Emergency department overuse: routing low-acuity visits away from the ED with virtual care

Emergency departments (EDs) are a critical component of the healthcare industry in the U.S. They offer a safety net for people with emergent care needs.

But with its 24/7 availability and the increasing expectations of on-demand service, we see more and more people seeking care at the ED. The CDC reports that an estimated 20 percent of U.S. adults visit the emergency room each year, resulting in approximately 141.4 million annual ED visits.

ED use is also increasing relative to availability. The 2012 Health, United States report noted a 34 percent increase in ED visits between 1995 and 2010 – nearly twice the rate of population growth. During that same time, the CDC found that the number of hospital emergency departments decreased by approximately 11 percent. While we’ve seen an increase in free-standing EDs in recent years that has helped redress the imbalance, the rise in demand and reduction in supply are precipitating very real concerns about overuse.

The good news is, there are steps that hospitals and health systems can take to mitigate these issues. Among them, one option for hospitals and health systems is launching a virtual care service. With all the interventions, triage points, and other tactics, how does virtual care fit into a health system’s strategy to reroute patients to a more cost-effective, lower acuity point of care? The answer is that ED overuse really comes down to patient access.

ED Overuse and Access Challenges
Despite its purpose as a safety net for patients needing emergency stabilization, the ED is increasingly being used to combat access barriers. In a 2005 study published in the Journal of Emergency Nursing, three key themes emerged for why patients sought care in the ED: inability to get a primary care appointment, non-physician staff referrals and convenience.

Not much has changed since then. Just this year Merritt Hawkins released a study that found Americans wait on average 24 days for a new patient primary care appointment. Factors such as limited primary care hours, transportation challenges, and lack of insurance can also play a part in patients choosing the ED for non-urgent care. For some patients, using the ED for common complaints becomes routine, as “frequent fliers” are often not advised of alternative care options.

These access barriers increase the use of EDs for non-emergent needs. One study found that only 29 percent of patients required care specific to the ED, with 24 percent of patients not requiring immediate attention and 42 percent needing care that could have been delivered safely and effectively in a primary care setting. This overuse of EDs is driving additional access challenges. The most recent National Report Card on the State of Emergency Medicine rated emergency care access in the U.S. a D-minus – this failing grade is not a confidence-inspiring rating.

The Solution is Virtual
While there are a variety of interventions EDs can employ to reduce overcrowding and overuse, the need for a well-rounded strategy is imperative, especially as ED usage continues to increase. As this issue persists, health systems look to available tactics and technology to address the various factors that drive patients to the ED when emergency care isn’t necessary.

One of the best ways to help reduce ED overuse is by addressing its root cause: access. This is where virtual care comes in. Health systems with a virtual care offering have a built-in answer to the access barriers that often drive patients with non-emergent but important health concerns to seek care in the ED.

Primary care wait times: Routing patients who can be treated online to a virtual care solution addresses the wait time challenge in two distinct ways. First, it provides on-demand access for those patients, and second, transferring patients to an online access point opens up appointment slots in the primary care setting.

Convenience and after-hours care: Virtual care is available on-demand, 24-hours a day. This means that if a patient wakes up with UTI symptoms in the middle of the night, they can complete a visit, go back to bed, and have a diagnosis and treatment plan waiting for them in the morning.

Cost of care and lack of insurance: The Emergency Medical Treatment and Labor Act requires EDs to treat anyone regardless of their ability to pay, making the ED the only viable treatment option for many who are uninsured. Moreover, with high deductible health plans becoming the norm, patients may decide to avoid treatment for common conditions due to cost, increasing the likelihood of developing complications that require an ED visit. Virtual care offers a low-cost option for these patients. Health systems can offer these services at discounted rates or can offer promo codes for free care to patients, making this a viable alternative for the uninsured.

Virtual Care and the ED Going Forward
The ED fills a very specific and vital niche in the care continuum, and the need for EDs is only going to grow. Factors including an aging population and the challenges to accessing primary care services, mean it’s increasingly important that EDs remain focused and available for the most urgent cases. EDs need to not serve as 24/7 urgent care or primary care centers. Implementing virtual care can reduce non-emergent care in the ED, reduce ED wait times for those in need of emergent care, and direct non-emergent cases to a more appropriate and cost-effective level of care .

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