Do you have a sense for the national utilization trends for ED services? Do you know who we are caring for in our emergency departments and what the community expects from us? Do you know how your ED compares in terms of census and acuity and who exactly can be expected to show up at your door? You should! Here is a great cocktail-party factoid: the equivalent of the entire U.S. population will visit the ED every three years. You may not go to the ED, but your grandmother goes twice. The emergency department is part of the fabric of everyday life and occupies a central place in most communities.

In this column, I will review the trend data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to paint a vivid picture about who comes to us in the ED. From these data trends, we can anticipate what this means for the operational management of your ED. The latest date for which we have national ED visit trend data is 2009. The NHAMCS report gives us a context for looking at the trends we are seeing locally. The 2009 report is based on data from a sample of 34,942 ED visits from 356 emergency departments. From this data and using national population census numbers, an estimate of utilization of ED services by populations was developed, and such data should be used to plan whom you will care for and what their anticipated needs will be. A few highlights of this report include:

• ED visits continue to rise and will reach more than 140 million this year (2014). ED visits have increased an average of 2.8 percent each year for the last 20 years.
• The population studies indicate the utilization rate of the ED jumped from 414 visits per 1,000 population in 2008 to 451 visits per 1,000 in 2009. Our communities are using us more, often as the only available option for unscheduled care.
• Eighteen percent will arrive by ambulance (this is increasing), and 82 percent will walk in.

Who are the highest utilizers of ED services in your community? You may be surprised. It is probably not unexpected that homeless persons are the high utilizers in terms of ED visits, but infants are as well. In total, with the modified census data, the top prevalence uses of the ED are:

• Homeless persons, at 1,005 visits per 1,000 population (the homeless come more than once per person per year).
• Infants under age one, at 979 visits per 1,000 population, suggesting that we are indeed the place where young families turn when they have concerns about an infant’s health and wellness.

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