Emergency Department Utilization

Amid rising demand for health care in America and increased strain on medical providers, more patients are turning to emergency departments for care — even in non-emergency situations. This causes emergency department (ED) utilization to dramatically escalate, creating problems for both patients and health care providers.

But what exactly is ED utilization, and what is the cause of overutilized ERs? In this article, we deliver a high-level exploration of these topics.

What Is Emergency Department Utilization?

ED utilization is a number that expresses how efficiently an emergency department is running. Medical providers use the health of the surrounding population to predict the rate at which the community will use the local emergency department and compare it to the rate at which it’s actually being used. This gives them an “observed-to-expected” utilization ratio, which expresses whether they’ve had more, less, or the same number of visits as anticipated.

They then multiply this ratio by the number of emergency visits they’ve had across health plans to see how they compare to the national average for ED utilization.

The Misuse of Emergency Room Services

The emergency department is the only department in the US healthcare system that offers full, on-demand 24/7 medical services for health problems of any severity, without regard for the patient’s ability to pay. Emergency departments have a legal obligation to treat each person who comes to them for care, and for this reason, emergency rooms are vulnerable to misuse.

According to the CDC, emergency visits have risen across all demographics and coverage levels for at least two decades, with many seeking for primary care services in emergency departments due to convenience, fast access to specialty medical services, and the perception of higher-quality care. BlueCross BlueShield reported seeing members visit the ER more than 20 times in one year for such reasons.

Primary care-related emergency visits can be classified as visits for medical situations that did not require treatment within 12 hours and could reasonably have been handled in a primary care setting. Unfortunately, the misuse of emergency room services decreases ER efficiency and jeopardizes the quality and affordability of American health care.

Billions of dollars are wasted annually on preventable emergency visits
Roughly 13% to 27% of emergency visits in the US could be handled in primary care offices and urgent care clinics

The emergency department is the only department in the US healthcare system that offers full, on-demand 24/7 medical services for health problems of any severity, without regard for the patient’s ability to pay. Emergency departments have a legal obligation to treat each person who comes to them for care, and for this reason, emergency rooms are vulnerable to misuse.

Why Is a High ED Utilization Problematic?

Overuse of emergency services not only comes at a high expense to the health care system and its patients, but it also indicates poor care management, low-quality medical presence in the community, or a complete lack of health care options. Perhaps the worst consequence of high ED utilization is more crowded ERs, which make it harder for healthcare professionals to treat the more pressing emergencies in a timely manner.

What Is Being Done to Prevent ED Misuse?

According to the New England Healthcare Institute, medical providers are working to improve access to primary care by making non-emergency facilities more accessible, incentivizing the use of primary care over emergency care, and leveraging technology to improve the patient experience.

Thankfully, we live in a time in which technology is solving many long-standing issues in the medical field and beyond. Emergency departments have begun to use software and other technology that makes it easier for providers to manage chronic disease cases and to communicate and coordinate patient care more seamlessly. Digital tools even allow them to identify and address the problem of “ER super users” with ease.