Why Do They Come?

The acuity of visits to the emergency department continues to increase, with a mere 4.3 percent of ED visits classified as non-urgent (the highest rates of these visits were for patients under age 15).

The reasons for visits were coded using a classification system developed by the CDC’s National Center for Health Statistics. The NHAMCS includes a set of tables that relate to that classification, and estimates are presented by age and sex. Injuries accounted for an estimated 42.2 million visits, or 29 percent of ED visits. By comparison, in 2009 there were an estimated 45 million encounters for injuries. This trend reflects the success of many injury prevention programs, leading to an ED population distribution that features less injury and more illness.

The leading causes of injury, poisoning, and adverse effect–related ED visits were falls (10.5 million visits, or 23 percent of total injury visits) and motor vehicle traffic crashes (3.7 million visits, or 8.1 percent of total injury visits).

When viewed through the lens of “presenting complaint,” stomach and abdominal pain were the most common in 2016, accounting for around 9 percent of visits. Chest pain was next highest at 5 percent.

There were 5.5 million visits with a primary diagnosis of mental disorder noted in the emergency departments, of which 2.4 million visits included evaluation by a mental health provider.

Quality Performance Measures

Roughly 3.2 million visits resulted in the patient leaving before treatment was complete, or about 2.2 percent of all ED visits.

There are hospital quality indicators related to ED revisits and hospital readmissions that ED leaders must be aware of. About 2.7 percent of visits were made by patients who had been seen in the same emergency department in the preceding 72 hours (down from an estimate of 5.7 percent in 2015), and the CDC estimates 4.9 percent of ED visits were for follow-up.

The CDC report in 2011 indicated 6.3 percent of patients admitted through emergency departments had been discharged from a hospital in the preceding seven days. In 2016, roughly 2.9 percent of ED visits that led to hospital admission were patients who had been in an emergency department within the prior 72 hours. That number is down from 4.7 percent in 2011.

There is an ongoing increase in the use of diagnostic tools in the emergency departments, especially ECGs. The use of CT scanning appears to have plateaued, but the use MRI and other special imaging procedures (such as ultrasound) is increasing.