The CDC Data: Americans Vote With Their Feet
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It should come as no surprise that there are racial and ethnic disparities in ED visit rates, reflecting overall differences in health care delivery and access. The visit rate for Caucasians is 413 visits per 1,000 population. The visit rate for African Americans is 851 visits per 1,000 population. The visit rate for other races is 242 visits per 1,000 population. The utilization for all groups continues to rise.

The admission rate for ED patients has risen insidiously over the past two decades to 17 percent, with many larger urban and tertiary care hospital emergency departments reporting rates of twice that.

A change in the categories of patients presenting to EDs has been noted over the past 30 years. In particular, accidents and injuries are decreasing as a percentage of the ED visits. In 1980, just more than half of ED patients had illness, 40 percent had injuries, and a small percent had behavioral problems. Fast-forward to 2010 and a full 70 percent had illness, only 23 percent had injury, and behavioral complaints accounted for close to 10 percent of ED visits nationwide. The decrease in injuries is a success story about the culmination of many safety initiatives, including seatbelt usage, drunk-driving initiatives, and occupational safety initiatives. Sadly and concurrent with this decrease in accidents and injuries, mental health resources have been unfunded, and the behavioral health needs of the community have increased. The behavioral health category of patients encompasses acute psychiatric crises, substance abuse, detoxification needs, and acute drug and alcohol intoxication. These needs are being met with difficulty because strategies and solutions must come from communities and have been harder to develop.

In addition, the percentage of geriatric patients arriving with complex medical problems has been increasing. This has resulted in more complicated diagnostic and management strategies for patients with many comorbid conditions. The admission rate for ED patients has risen insidiously over the past two decades to 17 percent, with many larger urban and tertiary care hospital emergency departments reporting rates of twice that. Further, the acuity is rising when tracked by CPT codes (by the Emergency Department Benchmarking Alliance Annual Survey). These patients do not lend themselves to a quick in-and-out model for an ED visit and may require changes in the way we orchestrate the ED visit. In addition, the expectations of the public will need to be managed as the services being provided are changing.