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3% of ED visits are avoidable? We can prevent more than that—and here's how

October 17, 2017

    Only 3.3% of ED visits are considered avoidable, according to a recent report in the International Journal for Quality in Health Care. At first glance, this finding may sound surprising. That's because the study used a definition of "avoidable"—"discharged ED visits not requiring any diagnostic tests, procedures, or medications"—that doesn't pain the full picture.

    During conversations with population health managers, we characterize avoidable ED use more broadly. Often, the avoidable ED visit definition encompasses patients who could have been treated in an ambulatory setting, patients whose visit required ED-level care but could have been prevented by effective and timely primary care, and those who did not need care for at least 12 hours. In fact, an estimated 60% of Medicare ED visits fall into one of these three categories.

    Since non-emergent and primary care-treatable ED visits make up a significant portion of avoidable ED volumes, these patients likely either lack accessible, low-acuity alternatives to care or assume that the ED is the only place that can effectively meet their care needs.

    The small percentage of complex patients who make up a significant proportion of ED use tend to have a range of medical and psychosocial needs and rely on many health care resources, including the ED. Some of these ED visits are avoidable, too.

    Population health managers deploy a range of tactics to address the cost and quality implications of avoidable ED utilization. We find that these tactics typically fall within three strategies:

    1. Increase patient access to care

    Providing access to low-cost ED alternatives is critical to decreasing avoidable ED visits. For most patients, primary care serves as the main alternative to the ED.

    Health systems can connect ED patients with PCPs to further reduce primary care-treatable or preventable ED visits. Besides focusing on primary care, organizations can bolster convenient care access points, such as 24/7 phone lines and telehealth visits.

    2. Educate and encourage appropriate use health services

    Providers must inform patients of available alternate care sites and encourage them to use health services that are most appropriate for their symptoms, both proactively and following an inappropriate visit.

    Patients often inappropriately visit the ED due to the misperceptions that they had no care alternative or they could only receive the full range of necessary care from the ED.

    3. Design targeted measures for the most-complex patients

    When addressing avoidable ED utilization, identify subgroups of patients who would benefit from more tailored interventions. These more challenging patients especially benefit from interventions like ED-based navigation and post-discharge home visits.

    And remember, providers do not have to take on all of these patients' needs alone. Providers can seek out cross-continuum partnerships that fill clinical and non-clinical gaps, such as with post-acute care facilities and community paramedics.

    Learn how to address the social determinants of health

    Recognizing the role that non-clinical risk factors, such as food insecurity and unstable housing, play in effective clinical management, providers must increasingly scale patient management efforts beyond traditional care settings. Join us Thursday, Dec. 7 to learn how partnering with community-based organizations can advance your population health strategy.

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