D. , an emergency medicine physician at Piedmont Atlanta Hospital .

Every patient who visits the emergency department (ED) will go through triage, which allows the ED team to establish the severity of that person’s condition. Triage takes into account the patient’s vital signs, as well as his or her complaint. Dr. Oyler says measuring the patient’s vital signs is the most crucial component of triage because these signs are essential to assessing the patient and are something that cannot be faked. The patient is then categorized based on the Emergency Severity Index:

• Level 1 – Immediate: life-threatening
• Level 2 – Emergency: could be life-threatening
• Level 3 – Urgent: not life-threatening
• Level 4 – Semi-urgent: not life-threatening
• Level 5 – Non-urgent: needs treatment as time permits

“It’s hugely important for us to establish who is the sickest, so we can provide the interventional care they need immediately, then work our way down the list as fast as we can,” says Dr. Oyler. Based on the assessment by the triage nurse, the patient will either be:

• Taken to an exam room. If all rooms are full, that person will be next in line for a room. Dr. Oyler emphasizes that patients are not seen in the order of arrival, but based on the severity of their condition.
• Offered a fast-track service. The fast track does not have all of the capabilities of the emergency department, but is intended to help patients with minor emergencies get through the system. People in the waiting room may see other patients with minor injuries being called back before those with more serious injuries, but they are actually being treated in the fast-track area, Dr. Oyler explains.

Behind the waiting room doors

“A quiet waiting room is something we ideally love to have, but it is not a reflection of what is going on in the back,” says Dr. Oyler. “You can have one person or 20 people in your waiting room, but you could have complete chaos in the back with very, very sick patients.” Although the ED waiting room may not seem busy, the behind-the-scenes ambulance bay can bring in patients at all hours of the day. “You can have an incredibly long wait in our emergency department if you show up with a non-life-threatening condition that could have waited for treatment at your primary care physician’s office the next day,” he says. “We are sensitive to the fact that you are waiting,” says Dr. Oyler. “We want you to get back to a room and be seen as fast as possible, but we’re also prioritizing care for people who absolutely have to have it right then and there.” Dr. Oyler stresses the importance of patience if your illness or injury is not life-threatening. “We know you’re suffering and it’s not what we desire, but when your time comes, you’re going to get the service you wanted.” If your condition is not an emergency, you can save time and money by visiting an urgent care center or your primary care physician’s office. Insurance co-pays are usually more expensive at the emergency department compared to co-pays at other facilities. For more information on emergency services throughout the Piedmont system, visit our locations map to choose an emergency room near you .

Need to make an appointment with a Piedmont physician? Save time,  book online .

• emergency department
• Emergency Medicine
• Jeffrey Oyler
• urgent care

Related Stories

Schedule your appointment online

Schedule with our online booking tool

*We have detected that you are using an unsupported or outdated browser. An update is not required, but for best search experience we strongly recommend updating to the latest version of Chrome, Firefox, Safari, or Internet Explorer 11+

Share this story

Download the Piedmont Now app

• Indoor Hospital Navigation
• Find & Save Physicians
• Online Scheduling

Download the app today!

Know where to go: How to choose between the doctor’s office, urgent care and the ER

When you’re feeling sick or are injured, there are several places you can go for medical care: a doctor’s office, an urgent care center, a retail health clinic or the emergency room. Here’s a quick guide to help you know where to go, based on the urgency of your ailment and your budget. BCBS members can can visit the Blue Cross Blue Shield Provider Finder  to find in-network providers. This includes doctors, dentists, hospitals, urgent care centers, and more. You can also log into your local BCBS company's site . 

The Doctor’s Office Is Your First Option for Non-Emergencies

Your primary care doctor should be your first call in non-emergency situations. Your doctor knows you and your health history, including what medications you are taking and what chronic conditions might need to be considered in your treatment. Plus, the co-pay for a visit to your doctor’s office will cost far less than a trip to the emergency room. This option can also help you avoid the long wait times typically found in an emergency room. Even if your doctor is unavailable or not an expert in the area of care you need, he or she can refer you to a specialist or another medical professional.

If you don’t have a primary care doctor, take some time to review the options in your network and select one. If you are a BCBS member, you can use the Blue Cross Blue Shield Provider Finder  to help your research. You can also read our  tips on how to choose a doctor that’s right for you .

Urgent Care Centers and Retail Health Clinics Offer Affordable Alternatives

If you can’t reach your doctor or need care outside of regular office hours, urgent care centers and retail health clinics are good options. Retail health clinics are walk-in clinics found in many large pharmacies and retail stores. They are staffed by nurse practitioners and physician assistants and are designed to treat simple conditions, like cold and flu, ear infections and skin conditions. Urgent care centers have physicians on staff and can provide care for a greater range of conditions, including performing x-rays.

In most cases, the out-of-pocket cost for visiting a retail health clinic or urgent care center will cost less than a trip to the emergency room, but it’s always a good idea to check to make sure the location you select is covered by your plan. BCBS members can use the Blue Cross Blue Shield Provider Finder  to locate in-network facilities. You can find a list of the urgent care centers in your network on your Blue Cross Blue Shield (BCBS) company’s website , or by calling the 1-800 number on the back of your member ID card.

24-Hour Nurse Lines Provide Phone Consultations

Many BCBS companies also offer a 24-hour nurse line , which you can call any time with questions about your symptoms, complications from medication or advice on when to go to the doctor or emergency room. Check the back of your member ID card or your local BCBS company’s website for more information.

