Many ED Visits Not the Closest, Study Says

Megan Brooks

March 19, 2015

When in need of an emergency department (ED), Americans do not always head to the closest one, according to a new data brief from the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS).

"EDs definitely would want to know where their patient populations are coming from. There may be an assumption that they are strictly coming locally, but we are definitely seeing that patients are traveling, for whatever reasons, to go to EDs that are further away," first author Amy M. Brown, MPH, told Medscape Medical News.

Brown and colleagues at the Centers for Disease Control and Prevention analyzed data on more than 50,000 ED visits in the United States, using the 2009-2010 National Hospital Ambulatory Medical Care Survey.

"One of the key aspects of the [survey] is trying to understand healthcare trends, and certainly one of those trends is finding out where patients access care," Brown said.

"This analysis shows that not everyone is going to the closest ED, and this is more so the case in the more populated areas. Some of this may be due to the fact that there just is a higher number of EDs to choose from in the more populated areas, and in rural areas they are going to the closest one because that's the one that is available," Brown explained.

The researchers note in the brief that from 1991 through 2010, the number of ED visits in the United States increased 44%, whereas the number of hospital EDs declined 10%, which contributed to ED overcrowding and longer wait times.

However, until now, little was known about which ED patients visit, how often they go to the ED closest to their home, and how differences in geography, patient demographics, and hospital characteristics influence ED selection patterns.

The new analysis shows that in 2009 to 2010, visits to EDs occurred an average of 6.8 miles from the patient's residence, whereas the nearest ED was 3.9 miles from the home; less than half of all ED visits (43.8%) occurred at the ED closest to where the patient lived.

ED visits within more populated areas (50,000+ residents) were less apt (37.2%) to take place at the closest ED compared with visits outside of these areas (70.1%).

The survey also revealed "some interesting associations" with age, hospital size, and waiting times, Brown said. Within the urban areas, visits that did not take place at the closest ED occurred more often among younger patients, at larger hospitals, and in EDs with longer waiting times compared with visits to the closest ED.

"Waiting time doesn't seem to be a big enough draw away from the closest ED that they are even bypassing hospitals that are closer and have a shorter waiting time and going to other, further away EDs," Brown noted. "If they didn't go to the closest one, they did go to larger hospitals, so patients might be thinking bigger is better."

She emphasized that more research is needed to "tease out" what factors are contributing to the trends identified.

A limitation of the data is that only straight-line distances (not actual driving time) between patients' Zip codes of residence and ED addresses were calculated, and that where patients were actually coming from at the time of the ED visit was not taken into account. In some instances, the patient may have been away from home (eg, at work or school or on vacation) before traveling to the ED.

Emergency Department Visits and Proximity to Patients’ Residences, 2009–2010. NCHS Data Brief No. 192. Published online March 19, 2015. Full text


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