Mythbuster

Are low-acuity visits driving ED overcrowding?

Many leaders believe that low-acuity patients, who could better be treated in alternate settings, are the main cause of emergency department overcrowding. But our research shows that's not the case — it's actually acute patients driving this trend. Download our resource to learn how to make your ED processes faster and more efficient.

Here’s the myth

Emergency department (ED) overcrowding has grown in recent years. Most health system and political leaders believe that the culprit is too many low-acuity patients presenting to the ED, what are called “inappropriate” patients. The common wisdom is that these patients can and should seek treatment at lower-acuity, more appropriate sites of care. Governments, health systems, and payers are thus investing significantly in sites of care to serve as ED alternatives, to which they can ideally divert a substantial number of inappropriate ED presentations.

Stakeholders across the industry hope that a resulting reduction in inappropriate presentations will enable EDs to boost performance and reduce crowding to a manageable level.


Here’s the reality

Leaders are right when they say that a significant portion of ED presentations are by low-acuity patients who can be treated in ED alternatives. But the main source of ED capacity challenges, increases in wait times, and burdens on clinician time is the patient cohort that health systems and regulators view as “appropriate”: acute presentations that require time-sensitive interventions.

There are three factors that point to this reality:

  1. Appropriate ED presentations are driving ED demand growth. The annual growth rate of appropriate ED visits far outpaces that of inappropriate visits. Acute ED presentations now make up a majority of total ED visits and will continue to increase in share.
  2. Appropriate patients are the primary driver of ED wait time pressures. In fact, diverting low-acuity visits may worsen overall ED wait time performance.
  3. There is limited opportunity to free up clinician time by diverting low-acuity visits. Just 6% of new demand on ED nurse time over the last decade was driven by low-acuity visit growth. The other 94% — a far greater opportunity for reduction — was driven by acute visit growth.

Ideally, systems and governments could invest in all possible solutions. But the scarcity of resources, investing in acute care efficiencies such as clinical decision support system (CDSS) technologies, longitudinal care management, hospital-in-the-home (HITH), and remote patient monitoring (RPM) tools are more sustainable solutions for addressing the root of the ED capacity problem than other popular investments such as building ED alternatives or urgent care clinics.


SPONSORED BY

INTENDED AUDIENCE
  • Government
  • Hospitals and health systems
  • Organizations outside the United States

AFTER YOU READ THIS
  • You will understand why high-acuity 'appropriate' patients represent a far greater long-term challenge for ED overcrowding than low-acuity visits.
  • You will learn what types of resource investment and partnerships will provide the greatest impact on alleviating ED overcrowding.
  • You should analyze the CAGR of your ED patients by triage-level cohort to understand how quickly your high-acuity presentations are growing.

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