A recent study published in the International Journal for Quality in Health Care found that 3.3% of all emergency department visits were avoidable.
Of these, the top 3 discharge diagnoses were alcohol abuse, dental disorders, and depressive disorders. The study suggests that avoidable emergency department visits could be reduced by increasing access to dental and mental health facilities.
The study analysed data representing 424 million visits made to emergency departments in the United States by patients aged 18 to 64 between 2005 and 2011. It defines ‘avoidable’ as those cases where no diagnostic or screening services, procedures, or medications were performed or given for patients that were discharged home. It found that 6.8% of all avoidable visits were caused by alcohol-related or mood disorders and 3.9% of all avoidable visits related to dental disorders. It also notes that 14% of avoidable visits were made by ambulance.
Emergency departments are designed to treat patients in immediate physical danger, conditions that threaten life and limb. Definitively treating for conditions arising from mental health or dental problems require specialist care beyond that of the emergency department. The study notes that 16.9% of all mood disorder related visits, 10.4% of all alcohol related visits, and 4.9% of all dental-related visits were avoidable.
Despite these significant percentages, the vast majority of diagnoses in these areas were not deemed avoidable so it should not be assumed that all patients with these conditions should not attend the emergency department. However, these findings suggest that policy initiatives could alleviate pressure on emergency departments by addressing gaps in dental and mental health care in the United States, which could provide treatment to this group of emergency department visitors at a lower cost elsewhere.
Dr. Renee Hsia, lead author of the study, states, “We chose to use a particularly conservative definition of “avoidable” to quantify the proportion of visits that did not require labs, x-rays, procedures, or medications. These diagnosis codes certainly should not be used prospectively to define which conditions are non-emergent; the main take-away is actually that the percentage of these potentially avoidable conditions that come to the ED is very small. Efforts to contain healthcare costs by focusing on decreasing potentially avoidable ED use may be fairly low-yield.”
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Direct correspondence to:
Renee Y. Hsia, Department of Emergency Medicine,
UCSF, San Francisco General Hospital,
1001 Potrero Ave, 1E21,
San Francisco,
CA 94110, USA.
Tel: +1-415-206-4612; Fax: +1-415-206-5818;
E-mail: renee.hsia@ucsf.edu
To request a copy of the study, please contact:
Daniel Luzer
daniel.luzer@oup.com
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URL: https://academic.oup.com/intqhc/article-lookup/doi/10.1093/intqhc/mzx081
Journal
International Journal for Equity in Health