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Emergency departments now account for half of all hospital inpatient admissions

ED doctors play increasingly important role

Emergency departments are now responsible for half of all inpatient admissions and accounted for nearly all the increases in admissions between 2003 and 2009, according to a new report from Rand Corporation.

The study was conducted on behalf of the Emergency Medicine Action Fund, a consortium of emergency medicine physician organizations, in order to provide a more complete picture of the role EDs play in the U.S. healthcare system.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," said Art Kellermann, MD, the study's senior author and a senior researcher at Rand, in a press release. "While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."

Overall, hospital admissions in the 2003 to 2009 period grew at a slower rate than the overall population, the study noted, but nearly all of the increase in admissions to hospitals were the result of 17 percent growth of unscheduled admissions from the emergency department.

But that increase was offset by a drop of more than 10 percent in hospital admissions from doctors' offices in the same period. According to the Rand researchers some of this is the result of more doctors and outpatient facilities directing patients to the ED that they previously would have referred for a hospital admission.

The result is that ED physicians are now major influencers in total hospital admissions, accounting for about half of all inpatient admissions every year, which accounts for most of a hospital's revenue. In all, inpatient care represents roughly 31 percent of the total spent each year on healthcare in this country.

Along with this broader trend, the Rand researchers confirmed that EDs are still a focal point in terms of people seeking non-urgent – and more expensive – care, as opposed to finding other providers. The report noted that most people who seek non-urgent care in the ED do so because they are not aware of any other viable alternative.

"Although the core role of EDs is to evaluate and stabilize seriously ill and injured patients, the vast majority of patients who seek care in an ED walk in the front door and leave the same way," the report noted.

The researchers suggest that policy initiatives designed to discourage the use of emergency departments for non-urgent care should focus on providing avenues to timely access to primary care and less expensive forms of care, as opposed to merely blocking access for these services.

"We believe there needs to be more effort to integrate the operations of emergency departments into both inpatient and outpatient care systems," said Kristy Gonzalez Morganti, lead author and policy researcher at Rand, in a prepared statement.

Such efforts should include increased use of interconnected health information technology, better coordination of care and case management and more collaborative approaches to medical practice.

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