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ACEP Now: Vol 35 – No 04 – April 2016

(click here for larger image) Table 1. Critical Trends in 11 years of the EDBA Data Survey

Use of CT scanning appears to have reached a high of 22 procedures per 100 patients, but MRI and other special imaging procedures like ultrasound are used at an increasing rate. The other diagnostic tool that is increasing in ED use is the 12 lead ECG. From 2004 to 2014, ECG utilization increased from 17 uses per 100 patients seen to 26 uses. This trend is likely to continue.

There is a continuing growth in the percentage of overall hospital admissions presenting through the ED. The EDBA data survey over the last five years finds that between 65 and 68 percent of hospital inpatients are processed through the ED. This reflects the role of the ED as the “front door” of the hospital.

There is a tremendous effort by many ED leaders to increase the flow of patients. ED providers have the greatest control over the flow of patients who are evaluated, treated, and released for outpatient follow-up. This represents more than 80 percent of the patients seen in American EDs. Patients managed completely in the ED represent the overwhelming majority of the flow. Despite increasing volumes over the last 11 years and increasing age and acuity of patients, the flow of patients has improved (see Tables 1 and 2). For all patients, the door-to-provider time has decreased from more than 40 minutes to about 28 minutes. (The 2011 NHAMCS study reports this number is 27 minutes.) Overall median length of stay for the complete spectrum of ED patients has decreased about 15 minutes, from about 190 minutes to about 175 minutes. Patients treated and released from the ED have been processed an average of 10 minutes quicker in 2014 than in 2008, from 160 to about 150 minutes. Flow improvements have resulted in an overall reduction in ED patient walkaways, from more than 3 percent to about 2.2 percent.

(click here for larger image) Table 2. Trend in ED Median Length of Stay, Time to Provider, and Walkaways

Data from the CDC and from the EDBA indicate that the emergency department is an important and valuable element of the health system, providing unscheduled care to an increasing number of patients over the last 23 years. The ED patient population is increasingly composed of older persons, a proud accomplishment indicating that efforts to reduce premature death from illness and injury are working.