The rate of patients in California who visit the emergency department (ED) for non-injury conditions has increased, indicating a shift in the ED's role in healthcare, according to a study published in Health Affairs.
Researchers led by Renee Y. Hsia, M.D., of the University of California San Francisco, analyzed records of California ED visits between 2005 and 2011. They found the overall "visit rate" fell 0.7 percent during this period, while visits increased 13.4 percent for non-injury diagnoses, with visit rate growth particularly high for nervous system disorders, symptoms of abdominal pain and gastrointestinal system diseases, according to the study.
"While many people think of the ED as simply a place to go when you have a car accident or some type of major trauma, it is increasingly the case that the emergency department is caring for complex medical patients," Hsia wrote in a statement. "At the same time, as our population ages, we are seeing a significant rise in older patients with falls or other trauma. The emergency department therefore plays a critical role in our healthcare system's ability to care for the acutely injured as well as complex disease."
ED visits for injuries grew at a slower pace than non-injury diagnoses for Medicaid patients and patients with private insurance, but the rate fell among the uninsured, according the study. Meanwhile, Medicare patients saw similar growth for injury and non-injury diagnoses. Injury-related diagnoses were more common in patients 45 and older, whereas patients between the ages of 5 and 44 had more non-injury related diagnoses, and significant growth in the rate of patients using the ED to address mental health conditions, according to the study.
The findings, Hsia wrote, reflect "both changes in the population disease burden and the ED's more central role in healthcare compared to its original charge to treat injured patients and provide charity care." Prior research indicated healthcare reform, at both the state and federal levels, also led to increased ED use.