Emergency physicians and emergency department leaders face an important time in determining how to serve the needs of the 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 US Centers for Disease Control and Prevention (CDC) has detailed a continuous increase in ED visits since at least 1992, as has data from the Emergency Department Benchmarking Alliance (EDBA), and it’s been confirmed in the experiences of most of the 4,800 EDs in the country.
Explore This IssueACEP Now: Vol 35 – No 04 – April 2016
The 1992 NHAMCS Emergency Department Summary stated that 89.8 million ED visits were made, about 357 visits per 1,000 population. Injuries were the cause of more than 35 percent of the visits. In 2011, visits had grown to 136.1 million, which calculates to 445 visits per 1,000 population.1 Injuries accounted for 29 percent of ED visits, with the highest injury rates in persons age 75 and older. The CDC has not been able to produce visit estimates for 2012 and subsequent years, but it is likely that volumes have increased at a minimum of the 2.4 percent growth rate of the first 19 years of the study. Continuing a 2.4 percent growth rate means that 150 million persons had ED visits in 2015.
More important for predicting ED utilization, staffing, design, and processes are the types of patients visiting the ED. The ED population is aging, which is in line 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. It hosted three summits that developed the definitions for the industry, the latest being published and used in the annual EDBA survey.2 The 2014 EDBA survey used data from 1,142 EDs that saw 45 million patients. This report now has 11 years of data useful in the ED planning process.
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 ED, the admission rates over the last 10 years are stable in a range between 16 and 18 percent.