The 2015 Emergency Department Benchmarking Alliance (EDBA) Performance Measures survey includes almost 1,200 emergency departments that served about 50 million patients, plus 57 additional freestanding emergency departments or urgent care centers.
The National Hospital Ambulatory Medical Care Survey (NHAMCS) from the Centers for Disease Control and Prevention (CDC) gives a statistical estimate of emergency department patients, treatment, and disposition based on federal demographic data and a statistical sampling of visits to American emergency departments. However, there has been no data release since December 2014, when the 2011 data tables were published. Emergency medicine leaders and ACEP have provided support for the CDC to publish this important release of data on an ongoing basis and have written to encourage them to publish data from years 2012 onward.
If we create an estimate based on the last published CDC numbers for 2011 of 136.3 million visits and include the historical average growth in emergency department visits since 1992 of about 2.5 percent over the subsequent five years, the American emergency department volumes seen in 2016 are likely going to hit about 150 million visits.
EDBA members reported that their volume increased as acuity remained stable. The ED patient volume at the same sites reporting in 2014 and 2015 increased by 4.3 percent—many departments had a higher increase in volume than that figure. Acuity mix, measured by physician level of service and by the percentage of patients who were admitted to the hospital from the emergency department, remained stable from 2014 to 2015.
About 75 percent of departments with an annual visit volume of more than 40,000 reported a “fast track” for patient care, and about 35 percent had a clinical decision unit or observation unit.
Children Versus Seniors
For 2015, there was a shrinking percentage of children treated in emergency departments, and therefore, the volume growth in American departments was based on increasing numbers of senior patients. This should be verified when the CDC publishes updated NHAMCS numbers, which will show an increasing level of Medicare patients.
There also was a growing number of trauma centers, particularly at the categories of Level II and Level III. Many of these new trauma centers serve injury populations that include large numbers of elderly patients. These service improvements are occurring in all regions of the country, not just the traditional Sun Belt locations.
Structure and Processing
Emergency departments have changed structure as they’ve grown in volume and complexity. Bed utilization was about 1,500 visits per patient care space. This was much lower in departments serving adult patient populations, at about 1,334 visits per care space. For departments serving pediatric patient populations, the figure was 1,887 visits per care space.