Emergency Rooms Treat Serious Issues

Emergency rooms are designed to treat urgent, acute and life threatening conditions and aren’t the place for routine care or minor ailments. If you feel you are dealing with a health emergency, call 911 or go to the emergency room right away. Otherwise, one of the above options will save you time and money, and clear the way for patients in need of emergency treatment. BCBS members can use the Blue Cross Blue Shield Provider Finder  to find nearby emergency rooms. 

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.

• Skip to main content
• Skip to header right navigation
• Skip to site footer
• Pricing Transparency

Beaumont Emergency Hospital

24-Hour Emergency Room - Beaumont, Texas

Ten Common ER Visits

Visiting the emergency room is not a pleasant experience for the vast majority of people. Between the long wait and the condition they are in, emergency room visits can be highly uncomfortable. Approximately 124 million people visit the ER each year, out of which 42 million of those people visit with injury-related problems. Today we’ll list the top 10 most common ER visits and what these symptoms could indicate.

10. Chest Pains

Chest pains are one of the most common reasons why people visit the ER. Cardiac arrest situations are common in the ER and although chest pain visits are declining in recent years, still nearly half a million people die each year due to heart complications.

9. Abdominal Pains

Around 2000 people visit the ER every single day due to abdominal pains. Most likely, bacterial and viral infections are the cause of abdominal pains. The culprit of abdominal pains can be a factor to several different diagnoses.

• Food Poisoining/Allergies
• Kidney Stones
• Stomach Virus
• Appendicitis
• Irritable Bowel Syndrome

8. Toothaches

Most people will not relate tooth-related issues with the ER, but an increasing number of people are pursuing emergency treatments when dentist offices are closed. The majority of patients report abscesses, and gum tissues problems.

7. Broken Bones and Sprains

Broken bones and sprains are a common occurrence that can happen to any individual regardless of their age or condition. They can be caused due to accidents or twisting an area of the body while playing sports or other physical activities. Not all sprains require ER treatment although broken bones need to be looked at immediately, particularly if they pose a risk to other organs. Some key ways to determine if the injury needs medical attention are:

• Discoloration
• Visible bone

 6. Upper Respiratory Infections

Infections and viruses are another common cause of people visiting the ER. The flu and common cold are fairly widespread diseases and unlike other illnesses, may require emergency treatment in severe cases.

5. Contusions and Cuts

Cuts and contusions are one of the most common reasons why people visit the ER. They can occur through any activity and often require urgent emergency attention. The majority of cuts and contusions are due to accidents with a glass or a knife and in case of severe bleeding, a trip to the ER becomes necessary.

4. Back Pain

Another increasing reason for visiting the ER is due to back related issues. Back pains or muscle strains in the back can be due to an accident or physical injuries while playing sports or by lifting heavy things. It was regarded as the number one reason for visiting the ER in the past, but the number has declined in recent years.

3. Skin Infections

Skin infections can cause abnormal reactions in the body and in the majority of cases they require urgent emergency care. A skin infection can also bring on other symptoms and can spread rapidly over the body in severe cases. Symptoms may include:

• Nerve damage
• Muscle weakness
• Lesions on the body
• Rashes and blisters

2. Foreign Objects in the Body

Emergency room centers all over the world report that one of the most common ER visits is due to foreign objects inside the body. There aren’t any stats regarding the number of doctors that have to deal with foreign objects but a recent analysis has shown that there are roughly 1,500 deaths per year due to foreign object problems.

1.     Headaches

The number one and the most common ER visit is due to headaches. They are the most common ailments amongst people and it stands to reason that headaches are the most common reason for a person to visit the ER.

• News and Events
• Health Symptoms Index
• Register Online

• Share full article

Advertisement

Supported by

Heat-Related E.R. Visits Rose in 2023, C.D.C. Study Finds

By Noah Weiland

Reporting from Washington

The rate of emergency room visits caused by heat illness increased significantly last year in large swaths of the country compared with the previous five years, according to a study published on Thursday by the Centers for Disease Control and Prevention.

The research, which analyzed visits during the warmer months of the year, offers new insight into the medical consequences of the record-breaking heat recorded across the country in 2023 as sweltering temperatures stretched late into the year.

What the Numbers Say: People in the South were especially affected by serious heat illness.

The researchers used data on emergency room visits from an electronic surveillance program used by states and the federal government to detect the spread of diseases. They compiled the number of heat-related emergency room visits in different regions of the country and compared them to data from the previous five years.

Nearly 120,000 heat-related emergency room visits were recorded in the surveillance program last year, with more than 90 percent of them occurring between May and September, the researchers found.

The highest rate of visits occurred in a region encompassing Arkansas, Louisiana, New Mexico, Oklahoma and Texas. Overall, the study also found that men and people between the ages of 18 and 64 had higher rates of visits.

How It Happens: Heat can be a silent killer, experts and health providers say.

Last year was the warmest on Earth in a century and a half, with the hottest summer on record . Climate scientists have attributed the trend in part to greenhouse gas emissions and their effects on global warming, and they have warned that the timing of a shift in tropical weather patterns last year could foreshadow an even hotter 2024.

Heat illness often occurs gradually over the course of hours, and it can cause major damage to the body’s organs . Early symptoms of heat illness can include fatigue, dehydration, nausea, headache, increased heart rate and muscle spasms.

People do not typically think of themselves as at high risk of succumbing to heat or at greater risk than they once were, causing them to underestimate how a heat wave could lead them to the emergency room, said Kristie L. Ebi, a professor at the University of Washington who is an expert on the health risks of extreme heat.

“The heat you were asked to manage 10 years ago is not the heat you’re being asked to manage today,” she said. One of the first symptoms of heat illness can be confusion, she added, making it harder for someone to respond without help from others.

What Happens Next: States and hospitals are gearing up for another summer of extreme heat.

