Future Utilization and the Emergency Department

April 23, 2014  |  Jon Huddy

Many hospitals recognize that major decisions lie ahead for their emergency departments — beginning with how to meet demand that continues to increase, despite a variety of efforts to reverse the trend.

ED usage soared over the past decade, rising from an average of about 380 ED visits per 1,000 population per year (or ~380/1,000/year) to ~420/1,000/year. Utilization has a direct bearing on the efficiency of an ED, so making sound volume projections for where the numbers are heading, and planning for different contingencies, is essential. Although no one can predict the future, it is possible to make educated projections based on careful analyses of various data, and develop a range of scenarios that can help drive decisions in terms of overall strategy for emergency services, ED design, processes, staffing, and other matters.

Assessing the Data

A good place to begin is understanding the trends affecting ED usage nationwide, and more specifically, the factors affecting ED usage in the hospital’s own state or region. But most important is understanding the demographic, socioeconomic, and market factors that characterize an ED’s own service area and patient population.

There are considerable national trends that affect a hospital’s ED utilization rates. To begin with, looking at demographics, it’s clear that senior patients use EDs at higher rates than say, people in their 20s. This is even more of a challenge, however, because of the tremendous numbers of aging baby boomers, and the fact that lifespans are becoming longer in general.

There are also socioeconomic and cultural factors involved. To cite just one example, consider the wide variation in ED utilization rates between California (with under 300/1,000/year), and West Virginia (with over 650/1,000/year). Determining the reasons for this imbalance could be a study in itself, but two very likely causes are the differences in socioeconomic level and culture/lifestyle (although there are other causes as well). These national trends and averages make it critical to understand the demographic makeup of the specific population residing in an ED’s service area.

Another factor to consider is the size and distribution of other emergency care options in an ED’s local service area, and the market share of each. It’s not only traditional EDs that one must consider; there are also newer alternative models — including freestanding EDs, urgent care facilities, and even stores offering walk-in medical services, such as Walgreens.

The last factor, and the most challenging to quantify, is the Affordable Care Act. One major factor in estimating the ACA’s impact is the tremendous variety of ways it’s being implemented in individual states, and the fluid political forces that are involved. It’s still not yet clear what lies ahead, although we expect that ED utilization rates over the next 3 to 5 years will continue to increase nationally.

Identifying Likely Scenarios

Clearly, there are complex variables at play — yet hospitals need to plan years ahead in order to continue efficiently caring for their patients. Therefore, they must find a way to project where their ED utilization is headed.

In fact, one of the core services that FreemanWhite is asked to perform — whether we’re ultimately redesigning the physical ED environment; helping to rethink processes and roles; or recommending service line strategic changes — is to make projections regarding future utilization. To do so, we draw on the experience of over 380 ED projects, use national databases about ED utilization, apply state-level data, as well as analyze detailed views of population data from multiple sources. We also analyze data about an ED’s specific market, and demographic data about the population living within its primary and secondary service areas.

Using the hospital’s own data, we determine whether ED use is spread more or less evenly across the ED’s service area, or if there are pockets of significantly higher or lower use. In some cases, we may also conduct benchmarking, based on a careful selection of peer facilities to analyze.

Working from the foundation of our collective ED experience, we use advanced modeling software to develop projections of future scenarios based on various assumptions, and provide the hospital with ranges of volume and usage. These projections can serve as the basis for decisions about the facilities themselves, patient management processes, and staffing considerations.

Across all of these areas, these data-driven projections provide more reliable, informed guidance for hospitals facing myriad economic and cultural challenges. As organizations seek to identify opportunities to streamline and to understand their usage trends, an analytics-driven approach can help to develop flexible plans which accommodate changes in the level and type of ED utilization. Equipped with this data, emergency departments can be better prepared for the challenges ahead.

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