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ACEP Now: Vol 36 – No 11 – November 2017

(click for larger image) Figure 1: Percentage of ED Visits by the Major Payers Over the Years of the CDC Data Survey (from newest to oldest)

Injuries accounted for an estimated 40 million visits, or 28.3 percent of ED visits. The highest injury rates were in those age 75 and older. By comparison, in 2009, there were an estimated 45 million encounters for injuries. This trend reflects the success of many injury prevention programs, leading to an ED population distribution that is less injured and more ill. The leading causes of injury visits were falls (10.6 million visits, 25 percent of total injury visits) and motor vehicle traffic crashes (4 million visits, 9.6 percent of total injury visits). Self-inflicted injuries or poisonings accounted for 468,000 visits.

(click for larger image) Table 1. Estimated ED Visits

There are growing numbers of patient visits related to primary mental health issues. In about 1.6 million visits, a mental health provider saw the patient in the emergency department, and in about 1.2 million ED visits, the result was admission to the mental health unit of a hospital.

A total of 15.6 million ED visits resulted in hospital admission, transfer, or death. However, in 2014, the number of ED visits with a disposition of died in the emergency department is too low to be estimated. About 8 percent of all ED visits resulted in hospital admission. Placement in observation units accounted for an additional 1.3 percent of all ED visits. The average hospital length of stay for patients admitted through the emergency department was 4.8 days.

There are a number of hospital quality indicators related to readmissions to the hospital, so ED leaders must be aware of the baseline level of activity for this. In approximately 3.5 percent of visits (compared to 4.7 percent in 2011) resulting in hospital admission, the patient had been seen in the same emergency department within the prior 72 hours. About 3.6 percent of visits were made by patients who had been seen in the same emergency department in the preceding 72 hours, and the CDC estimates that 4.9 percent of ED visits were for follow-up.

The use of CT scanning appears to have plateaued, but MRI and other special imaging procedures like ultrasound are increasing.

There is a continuing growth in the percentage of overall hospital admissions presenting through the emergency department. The Emergency Department Benchmarking Alliance (EDBA) data survey finds that about 66 percent of hospital inpatients are processed through the emergency department. This clearly demonstrates that the emergency department is the “front door” of the hospital.

Summary Talking Points from NHAMCS and EDBA Data

The data indicate that the emergency department is an important and valuable element of the health care system.

• There is a long-term trend that American emergency departments are seeing at least 2 percent more visits per year.
• More patients arrive with medical illnesses than injuries.
• More patients are elderly and arrive by EMS.
• For the first time, the largest group of patients being seen in the emergency department has Medicaid or CHIP insurance.
• The highest utilization rate of emergency services per population is by nursing home residents.
• Admission rates are falling except in the mental health group.
• About 3.5 percent of ED visits resulting in hospital admission were for patients who had been seen recently in the same emergency department.