Hospital emergency departments are on the front lines of patient care, providing vital information and insights into population health trends. Emergency room (ER) use data can aid hospital leaders and providers in understanding the needs of their patients -- particularly for rural communities.
As seen in the table below, patients primarily seek care at emergency departments for non-emergency medical events. Chest pain is by far the most common reason diagnosis at hospital ERs.
As a symptom of serious conditions like heart attacks, pleurisy, pneumonia, hypertension, and more, chest pain is not a symptom to be taken lightly. However, chest pain is often unrelated to the heart, and can be a symptom of muscle strain, tissue inflammation, bruised ribs, and other non-life-threatening injuries.
Headaches, which take the number 4 spot, play a similar role in alerting patients to potentially life-threatening medical conditions -- but generally not being cause for much concern. Though headaches can be a symptom of serious illnesses like brain tumors and aneurysms, they are often caused by muscle tension, sleep deprivation, and certain medications.
Top 20 ER Diagnoses at Hospitals
|Rank ||ICD-10 Code ||ICD-10 Description ||Est Total Claims |
|1. ||R0789, R079 || Other chest pain, chest pain unspecified ||4,346,349 |
|2. ||J069 || Acute upper respiratory infection, unspecified ||2,504,641 |
|3. ||N390 || Urinary tract infection, site not specified ||1,485,188 |
|4. ||R51 || Headache ||1,346,546 |
|5. ||R109 || Unspecified abdominal pain ||1,300,583 |
|6. ||R55 || Syncope and collapse ||1,084,963 |
|7. ||K529 || Noninfective gastroenteritis and colitis, unspecified ||1,037,738 |
|8. ||R42 || Dizziness and giddiness ||973,404 |
|9. ||M545 || Low back pain ||947,389 |
|10. ||S0990XA || Unspecified injury of head, initial encounter ||936,779 |
|11. ||R112 || Nausea with vomiting, unspecified ||923,386 |
|12. ||J029 || Acute pharyngitis, unspecified ||918,589 |
|13. ||J45901 || Unspecified asthma with (acute) exacerbation ||907,744 |
|14. ||K5900 || Constipation, unspecified ||854,185 |
|15. ||J209 || Acute bronchitis, unspecified ||831,156 |
|16. ||S161XXA || Strain of muscle, fascia and tendon at neck level, initial encounter ||796,144 |
|17. ||R509 || Fever, unspecified ||745,105 |
|18. ||K0889 || Other specified disorders of teeth and supporting structures ||716,165 |
|19. ||R1013 || Epigastric pain ||677,577 |
|20. ||S39012A || Strain of muscle, fascia and tendon of lower back, initial encounter ||655,739 |
Fig 1 Data from Definitive Healthcare's hospitals and IDNs platform using all-payor claims data from CY 2017.
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 centers in regions with a low population density, leaving patients to rely on hospital emergency departments for unexpected care.
Disturbingly, this can include 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 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 percent. In the same time period, urban hospital visits grew by just under 19 percent.
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 unnecessary care or treatment for non-life-threatening issues (as seen in the table above) such as chronic pain, psychosis, sprains, fractures, and other ailments better suited to urgent care centers. 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.
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