Admissions traffic from ED, outpatient clinics on the rise

The emergency department (ED) serves as the gateway to most hospital admissions more than ever before, according to a Healthcare Daily article.

ED visits account for more than half of all hospital admissions, a jump from the 1990s, when emergency room visits made up about one-third of admissions, according to a RAND Corp. study. ED admissions increased 17 percent across the country from 2003 to 2009, contributing to the 6 percent overall inpatient admissions growth.

One contributing factor is elective surgeries taking place at outpatient clinics, said Daniel Varga, M.D., chief clinical officer and senior executive vice president of Texas Health Resources, a health system in North Central Texas that saw a 15 percent increase in ED admissions from 2005 to 2013, according to Healthcare Daily.

"The lower-acuity cases are gone now," he said. "We can foresee a time when a hospital will become one big ICU."

High-intensity visits also increased, such as those that involved advanced imaging and consultations with specialists, according to a study that examined California EDs from 2002 to 2009, which noted the number of visits more than doubled--from 778,000 to 1.5 million per year.  

As more hospitals merge and consolidate and the population ages, ED admissions continue to increase. ED visits grew by 26 percent between 1994 and 2004 while American hospitals shut down 198,000 beds, according to a 2006 article in the New England Journal of Medicine

High ED volumes mean patients lack access to primary care or insurance, and hospitals lose more money due to the uncompensated care they have to provide, according to the article. However, testing and diagnosing efficiency in the ED can help patients avoid a hospital stay or shorten admission length, said Dighton Packard, M.D., Baylor Health Care System's chief of emergency medicine.

To learn more:
- here's the article
- read the RAND Corp. study
- check out the California ED study
- here's the NEJM article