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ACEP Now: Vol 38 – No 12 – December 2019

Figure 1: Admission Rate by Type of Emergency Department

Another data set, provided by the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the Centers for Disease Control and Prevention (CDC), provides a different statistical estimate of emergency department patients, treatment, and disposition based on federal demographic data and a statistical sampling of visits to American emergency departments. The latest data tables published reflect patient visits from 2016.

The NHAMCS report finds about 11 percent of ED visits resulted in admission and about 2.7 percent resulted in patient transfer. The NHAMCS report typically finds a lower-acuity population than is reported in the EDBA data surveys, likely due to its sampling methodology—its surveys may contain more low-volume and low-acuity emergency departments. Meanwhile, the EDBA report is based on ED data of actual patient outcomes and does not use sampling methods.

Admission and transfer rates impact the overall flow of the emergency department. Effective inpatient movement is associated with efficient ED flow and should be a priority for emergency physicians and hospital leaders.^1,2

ED Admissions Data Trends

A core competence of emergency medicine practice is determining which patients would benefit from inpatient care and which can be safely managed as outpatients. Various guides purport to define which patients qualify for inpatient services and further attempt to divvy those patients among those who will benefit from full admission versus observation. The reality is that a complex mix of factors determines the safety of outpatient care for a patient undergoing evaluation in the emergency department.

Emergency physicians deliver great value to the health system by making those determinations in about three hours from the time a patient arrives in the emergency department. Trend data indicate the medical community entrusts emergency physicians to determine which patients will benefit from inpatient care after the patient receives diagnostic workup and initial treatment in the emergency department. Indeed, the use of emergency departments as a processing center for hospital admissions has increased over the last 14 years, from 58 percent to about 70 percent (see Figure 2).

Figure 2: Percentage of Hospital Admissions Through the Emergency Department

Systemically, admission needs for patients over the past 14 years have remained relatively consistent (see Figure 3), varying in a narrow range between 16 percent and 18 percent. Despite improvements in outpatient services, there have been no reductions in overall average admission rates.