Dr. Srikanth Paladugu, an epidemiologist at the New Mexico Department of Health, said the state had nearly 450 heat-related emergency room visits in July last year alone and over 900 between April and September, more than double the number recorded during that stretch in 2019.

In preparation for this year’s warmer months, state officials are working to coordinate cooling shelters and areas where people can be splashed by water, Dr. Paladugu said.

Dr. Aneesh Narang, an emergency medicine physician at Banner-University Medical Center in Phoenix, said he often saw roughly half a dozen heat stroke cases a day last summer, including patients with body temperatures of 106 or 107 degrees. Heat illness patients require enormous resources, he added, including ice packs, fans, misters and cooling blankets.

“There’s so much that has to happen in the first few minutes to give that patient a chance for survival,” he said.

Dr. Narang said hospital employees had already begun evaluating protocols and working to ensure that there are enough supplies to contend with the expected number of heat illness patients this year.

“Every year now we’re doing this earlier and earlier,” he said. “We know that the chances are it’s going to be the same or worse.”

Noah Weiland writes about health care for The Times. More about Noah Weiland

Explore Our Weather Coverage

Extreme Weather Maps: Track the possibility of extreme weather in the places that are important to you .

Tornado Alerts: A tornado warning demands instant action. Here’s what to do if one comes your way .

Climate Change: What’s causing global warming? How can we fix it? Our F.A.Q. tackles your climate questions big and small .

Evacuating Pets: When disaster strikes, household pets’ lives are among the most vulnerable. You can avoid the worst by planning ahead .

• Skip to main content
• Keyboard shortcuts for audio player

• Your Health
• Treatments & Tests
• Health Inc.
• Public Health

How do you help patients who show up in the ER 100 times a year?

Leslie Walker

Dan Gorenstein

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money. Douglas Sacha/Getty Images hide caption

The hope was that bringing many other services to people with high needs would stabilize their health problems. While the strategy has succeeded sometimes, it hasn't saved money.

Larry Moore, of Camden, N.J, defied the odds — he snatched his life back from a spiral of destruction. The question is: how?

For more than two years straight, Moore was sick, homeless and close-to-death drunk — on mouthwash, cologne, anything with alcohol, he says. He landed in the hospital 70 times between the fall of 2014 and the summer of 2017.

"I lived in the emergency room," the 56-year-old remembers. "They knew my name." Things got so bad, Moore would wait for the ER nurses to turn their backs so he could grab their hand sanitizer and drink it in the hospital bathroom.

"That's addiction," he says.

Then, in early 2018, something clicked, and turned Moore around. Today, he's more than five-years sober with his own apartment, and he has only needed the ER a handful of times since 2020. He's active in his church and building new relationships with his family.

Moore largely credits the Camden Coalition , a team of nurses, social workers and care coordinators for his transformation. The nonprofit organization seeks out health care's toughest patients — people whose medical and social problems combine to land them in the ER dozens of times a year — and wraps them in a quilt of medical care and social services. For Moore, that meant getting him medical attention, addiction treatment and — this was key for him — a permanent place to live.

"The Camden Coalition, they came and found me because I was really lost," Moore says. "They saved my life."

For two decades, hospitals, health insurers and state Medicaid programs across the country have yearned for a way to transform the health of people like Moore as reliably as a pill lowers cholesterol or an inhaler clears the lungs. In theory, regularly preventing even a few $10,000-hospital-stays a year for these costly repeat customers could both improve the health of marginalized people and save big dollars.

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving. Dan Gorenstein/Tradeoffs hide caption

Larry Moore (left) in 2020 with staff members from the Camden Coalition. The housing and addiction treatment the organization helped him get has been life saving.

But breaking this expensive cycle — particularly for patients whose lives are complicated by social problems like poverty and homelessness — has proved much harder than many health care leaders had hoped. For example, a pair of influential studies published in 2020 and 2023 found that the Coalition's pioneering approach of marrying medical and social services failed to reduce either ER visits or hospital readmissions . Larry Moore is the outlier, not the rule.

"The idea that someone should go to the emergency room 100 times in a year is a sign of deep, deep system dysfunction," says Jeff Brenner, the primary care physician who founded and led the Camden Coalition from 2002 until 2017. "It should be fixable. We're clearly still struggling."

Yet, Brenner and others on the frontlines of one of health care's toughest, priciest problems say they know a lot more today about what works and what misses the mark. Here are four lessons they've learned:

Lesson 1: Each patient needs a tailored, sustained plan. Not a quick fix

The Camden Coalition originally believed that just a few months of extra medical and social support would be enough to reduce the cycle of expensive hospital readmissions. But a 2020 study published in the New England Journal of Medicine found that patients who got about 90 days of help from the Coalition were just as likely to end up back in the hospital as those who did not.

That's because, frontline organizations now realize, in some cases this wraparound approach takes more time to work than early pioneers expected.

"That 80th ER visit may be the moment at which the person feels like they can finally trust us, and they're ready to engage," says Amy Boutwell, president of Collaborative Healthcare Strategies , a firm that helps health systems reduce hospital readmissions. "We do not give up."

Frontline groups have also learned their services must be more targeted, says Allison Hamblin , who heads the nonprofit Center for Health Care Strategies, which helps state Medicaid agencies implement new programs. Organizations have begun to tailor their playbooks so the person with uncontrolled schizophrenia and the person battling addiction receive different sets of services.

Larry Moore, for example, has done fine with a light touch from the Coalition after they helped him secure stable housing. But other clients, like 41-year-old Arthur Brown, who struggles to stay on top of his Type 1 diabetes, need more sustained support. After several years, Coalition community health worker Dottie Scott still attends doctor's visits with Brown and regularly reminds him to take his medications and eat healthy meals.

