Examining conventional assumptions of emergency department utilization:

Purpose: Emergency Departments (EDs) have entered a crisis period characterized by overcrowding, boarding of patients, and ambulance diversion raising concerns about patient safety and increasing healthcare costs. Reducing utilization of the ED for non-urgent care by Medicaid patients may help alleviate these problems and has received considerable attention. This paper attempts to distinguish supportable facts from six widely held assumptions about ED utilization.

Methods: We analyzed national survey data and Texas Medicaid claims data to investigate ED utilization patterns.

Results: An incline in per capita ED utilization and a decline in number of hospitals have contributed to the ED crisis. Medicaid/SCHIP clients are high utilizers of all hospital-based ambulatory care, including the ED. Their ED utilization for non-urgent conditions explains part of this trend. However, they utilize ED services regardless of the urgency of the presenting condition at a higher rate than non-Medicaid patients. In Texas, a decline in the ratio of Medicaid PCPs to enrollees possibly contributes to ED utilization. No consensus has emerged detailing how much ED care could be diverted to another setting or the cost differential between treating non-urgent conditions in the ED versus doctor's office. HMOs have not appeared to restrain ED utilization.

Conclusion: Shifting non-urgent ED utilization to another setting is unlikely to produce substantial cost savings. However, redirecting non-urgent cases to other settings could improve quality of care for patients and reduce burden on the ED system.