Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Holly Shipp, MPH¹, Leslie Upledger Ray, PhD MPH MPPA MA¹, Alan M. Smith, PhD, MPH¹, Barbara M. Stepanski, MPH¹, Kristin Garrett, MPH², and Shreya Shah, MPH². (1) Emergency Medical Services, County of San Diego, 6255 Mission Gorge Road, San Diego, CA 92120, 619-285-6429, holly.shipp@sdcounty.ca.gov, (2) Community Health Improvement Partners, 707 Broadway, Suite 905, San Diego, CA 92101

Purpose: To evaluate emergency department (ED) utilization patterns in a population-based study of a county with 3-million people to address ED overcrowding, high ED costs, and adequacy of care.

Methods: Quarterly ED data was reported to Emergency Medical Services (EMS) by civilian EDs through a collaborative effort between EMS and the Hospital Association (CHIP). The ED algorithm, developed by John Billings at New York University, was applied to classify patients according to urgency of their visit. Patients with a medical diagnosis were categorized into one of four groups.

Results: During the 6-month study, over 300,000 patients were discharged from 1 of 18 EDs. 20% of all patients were non-emergent, 20% were emergent, primary care treatable, 6% were emergent, preventable, 13% were emergent, not preventable, and 41% were for other visits, including injury. Children 0-14 years were 2.6 times more likely, Black patients were 2.1 times more likely, uninsured patients were 2.0 times more likely, and Medicaid patients were 2.1 times more likely to have a non-emergent visit than an emergent, non-preventable visit.

Conclusions: Surprisingly high rates of ED use for non-emergent conditions and for care that could otherwise be rendered in primary care settings were found in this analysis. This is a clear indication that primary care is not accessible to all segments of the population. EMS staff are working to develop a complimentary algorithm to classify injury diagnoses. CHIP staff are implementing programs to improve health literacy and increase health insurance coverage that may assist in decreasing non-emergent visits.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Describe the characteristics of patients discharged from the ED.
• Discuss ways in which they might utilize emergency department billing data to characterize ED users in their target population.
• Apply the ED Use Profiling Algorithm to their own data.

Keywords: Emergency Department/Room, EMS/Trauma

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 3147.7 kb)