Aaron Truchil, the Coalition's senior analytics director, likens this shift in treatment to the evolution of cancer care, when researchers realized that what looked like one disease was actually many and each required an individualized treatment.

"We don't yet have treatments for every segment of patient," Truchil says. "But that's where the work ahead lies."

Lesson 2: Invest more in the social safety net

Another expensive truth that this field has helped highlight: America's social safety net is frayed, at best.

The Coalition's original model hinged on the theory that navigating people to existing resources like primary care clinics and shelters would be enough to improve a person's health and simultaneously drive down health spending.

Over the years, some studies have found this kind of coordination can improve people's access to medical care , but fails to stabilize their lives enough to keep them out of the hospital. One reason: People frequently admitted to the hospital often have profound, urgent needs for an array of social services that outstrip local resources.

As a result of this early work, Hamblin says, state and federal officials — and even private insurers — now see social issues like a lack of housing as health problems, and are stepping in to fix them. Health care giants like insurers UnitedHealthcare and Aetna have committed hundreds of millions of dollars to build affordable housing, and private Medicare plans have boosted social services , too. Meanwhile, some states, including New York and California, are earmarking billions of Medicaid dollars to improve their members' social situations, from removing mold in apartments to delivering meals and paying people's rent .

Researchers caution that the evidence so far on the health returns of more socially focused investments is mixed — further proof, they say, that more studies are needed and there's no single solution that works for every patient.

Some health care experts also still question whether doctors and insurers are best positioned to lead these investments, or if policymakers and the social service sector should drive this work instead.

Lesson 3: Recent boom in new programs demands better coordination

This spike in spending has led to a wave of new organizations clamoring to serve this small but complex population, which Hamblin says can create waste in the system and confusion for patients.

"All of these barriers to entry and handoffs don't work for traumatized people," former Coalition CEO Brenner says. "They're now having to form new, trusting relationships with multiple different groups of people."

Streamlining more services under a single organization's roof is one possible solution. Evidence of that trend can be seen in the nationwide growth of clinics called Certified Community Behavioral Health Clinics, These clinics deliver mental health care, addiction treatment and even some primary care in one place.

Brenner, who now serves as CEO of the Jewish Board, a large New York City-based social service agency with a budget of more than $200 million a year, is embracing this integration trend. He says his agency is building out four of that newer type of behavioral health clinic, and offering clients housing on top of addiction treatment and mental health care.

Other groups, including the Camden Coalition, say simply getting neighboring care providers to talk to one another can make all the difference. Coalition head Kathleen Noonan estimates the organization now spends just 25% of its time on direct service work and the rest on quarterbacking, helping to coordinate and improve what she calls the "local ecosystem" of providers.

Lesson 4: Rethink your definition of success, and keep going

Twenty years ago, the goal of the Camden Coalition was to help their medically complex patients stay out of the E.R. and out of the hospital — provide better health care for less cost. Noonan, who took over from Jeff Brenner as CEO of the Coalition, says they've made progress in providing better care, at least in some cases — and that's a success. Saving money has been tougher.

"We certainly don't have quick dollars to save," Noonan says. "We still believe that there's tons of waste and use of the [E.R.] that could be reduced ... but it's going to take a lot longer."

Still, she and others in her field do see a path forward. As they focus on improving their patients' mental and physical health by developing and delivering the right mix of interventions in "the right dose," they believe the cost savings may ultimately follow, as they did in Larry Moore's case.

The stakes are high. Today, homelessness and addiction combined cost the U.S. health care system north of $20 billion a year, wreaking havoc on millions of Americans. As health care delivery has evolved in the last two decades, the question is no longer whether to address people's social needs, but how best to do that.

This story comes from the health policy podcast Tradeoffs . Dan Gorenstein is Tradeoffs' executive editor, and Leslie Walker is a senior reporter/producer for the show, where a version of this story first appeared. Tradeoffs' weekly newsletter brings more reporting on health care in America to your inbox.

• Camden, N.J.
• health costs
• Emergency Room
• emergency room frequent flier

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Header - Callout

In Crisis? Call or Text 988

Preliminary Findings from Drug-Related Emergency Department Visits, 2021

Preliminary Findings from Drug-Related Emergency Department Visits, 2021. An analysis of 2021 preliminary data presents (1) nationally representative weighted estimates for the top five drugs in drug-related ED visits, (2) the assessment of monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals, and (3) the identification of drugs new to DAWN’s Drug Reference Vocabulary.

https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP22-07-03-001.pdf

More Like This

Report resources.

Thanks for visiting! GoodRx is not available outside of the United States. If you are trying to access this site from the United States and believe you have received this message in error, please reach out to [email protected] and let us know.

What Is a Level 5 Emergency Room Visit, and Why Does It Cost So Much?

If you visit the emergency room, your bill will typically include a "ER visit level" line item that’s based on the complexity of your treatment. A Level 5 emergency room visit, or ER visit level 5, is reserved for the most severe cases.

Visit levels range from 1 to 5, from mild to most severe, and most ER visits fall around level 3 or level 4, explains Goodbill lead medical coder, Christine Fries.

A Level 5 emergency room visit charge is reserved for the most severe cases. Most visits fall around level 3 or 4.

Generally speaking, you’re billed for an ER visit level 4 if you get two or fewer diagnostic tests, which can include labs, EKGs or X-rays. Once you get three or more diagnostic tests, you’ll be billed for an ER visit level 5.

‍ Read more ER visit levels here: Why Did My Emergency Room Visit Cost So Much?

But watch out: Hospitals sometimes inflate the leveling on your bill, also known as "upcoding," even if your visit didn’t meet the criteria for that level. The difference in cost between an ER visit level 4 and an ER visit level 5 can be thousands of dollars, she says.

