Hospital emergency departments are on the front lines of healthcare, equipped with the specialists and resources necessary to provide critical care to patients facing sudden illness or severe injury.
As well-equipped as these facilities are, however, most patients seeking care in emergency departments do so for non-emergency medical events.
Every medical encounter in an emergency department/emergency room (ER) produces data that can help hospital leaders and providers understand the needs of their patients. We’ve analyzed these data to examine how patients use hospital emergency departments.
Check out the list below to see the most common diagnoses behind ER visits in the U.S.
Most common ER diagnoses in 2021
||Contact with and (suspected) exposure to COVID-19
||Chest pain, unspecified
||Shortness of breath
||Other chest pain
||Unspecified abdominal pain
||Essential (primary) hypertension
||Nausea with vomiting, unspecified
||Urinary tract infection, site not specified
||Dizziness and giddiness
||Acute upper respiratory infection, unspecified
||Unspecified injury of head, initial encounter
||Syncope and collapse
||Altered mental status, unspecified
||Other nonspecific abnormal finding of lung field
Fig. 1 Data from Definitive Healthcare's HospitalView product, using all-payor claims data from CY 2021.
What causes the most emergency room visits?
Even as the Centers for Disease Control and Prevention announced the lifting of certain COVID-19 guidelines, the pandemic remains a concern for many communities across the U.S.
In fact, our data show how this concern was even greater in 2021, when exposure to COVID-19 was the top reason for patients’ ER visits. Coronavirus exposure prompted more than 8.1 million trips to the emergency department that year, or about 18% of the 44,328,007 total visits on our list.
Chest pain and shortness of breath were the second and third most common reason for ER visits in 2021, with over 3.8 million and 3.3 million diagnosis claims respectively.
As symptoms of serious conditions like heart attacks, pleurisy, pneumonia, hypertension, and more—including COVID-19—chest pain and shortness of breath are not to be taken lightly. However, these symptoms are more often caused by milder concerns like muscle strain, tissue inflammation, bruised ribs, and other non-life-threatening injuries.
COVID-19 itself takes the number four spot on our list, leading to more than 2.9 million ER visits in 2021.
How ERs serve rural patients
Patients living in rural areas of the U.S. often use care facilities and ERs differently than urban patients. There are likely to be fewer urgent care facilities in regions with a low population density, leaving patients to rely on hospital emergency departments for unexpected care.
Unfortunately, this often includes chronic care management. If patients do not have regular access to specialists, they are more likely to bring themselves and their family members to the nearest hospital emergency department for rapid treatment of their symptoms.
Rural patients are also more likely to be uninsured, further restricting the care they can access. However, even those with insurance may have difficulty finding covered providers within a reasonable distance of their homes, preventing them from seeking care outside their local ER.
According to a 2019 study from the University of New Mexico, rural emergency department visits rose from 16.7 million to 28.4 million between 2005 and 2016—a difference of more than 70%. In the same time period, urban hospital visits grew by just under 19%.
Even in urban areas, emergency departments are often overcrowded, with some patients waiting upwards of two hours. In many cases, these extended wait times are due to patients seeking treatment for non-life-threatening issues (as seen in the table above) such as chronic pain, sprains, fractures, and other ailments better suited to urgent care centers.
Addressing long ER wait times
Avoidable emergency room visits like those listed can lead to the delay of medication administration and other treatments for patients in imminent danger from more serious injuries. Often, patients simply aren't sure what constitutes an emergency department visit rather than a trip to urgent care—some patients may not even be aware there is a difference between the two care centers.
To reduce wait times and improve care outcomes, some hospital ERs are employing telehealth software. Patients are assessed by an NP or PA upon arrival for stability, and lower-risk patients are eligible to consult with an in-network physician at another location.
New York Presbyterian Weill Cornell Medical Center (NYPWC) launched a telehealth service in July 2016. Within one year, emergency department wait times plummeted from an average of 150 minutes to 18 minutes, according to Definitive Healthcare data. This program was considered such a success that NYPWC expanded it by launching the Hauser Institute for Health Innovation in 2019.
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