By Pamela J. Gallagher 

In 2019, emergency departments (ED) across the U.S. saw an average of 2.1 million patients per week, according to the Centers for Disease Control and Prevention (CDC). Over the past several decades, healthcare organizations have invested large amounts of money, time, and effort to study the trend of ever-increasing numbers of high-utilizers in the ED and discover solutions to slow this growth.  Hospitals have offered care navigators, clinics for less emergent issues, and countless other alternatives, but with next to no progress.  People, it seems, just wanted to come to the ED.

In the midst of the COVID pandemic, however, the CDC reports that ED visits declined nearly 50% during the early COVID-19 pandemic. While this may be partially due to patients choosing to stay home who likely didn’t need to come to the ED in the first place, physicians are deeply concerned that those with true medical emergencies are avoiding a necessary ED visit due to fear of being infected with the virus.

This is a huge hit for hospitals’ revenue. As healthcare facilities struggle to adjust financially and operationally, I believe the healthcare industry will see major changes to the way EDs function as a part of the financial whole.

ED volumes

In my research for this article, I came across studies from as early as the 1990s about combating increasing ED volumes, especially the number of frequent visitors. But the numbers have only continued to skyrocket since that time. Despite the fact that frequent and nonfrequent ED users give similar reasons for using the ED—factors such as convenience, timely access, quality, and costs—one study found that approximately 5% of patients who use the ED are responsible for 25% of all ED visits. Another study revealed that ED volumes have increased, driven by the closure of existing EDs outpacing the increase of new EDs. The change in inpatient and observation requirements has also led to an increase in ED volumes as EDs are often the place patient status is determined and increases the volumes and length of ED visits. These researchers have also showed that primary care interventions in a patient’s medical path may reduce visits to the ED.

In the midst of the pandemic, we have seen a sudden shift in patient behavior as ED volumes have plummeted. Patients are using other care options such as primary care physicians, telehealth, or visits to a specialist rather than the ED.  ED injury visits are down, in large part because people are staying home more and have fewer opportunities to injure themselves. There is also confusion about access to EDs, with some patients mistakenly believing that hospitals are closed to non-COVID patients. 

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