ER visit levels are sometimes inflated on your bill, known as "upcoding." The difference in cost can be thousands of dollars.

"That’s probably the line we see most often stepped over, is they’re billing that ER visit level 5, when it just wasn’t there," Fries told patient advocacy nonprofit Healthcare Reformed in an interview. "With just a single line item flagged as upcoding between an ER visit level 4 and 5, we’ve saved patients over $2,000." 

On your bill, a Level 5 emergency room visit charge may show up differently, depending on the hospital. Here are some common ways it might appear on your bill:

• Level 5 ED visit
• ER visit level 5 / ER visit lvl 5
• ED visit level 5 / ED visit lvl 5

To learn more, listen to Fries' full video interview below.

@christyprn Video quality is down📉, but educational quality is UP. 📈 #healthcare #healthcarereform #medicalbills #hospitalbill #medicaldebt #patientadvocate ♬ original sound - Christy, RN | Advocate

Guides, news, and articles to help you tackle hospital bills.

Why Do ER Visits Cost So Much?

Here are 5 things you need to know about ER visit costs, and how to tell if your bill is correct.

How to Negotiate Your Hospital Bill

Read our expert tips on how to negotiate your hospital bill to save up to thousands of dollars.

Can Hospital Bills Affect My Credit?

You have time before your bill can go to collections or affect your credit.

Building trust and confidence into every health care transaction.

© 2022  Goodbill, Inc.

• Un common compassion
• Un wavering dedication
• Un breakable resolve

• Find a Provider

Featured Services

Specialty services.

• < Back Locations
• VCU Medical Center (Downtown Richmond)
• Children's Hospital of Richmond at VCU
• Community Memorial
• VCU Massey Comprehensive Cancer Center
• Pauley Heart Center
• Search VCU Health
• VCU Health Home
• Medical Services

Find a Location

Request an Appointment

• Refer your Patient

Patients & Visitors

VCU Health MyChart

Pay My Bill

For Your Health

Hospitals & care centers.

• VCU Health Community Memorial Hospital
• VCU Health Tappahannock Hospital

Comprehensive Care Centers

• Hume-Lee Transplant Center
• Neurosciences

Research & Clinical Trials

Health professionals, vcu health sciences: education.

How can we help you today?

General Information

1-800-762-6161

Get Directions with VCU Health Way Finder

COVID-19 Information

EpicCare Link

Traffic Updates

Traffic updates at our MCV Campus

What can we help you find?

Popular search terms.

• Medical Records
• Our Services

Related Search Terms

Related search results, providers ( 0 ), locations ( 0 ), classes & events ( 0 ), providers by specialty ( 0 ), suggested terms, news center.

• COVID-19 Vaccine
• Sign up for COVID-19 and Vaccine Updates
• COVID-19 Symptom Checker
• Latest News
• In The Media
• Inspiring Stories
• News Releases
• Health and Wellness
• Removing obstacles facing our community
• Helping our communities during COVID-19
• Creating opportunities in our workforce
• Research on health disparities
• For Journalists
• Search Our News

One year of emergency, trauma and inpatient care for kids in the Children’s Tower

Children’s hospital of richmond at vcu celebrates the first anniversary of its new facility opening..

4/30/2024 12:00:00 AM

By Kate Marino

Today marks the first birthday of Children’s Hospital of Richmond at VCU’s Children’s Tower . Patients moved from the pediatric floor of VCU Medical Center into the 16-story, completely kid-focused Children’s Tower on April 30, 2023. “Building a comprehensive children’s hospital had been a top priority from the time that I arrived at VCU 15 years ago, and I am very proud of all the work by so many to make this dream for our children a reality,” VCU President Michael Rao said. “From the Children’s Hospital Foundation board to our donors, to our leadership and staff, intense and focused planning helped to make this one of the best and most modern pediatric hospitals in the country. Our teams have always provided excellent care, and this dedicated environment helps them meet the needs of our youngest patients.” The Children’s Tower houses the pediatric acute and intensive care units and emergency room, along with the region’s only Level I pediatric trauma center. This includes 24/7 access to any pediatric specialist a child may need. Caring for more children and families than ever before In addition to the 72 all-private acute and intensive care rooms and 21 rooms in the emergency department, the tower allows for improved availability of pediatric-specific operating rooms, imaging suites and trauma bays equipped with the latest technology. Since April 2023, the Children’s Tower has facilitated an increase of:

• 40% in acute care admissions
• 20% in emergency department visits
• 16% in intensive care admissions
• 25% in surgeries

“A year ago, we were elated to fulfill our promise of opening a full-service, comprehensive children’s hospital dedicated to providing families with nationally ranked care in an environment just for them,” CHoR president Elias Neujahr said. “In the past year, our teams have cared for more patients than previously possible in our ‘hospital within a hospital’ setting. This equates to thousands of families who were able to get the lifesaving and life-changing care they needed for their children.” One of these families was the Piersons, whose then 3-year-old daughter Maddie moved on opening day into the pediatric bone marrow transplant unit of the Children’s Tower, developed for her and other children requiring specialized care due to weakened immune systems. Maddie was one of the first patients in the country to receive a targeted treatment which successfully eliminated her rare and challenging form of leukemia. CJ Sears came to the Children’s Tower emergency department by way of a small community hospital following a fall in his sophomore physical education class. After orthopaedic surgery and an overnight stay, he returned home to continue healing.

