Mental Health, Alcohol Abuse Top Causes of Avoidable ED Visits

Megan Brooks

September 01, 2017

A significant number of "avoidable" visits to US emergency departments (EDs) are for mental health and alcohol problems, as well as dental problems, which the ED is not fully equipped to treat, a new study shows.

"Emergency physicians are trained to treat life- and limb-threatening emergencies, making it inefficient for patients with mental health, substance abuse, or dental disorders to be treated in this setting," say Renee Hsia, MD, and Matthew Niedzwiecki, PhD, from the Department of Emergency Medicine, University of California, San Francisco.

Their study was published online August 31 in the International Journal for Quality in Health Care.

Using the National Hospital Ambulatory Medical Care Survey, the researchers analyzed data on 424 million visits made to US EDs between 2005 and 2011 by patients aged 18 to 64 years.

The researchers "conservatively" defined "avoidable" ED visits as discharged ED visits that did not require any diagnostic tests, procedures, or medications.

They found that 3.3% of all ED visits met this definition of avoidable. For 14% of these avoidable visits, patients arrived by ambulance.

The top five chief complaints related to these avoidable visits were toothache, back pain, headache, symptoms/problems related to psychosis, and throat soreness.

The top three International Classification of Disease, Ninth Revision (ICD-9) diagnoses of "avoidable" visits included alcohol abuse, depressive disorders, and dental disorders.

When examining diagnoses using the Healthcare Cost and Utilization Project's Clinical Classification Software, alcohol-related problems and mood disorders (depression and anxiety) accounted for 6.8% of all avoidable visits, and disorders of the teeth and jaw accounted for 3.9%.

The researchers also determined the percentages of each diagnosis grouping that met their definition of "avoidable." They found that 10.4% of all alcohol-related visits, 16.9% of all mood disorder-related visits, and 4.9% of all tooth- and jaw-related visits were avoidable.

These findings suggest that policy initiatives could ease pressure on EDs by addressing gaps in the provision of dental and mental health care in order to treat this group of ED patients at a lower cost elsewhere, the researchers say.

The study had no funding. The authors have disclosed no conflicts of interest.

Int J Qual Health Care. Published online August 31, 2017. Abstract

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