Preventable Emergency Department Visits

A preventable emergency department (ED) visit occurs when a patient seeks ED treatment for a health condition that can be treated in a non-emergency setting or avoided due to previous preventive care.1 Many factors contribute to patients seeking ED care for non-emergencies. For instance, a 2012 BMC Health Services Research study identified three consistent themes linked to ED misuse: patient belief that visits will satisfy an immediate need such as pain alleviation; the presence of barriers to care access from primary care providers or other outpatient treatment; patient perception that an ED visit is convenient.2 It is estimated that as many as 20 percent of ED visits for non-emergency conditions could be resolved in a retail clinic or urgent care center, an outcome that could generate as much as $4.4 billion in annual cost savings.3 To examine preventable ED visits in Virginia, the VHHA Analytics Team leveraged the All-Payer Claims Database (APCD) – it contains 99 percent of Medicare and Medicaid claims and roughly 50 percent of commercial claims – to conduct an analysis of trends in the Commonwealth. Key findings from the analysis of 2016 data demonstrate that diagnoses for sprains, urinary tract infections, and acute bronchitis were the top three conditions associated with preventable ED visits. Those conditions account for 66 percent of the top 10 conditions linked to preventable ED visits in Virginia. Evaluating the data on a regional basis, the Eastern region (most populous) and the Southwestern region (least populous) are the top areas of the state for preventable ED visits, accounting for 47 percent of all such visits identified in the state. An assessment of peak activity reveals that Virginia saw a spike in preventable ED diagnoses in March 2016, followed by a downward trend in the summer months, then an uptick during the winter. (6/22)