Continued growth on the horizon

The Children’s Tower was built with an eye on the future. A dedicated cardiac catheterization and electrophysiology lab, the only of its kind in the region, will open this summer. Expansions to inpatient units, which have remained at or near capacity, are in the planning phases to meet demand. Additional amenities are also in the works, including the Teammates for Kids Child Life Zone scheduled to open in early fall 2024. This kid-friendly space will house areas for kids to watch movies, play video games, complete art projects and make music while in the hospital. This zone is one of the many facets intended to make the Children’s Tower more comfortable for pediatric patients and families. Playrooms, a family gym, family lounges and a café with kid-friendly food options were available on opening day, while an in-hospital Ronald McDonald House supported by RMHC Richmond, multifaith chapel and indoor children’s garden opened a couple months later.

A healing space for kids thanks to generous community support

This massive undertaking to support the care of children in our community, from construction to outfitting the tower, was a $420 million project, supported by Children’s Hospital Foundation’s $100 million capital campaign. “When we launched our capital campaign to support the Children’s Tower in 2019, the response was incredible and showed us how passionately the community felt about bringing a comprehensive children’s hospital to Richmond,” Lauren Moore, president and CEO of Children’s Hospital Foundation, said. “Our donors have been thrilled to hear about the incredible work being done in the Children’s Tower this year, and I am so grateful to everyone who has helped bring the facility to life. Without our community of support, none of this is possible.” The Children’s Tower is adjacent to the outpatient Children’s Pavilion, completing one block in downtown Richmond dedicated to providing medical care for children. While the Children’s Tower facility is celebrating its first birthday, CHoR has a 104-year history of caring for kids. First responders from throughout the region will join the birthday celebration this evening by shining their vehicle lights and waving to patients from the streets below. This second annual “goodnight lights” event will take place at 8:45 p.m. at 1001 E. Marshall Street, Richmond.

Explore the Children's Tower.

Need help getting to your appointment? Check out VCU Health's Way Finder app.

Rising child mortality in the U.S. has the most impact on Black and Native American youth

Inspired by his own journey, VCU nursing student Aaron Wimer aims to make an impact in mental health care

Family and diversity inspire Sheila Hernández-Rubio on her path toward medicine and community

Supreme Court wrestles with abortion clash over emergency room treatment for pregnant women

WASHINGTON — The Supreme Court appeared divided Wednesday as it grappled with whether provisions of Idaho's near-total abortion ban unlawfully conflict with a federal law aimed at ensuring certain standards for emergency medical care for patients, including pregnant women.

Some conservative justices, who have a 6-3 majority, appeared skeptical about the Biden administration’s lawsuit arguing that the state ban restricts potentially lifesaving treatment for women suffering complications during pregnancy.

Liberal members of the court appeared to back the administration's position.

The justices are weighing an appeal brought by Idaho officials who are contesting a lawsuit the Biden administration filed over abortion access in emergency situations.

The state abortion law was enacted in 2020, with a provision stating it would go into effect if the Supreme Court overturned Roe v. Wade, the 1973 ruling that found women had a constitutional right to abortion.

The 2020 law, called the Defense of Life Act,  went into effect  in 2022 when the Supreme Court  rolled back  Roe.

The state law says anyone who performs an abortion is subject to criminal penalties, including up to five years in prison. Health care professionals found to have violated the law can lose their professional licenses.

The federal government sued, leading a federal judge in August 2022 to block the state from enforcing provisions concerning medical care that is required under the federal Emergency Medical Treatment and Labor Act, or EMTALA.

The federal law, enacted in 1986, requires that patients receive appropriate emergency room care. The Biden administration argues that care should include abortions in certain situations. The law applies to any hospital that receives federal funding under the Medicare program.

There is an exception to the Idaho law if an abortion is necessary to protect the life of the pregnant woman, although the scope of the exception came under close scrutiny during the oral argument.

Idaho’s lawyer, Joshua Turner, faced tough questioning about whether the exception can also apply to a situation in which a woman has complications that pose a substantial health risk but not imminent death.

Liberal Justice Elena Kagan said federal law says “that you don’t have to wait until the person is on the verge of death.”

“If the woman is going to lose her reproductive organs, that’s enough to trigger this duty on the part of the hospital to stabilize the patient,” she said.

Fellow liberal Justice Sonia Sotomayor asked similar questions, providing several examples of real-life situations in which women have faced emergency situations when doctors had to make calls about whether to authorize abortions, including a situation in which a patient at 16 weeks of pregnancy whose water broke was at risk of sepsis or a hemorrhage after she was refused an abortion in Florida.

"Is that a case in which Idaho the day before would have said it's OK to have an abortion?" Sotomayor asked.

Turner argued that such medical decisions are “subjective” and that a doctor’s judgment in such instances would be based on good faith, not an objective standard.

Justices Amy Coney Barrett and Brett Kavanaugh, both conservatives, indicated they saw Idaho’s law as allowing for treatment similar to what the Biden administration says the federal law requires, suggesting that there may not be any conflict.

At one point Barrett said she was "shocked" at Turner's answers to questions about what kind of treatment was allowed, because "I thought your own expert had said below that these kinds of cases were covered."

Kavanaugh likewise questioned the daylight between the two laws, wondering what the implications are if "Idaho law allows an abortion in each of the emergency circumstances that is identified by the government."

"What does that mean for what we're deciding here?" he asked Turner.

Conservative Justice Samuel Alito seemed most skeptical of the federal government's argument, at one point mentioning language in the federal law referring to treatment for an "unborn child," a term more commonly used by anti-abortion advocates.

"Isn't that an odd phrase to put in a statute that imposes a mandate to perform abortions?" Alito asked Solicitor General Elizabeth Prelogar.

"Have you seen abortion statutes that use the phrase 'unborn child'? Doesn't that tell us something?"

