Visits to U.S. Emergency Departments at All-Time High; Number of Departments Shrinking

From the National Center for Health Statistics

Visits to the nation’s emergency departments (EDs) reached a record high of nearly 114 million in 2003, but the number of EDs decreased by 12 percent from 1993 to 2003, according to a new report released today by the Centers for Disease Control and Prevention (CDC).

The report attributes the rise in ED visits to increased use by adults, especially those 65 years old and over. Among people aged 65-74, the ED visit rate was more than five times higher for those residing in a nursing home or other institution compared with those not living in an institutionalized setting.

The report also finds that Medicaid patients were four times (81 visits per 100 people) more likely to seek treatment from an ED than those with private insurance (22 visits per 100 people).

“Emergency departments are a safety net and often the place of first resort for health care for America’s poor and uninsured,” said Linda McCaig of CDC’s National Center for Health Statistics and the report’s lead author. “This annual study of the nation’s emergency departments is part of a series of surveys of health care in the United States and provides current information for the development of policies and programs designed to meet America’s health care needs.”

Other findings in the report include:

From 1993 through 2003, the number of ED visits increased 26 percent from 90.3 million visits in 1993 to 114 million in 2003. The U.S. population rose 12.3 percent during this period, and the 65-and-over population rose 9.6 percent.

The average waiting time to see a physician was 46.5 minutes, the same as it was in 2000. The wait time was unchanged despite increased visits. EDs have implemented a number of efficiencies, including “fast track” units, which may have kept the wait time constant. On average, patients spent 3.2 hours in the ED, which includes time with the physician as well as other clinical services.

Injury, poisoning, and the adverse effects of medical treatment accounted for over 35 percent of ED visits. The leading causes of injuries were falls, being struck by or striking against objects or persons, and motor vehicle traffic incidents, accounting for 41 percent of injury-related visits. Some 1.7 million visits were for adverse effects of medical treatment.

In 2003, patients arrived at the ED by ambulance in 14 percent of the visits, representing over 16 million ambulance transports. More than a third of patients who arrived at the ED by ambulance was 65 years of age and over.

X-rays, CT scans, or other imaging tests were provided in about 43 percent of visits. Medications were provided in over 77 percent of visits, with painkillers being the most frequent prescription, accounting for just over 14 percent of medications reported.

About 58 percent of all EDs were located in metropolitan areas, and they represented 82 percent of the annual usage. Board-certified emergency medicine physicians were available at 64 percent of EDs.

The CDC report describes hospital, patient, and visit characteristics for hospital emergency departments in the United States as well as trends in ED use between 1993 and 2003. The information is based on data from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department Summary, which is a national probability-based sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States conducted by CDC’s National Center for Health Statistics.