The Role of Emergency Departments
Emergency departments (EDs) play a key role in the nation’s health care system, according to a RAND Corporation study commissioned by the Emergency Medicine Action Fund, and policy-makers should pay closer attention to their operations—particularly their role as a “gateway to inpatient treatment.” It also is important to better integrate EDs into inpatient and outpatient settings, the new report says.
EDs have become an important source for hospital admissions. Nearly all of the inpatient admissions growth between 2003 and 2009 was due to an increase in scheduled admissions from EDs, the report finds, particularly among Medicare beneficiaries. As a result of this shift, ED physicians served as the major decision makers for approximately half of all hospital admissions.
The study also finds that most patients visited the ED for a non-emergent health problem because they believed they lacked a viable alternative or because they were sent by a health care provider. “Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves,” the report says. EDs also support primary care practices by performing complex diagnostic workups.
“Evidence generated by our study and other published work indicates that efforts to reduce non-emergent and non-urgent use of EDs are most likely to succeed if they focus on providing convenient and affordable options outside the ED, rather than directing ED staff to turn patients away,” the study concludes. EDs should be better integrated into inpatient and outpatient settings through more interconnected health information technology, greater user of care coordination, and interprofessional collaboration.