Prelogar responded that the phrase did not displace the requirement that women get the treatment they need in emergency situations.

Conservative justices, including Neil Gorsuch, also questioned whether the federal government even has the power to mandate health standards when they are tied to Medicare funding.

In January, the Supreme Court allowed Idaho to enforce the provisions while also agreeing to hear oral arguments in the case. Other provisions of the ban are already in effect and will not be affected by how the justices rule.

The decision will affect not just Idaho but also other states, including Texas, that have enacted similar abortion bans that abortion-rights advocates say clash with the federal law.

In blocking parts of the state law that conflict with federal law, U.S. District Court Judge B. Lynn Winmill described the state’s actions as putting doctors in a difficult situation.

“The doctor believes her EMTALA obligations require her to offer that abortion right now. But she also knows that all abortions are banned in Idaho. She thus finds herself on the horns of a dilemma. Which law should she violate?” he wrote.

The San Francisco-based 9th U.S. Circuit Court of Appeals briefly put Winmill’s ruling on hold in September, but it subsequently allowed it to go back into effect, prompting the state officials to turn to the Supreme Court.

Prelogar wrote in court papers that EMTALA requires "necessary stabilizing treatment," which in cases involving pregnant women in emergency situations may require abortions.

"And in those limited but critically important circumstances EMTALA requires the hospital to offer that care," she added.

The state argues that it was only after Roe was overturned that the Biden administration said EMTALA could be interpreted to require abortions in some contexts, calling it a "nationwide abortion mandate."

EMTALA "merely prohibits emergency rooms from turning away indigent patients with serious medical conditions," Idaho Attorney General Raúl Labrador wrote in court papers. The law was not intended to override state laws regulating health care, he added.

The Idaho dispute is one of two abortion cases now pending at the Supreme Court, both of which arose in the aftermath of the 2022 decision to overturn Roe v. Wade. In the other case, the court is considering a challenge that could restrict access to mifepristone, the drug most commonly used for medication abortions.

Lawrence Hurley covers the Supreme Court for NBC News.

Ukraine-Russia war latest: Putin more confident than ever after inauguration speech; plot to 'kill Zelenskyy' stopped

Vladimir Putin has been officially sworn in as Russian president for a new six-year term, although many Western nations did not attend. The ruler seems more confident than ever. Elsewhere, Ukraine says it has foiled a plot to kidnap and kill President Zelenskyy.

Tuesday 7 May 2024 19:09, UK

• Putin sworn in again as president | Claims Russia would work with West
• 'We elect our president': Kremlin defends 'purely democratic' Russia
• Ivor Bennett analysis: Painted as a modern-day Tsar, Putin seems more confident than ever
• Plot to 'kidnap and kill Zelenskyy' stopped, Ukraine says
• Many nations boycott Putin's inauguration ceremony
• Putin has 85% approval rating - here's why
• Big picture : What you need to know as a new week begins
• Your questions answered: Why can't Ukraine destroy key Crimean bridge?
• Live reporting by Lauren Russell  and Ollie Cooper

We're pausing our live coverage of the war in Ukraine for the time being - thanks for tuning in.

Before you go, here is a recap of today's developments.

• Vladimir Putin was officially sworn in again as Russian president, marking the start of his fifth term in office;
• During his inaugural speech, Mr Putin said he is willing to work with the West, but it is down to them to cooperate with Russia;
• Two people have been arrested after Ukraine's intelligence agency foiled a plot to assassinate President Volodymyr Zelenskyy;
• The widow of former Putin critic Alexei Navalny criticised Mr Putin on the day of his inauguration calling him a murderer and a liar.

By Ivor Bennett , Moscow correspondent

Held inside the throne room of the Tsars, the ceremony felt almost like a coronation rather than an inauguration.

And that was part of the point. The symbolism was key.

Andreyevsky Hall, where Vladimir Putin took the oath of office, is dripping with gold. 

It oozes power. 

I think this was an attempt to paint him as a modern-day Tsar, who is the rightful ruler of Russia.

The other aim was to add the stamp of electoral legitimacy to his leadership, and his policies. 

The Kremlin’s chief spokesman Dmitry Peskov told me beforehand that this was just part of the "democratic" political process (see our 13.35 post).

The speech was typical Putin - talking up Russia's greatness, blaming the West for Moscow's isolation and doubling down on his current path of conflict abroad and a crackdown at home.

He said he ranks the safety of the Russian people "above all else".  

Translation - we're in this for the long haul. 

But whose fault is Russia’s status as a global pariah? 

Not ours, he said. 

This was all part of the Kremlin's narrative to portray the West as the aggressor, and Russia as the victim.

What might concern people both at home and abroad was the tone of the speech.

For example, he gave a thinly veiled warning that protest will not be tolerated, saying it’s important "not to forget the tragic price of internal turmoil", adding that Russia must be "absolutely resistant" to it.

And the last line: "We will overcome all obstacles and bring all our plans to life."

Vladimir Putin seems more confident than ever.

Polish Prime Minister Donald Tusk has said Europe needs to spend "big money" in order to prevent other powers in the world from "raising a hand against it". 

Speaking at a conference in the Polish city of Katowice, Mr Tusk called on European countries to take joint action to increase spending on defence by at least €100bn (£85bn).

"Europe must be prepared in the next dozen or so months and the entire next five years for a situation in which no power in the world will dare raise a hand against it," he said.

"Big money will move the war away from Europe's borders for a long time, perhaps permanently."

He also repeated the idea of building a common European air defence system - saying Europe has "more initiatives than real actions". 

Due to the war in Ukraine, Poland is strengthening its defence capabilities, allocating over 4% of its GDP.

