Emergency physicians and emergency department leaders face an important time in determining how to serve the needs of their communities in a changing health system. The trends that have driven the growth of emergency care have not been altered by government or payer policies to date. The National Hospital Ambulatory Medical Care Survey (NHAMCS) by the Centers for Disease Control and Prevention (CDC) has detailed a continual increase in ED visits since at least 1992, as have data from the Emergency Department Benchmarking Alliance (EDBA), and it is confirmed in the operations reports for most of the 5,000 or so emergency departments in the country.
The 1992 NHAMCS Emergency Department Summary estimated that 89.8 million ED visits were made, or about 357 visits per 1,000 population. Injuries in those years were the cause of about 40 percent of the visits. In 2012, visits had grown to 131 million, which calculates to 424 visits per 1,000 population.1 Injuries accounted for 28 percent of ED visits, with the highest injury rates in persons age 75 and older. Continuing a 2.4 percent growth rate means that 150 million persons visited American emergency departments in calendar year 2016.
Most important in predicting ED utilization, staffing, design, and processes are the types of patients visiting the emergency department. The ED population is aging, which is consistent with the demographics of the country. Those persons age 75 and older in 1992 had 558 visits per 1,000 population. In 2011, that number increased to 682 visits per 1,000 population. Similarly, in those persons ages 65 to 74, the utilization increased from 314 to 369. These are the fastest-growing demographics in the country and will continue to grow for the next 20 years.
The EDBA has worked collaboratively with the CDC in producing useful data reports, which are needed for future planning. The EDBA hosted three summits that developed the definitions for the industry, the latest being published and used in the annual EDBA survey.2 EDBA trends in the last 12 years are summarized in Table 1.
The EDBA data show a reduction in the mix of young patients (defined as under age 18), from about 22 percent to about 16 percent over the last 10 years. Ambulance transportation is a stable source of about 16 percent of ED patients, with patients arriving in this manner being admitted around 39 percent of the time. For the sicker or seriously injured patients arriving in the emergency department, the admission rate over the last 10 years is stable between 16 percent and 18 percent.