A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings

Abstract

Background Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center—the largest hospital in the Department of Defense—to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting. Materials and Methods We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances. Results During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent. Conclusions Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.

Implementation of the Acute Care Clinic Easy Scheduling System at the Brooke Army Medical Center

“…We used the information gathered in previous phases to pilot an alternate appointment scheduling system. 10 , 14 Previous studies have shown that ED overcrowding is a worldwide issue. 8 , 9 Phase 2 of this study involved interviewing patients to the ED, 35% of patients stated that their reasoning for reporting to the ED was the inability to get a timely appointment.…”

“… 8 , 9 A previous study by some of these same authors had similar findings in the same ED at the Brooke Army Medical Center (BAMC). 10 Civilian EDs have a unique obligation to serve all patients in need without considering their ability to pay. 11–13 However, all of the requirements of the Emergency Medicine Transfer and Active Labor Act do not necessarily apply to the MHS.…”

“…Our results showed that over half (59%) of patients were determined to be potentially manageable in a primary care setting. 10 …”

“…We sought to build our previous work 10 and develop a method for patients presenting to the ED to fill unused same- or next-day primary care appointments in lieu of an emergency visit using a real-time tracking system.…”

Analysis of Saturation in the Emergency Department: A Data-Driven Queuing Model Using Machine Learning

“…Staffing planification will form the key strategy of this optimization (11), and will be completed with other complementary strategies. These strategies will consider reorganization of the triage process (12), and the redirection of non-emergent cases (13), toward alternative unscheduled primary care services.…”