Ursula von der Leyen, president of the European Commission, agreed Europe must spend more on defence and declared that if she remains in office for another term she will propose new defence projects.

A Russian national has been sanctioned in the UK, US and Australia for his alleged role as the creator of the most prolific ramsomware group in the world. 

The sanctions target Dmitry Khoroshev who has been identified as one of the leaders of LockBit, the ransomware group responsible for extorting over $1bn from thousands of victims globally. 

In the US, Khoroshev has been charged with 26 counts of allegedly developing and administering a malicious cyber scheme.

The UK's foreign office said the LockBit group was behind attacks on over 200 UK businesses and major public server providers and 25% of all global ransomware attacks. 

Pro-Russian Chechen forces are baring the brunt of the frontlines in Ukraine and training Russian troops behind the scenes, the UK's Ministry of Defence says.

Around 9,000 personnel are currently serving within the Pro-Russian Chechen forces in Ukraine, which has been pushed back onto the frontline since the withdrawal of Russia's private military company, Wagner, the MoD said in its daily intelligence update. 

At the start of the Ukraine war in 2022, Chechen forces became known as "TikTok troops" for their presence on social media.

But, they have since provided personnel and given training to Russians at The Special Forces University in Gudermes, Chechnya. 

The MoD said troops receive up to 10 days' training at the so-called university. 

Chechnya has historically always supported Russia's military action in Ukraine.

Ukraine and Russia have accused each other of using banned toxins on the battlefield. 

The Organisation for the Prohibition of Chemical Weapons (OPCW), which is in The Hague, said that all accusations were "insufficiently substantiated".

But it added: "The situation remains volatile and extremely concerning regarding the possible re-emergence of use of toxic chemicals as weapons." 

Neither side has asked the OPCW to investigate the alleged use of chemical weapons.

Last week, Russia denied allegations from the US that it had used the choking agent chloropicrin against Ukrainian troops and utilised riot control agents "as a method of warfare".

Under the Chemical Weapons Convention, any toxic chemical used with the purpose of causing harm or death is considered a chemical weapon.

We've been covering the fifth inauguration of Vladimir Putin as Russian president.

The ceremony took place in Moscow's Grand Kremlin Palace, and our correspondent Ivor Bennett was there to experience the entire event.

He also interviewed Kremlin spokesman Dmitry Peskov about the state of democracy in Russia and the lack of opposition during the presidential election back in March.

Bennett asked Mr Peskov: "Western leaders and Western governments believe that Vladimir Putin has turned Russia into a dictatorship, why do you think that’s not the case?"

Mr Peskov replied: "This is not the case.

"It's just propaganda, it's rough propaganda, nothing else."

He went on to say Russia was "purely democratic", adding: "We choose our power. We elect our power. We elect our president. We vote for the president or don’t want to vote for the president.

"And we insist that we have the right to do it the way we want to do it.

"And we don’t want a third country to interfere in our choices, in our preferences."

Pressed on whether the lack of opposition to Vladimir Putin in Russia was democratic, Mr Peskov said: "But there is opposition inside the country, of course the conditions are much tougher here because we are in war conditions."

Mr Peskov used the word "war" twice in the interview - typically, the Kremlin refers to its invasion of Ukraine as a "special military operation" - a term he also used once.

Ivor Bennett then asked if it was even more important for the public to have the right to speak out in wartime.

"No, to the contrary. It needs tougher measures to ensure the victory, to ensure that we reach our goals," Mr Peskov replied.

Asked whether this was democratic, Mr Peskov insisted: "It is, it is."

He added that the Western media in Europe and the US exists in the "same circumstances".

Dozens of demonstrators gathered outside The Hague's Peace Palace in The Netherlands to protest the inauguration of President Vladimir Putin. 

The protesters, many of whom had travelled from Germany, carried a giant carnival float that showed a caricature of the Russian leader with blood on his hands in a striped prison uniform.

They also held Ukrainian flags and placards saying: "Putin to The Hague" - which is the home of the International Court of Justice.

Dina Musina, who works for a Berlin-based charity that supports Russian prisoners, said they need to "raise awareness about Putin's crimes internationally".

A plot to assassinate President Volodymyr Zelenskyy has been uncovered by Ukraine's state security service (SBU).

The SBU claimed two agents who were posing as Ukrainian state guard servicemen were tasked by Moscow to figure out a way to capture Mr Zelenskyy and later kill him. 

They also planned to kill other high-ranking Ukrainian officials, the SBU said in a statement on Telegram . 

Head of the SBU, Vasyl Malyuk, described the plot as a "gift to Putin before the inauguration".

The SBU said two suspects have been detained after an investigation gradually documented their alleged criminal actions.

Ukrainian claims that plots to kill Mr Zelenskyy are not new. 

The president said in 2022 there had been at least 10 attempts to assassinate him since the start of the war.

The widow of former Putin critic Alexei Navalny has criticised President Vladimir Putin on the day of his fifth inauguration as Russian leader. 

In a video posted on YouTube shortly before the ceremony took place in Moscow, Yulia Navalnaya called Mr Putin a liar, a thief and a murderer. 

She added that the war in Ukraine is "bloody and senseless" and no one wants it apart from the Russian leader.

"Huge sums of money are stolen from all of us every day to fund bombings of peaceful cities, riot police beating people with batons, propagandists spreading lies. And also for [the elite's] own palaces, yachts and private jets," she said.

"And as long as this continues, we can't stop the fight."

Having been exiled from Russia, Ms Navalnaya has vowed to continue the work of her late husband, who died in an Arctic penal colony on 16 February. 

She has accused Mr Putin of having him killed, an accusation which the Kremlin has always denied.

Be the first to get Breaking News

Install the Sky News app for free