Emergency departments have become the nucleus of the hospitals they serve. Emergency physicians not only provide lifesaving treatment, they also serve as gatekeepers to their hospital’s inpatient services.
Explore This IssueACEP Now: Vol 38 – No 12 – December 2019
Every day, emergency physicians in U.S. emergency departments manage about 411,000 patients and decide that about 74,000 would benefit from inpatient services. Those 74,000 patients represent about 70 percent of the 106,000 patients admitted to hospitals each day.
New data give us a clear view of our role.
The EDBA and NHAMCS Data
The Emergency Department Benchmarking Alliance (EDBA) studies and reports on the operations required to manage our evolving patient group. The 2018 EDBA Performance Measures annual survey includes almost 2,000 emergency departments that served about 76 million patients.
Admissions and transfers account for roughly 20 percent of all patient dispositions across the United States.
The “admission percentage” is the percentage of patients seen in the emergency department and then placed in an inpatient area of the hospital. This percentage includes the total number of admitted patients taken to an inpatient area, including those defined as observation patients by hospital processes. This is important for hospital administrators to know because ED patients who need inpatient services require a disproportionate amount of time and energy from emergency physicians and ED staff.
The “transfer percentage” is the percent of patients seen in the emergency department and then transferred from the emergency department to another emergency department or hospital. This group has uniform requirements under EMTALA for management, documentation, patient consent, and records maintenance. Small-volume emergency departments have the highest transfer rates, at about 5 percent.
The “percentage of hospital admissions processed through the emergency department” is calculated by measuring the total number of patients admitted from the emergency department and dividing it by the total number of general admissions to the hospital.
In 2018, inpatient units were the site of disposition of emergency patients in about 17 percent of visits. The emergency department remains the dominant source of hospital admissions in the United States with about 70 percent of hospital inpatients processed through it. In addition, about 2.8 percent of patients were transferred to another hospital, typically for admission, too.
In 2018, the EDBA data survey also measured critical time intervals of admitted patients. The median length of time from the moment the patient arrived in the ED until the decision was made to admit the patient for inpatient services was 188 minutes. The second critical time interval was from the time of an admission decision to when the patient was moved out of the emergency department to the inpatient unit. Nationally, that median time interval was 116 minutes.
There are significant variations in admission and transfer rates by type of emergency department and by patient group served (see Figure 1). In adult emergency departments, the admission rates are the highest at about 26 percent, with adults accounting for about 65 percent of all hospital admissions. In pediatric emergency departments, the admission rate is only 10 percent, but that patient group accounts for 71 percent of all hospital admissions in those facilities. Low-volume emergency departments (ie, those that see fewer than 20,000 patients per year) have the lowest admission rate of any volume cohort at 11 percent.