National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization

Abstract

Introduction: Reducing non-urgent emergency department (ED) visits has been targeted as a method to produce cost savings. To better describe these visits, we sought to compare resource utilization of ED visits characterized as non-urgent at triage to immediate, emergent, or urgent (IEU) visits. Methods: We performed a retrospective, cross-sectional analysis of the 2006–2009 National Hospital Ambulatory Medical Care Survey. Urgency of visits was categorized using the assigned 5-level triage acuity score. We analyzed resource utilization, including diagnostic testing, treatment, and hospitalization within each acuity categorization. Results: From 2006–2009, 10.1% (95% confidence interval [CI], 9.2–11.2) of United States ED visits were categorized as non-urgent. Most (87.8% [95% CI, 86.3–89.2]) non-urgent visits had some diagnostic testing or treatment in the ED. Imaging was common in non-urgent visits (29.8% [95% CI, 27.8–31.8]), although not as frequent as for IEU visits (52.9% [95% CI, 51.6–54.2]). Similarly, procedures were performed less frequently for non-urgent (34.1% [95% CI, 31.8–36.4]) compared to IEU visits (56.3% [95% CI, 53.5–59.0]). Medication administration was similar between the 2 groups (80.6% [95% CI, 79.5–81.7] vs. 76.3% [95% CI, 74.7–77.8], respectively). The rate of hospital admission was 4.0% (95% CI, 3.3–4.8) vs. 19.8% (95% CI, 18.4–21.3) for IEU visits, with admission to a critical care setting for 0.5% of non-urgent visits (95% CI, 0.3–0.6) vs. 3.4% (95% CI, 3.1–3.8) of IEU visits. Conclusions: For most non-urgent ED visits, some diagnostic or therapeutic intervention was performed. Relatively low, but notable proportions of non-urgent ED visits were admitted to the hospital, sometimes to a critical care setting. These data call into question non-urgent ED visits being categorized as “unnecessary,” particularly in the setting of limited access to timely primary care for acute illness or injury.