Avoidable ED Visits: Identification over Quantification

Avoidable Emergency Department (ED) visits are difficult to define but of vital interest to ED reimbursement and profit. A newly released study¹ from UCSF Department of Emergency Medicine estimated “avoidable” visits comprise 3.3% of ED visits. Some have hailed the study as evidence that avoidable ED visits are a “myth,” claiming there is no basis to challenge ED visit reimbursements for these visits.² In reality, we should take a more nuanced view of this conclusion.

Calculating the proportion of avoidable ED visits is subjective, and no single study estimate can capture the complexity of defining and measuring avoidability. Past research illuminates the subjectivity with prior estimates ranging from 5 to 90% depending on methodology, for example, hospital admissions or triage scores.³ The UCSF study chose an intentionally restrictive definition of avoidable visits as any visit “not requiring any diagnostic tests, procedures, or medications.” For example, this definition does not capture a patient who had a simple sore throat, was given ibuprofen for pain, and then discharged with instructions to see their primary doctor.

The debate about the exact proportion of avoidable visits distracts us from a more important question: whether patients are receiving the best quality care at the lowest cost, both to the system and the patient. Where should that sore throat really go to get the “right thing, at the right time, in the right way, for the right person”?⁴ The “right way” for a patient with a simple sore throat is a lower acuity setting like the primary doctor or an urgent care where they could likely get seen faster, more cost effectively, and without competition with sicker patients.

Avoidable ED visits exist. Instead of trying to decide if the proportion of avoidable visits is large enough to be an issue, let us focus on identifying the “right way” for each patient.

For more posts, see on my blog Margin and Mission.

References

Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care 2017;1–4.
Minemyer P. Only 3% of emergency room visits may truly be avoidable, study suggests [Internet]. Fierce Healthcare. 2017 [cited 2017 Sep 29];Available from: http://www.fiercehealthcare.com/healthcare/just-3-er-visits-may-truly-be-avoidable-study-suggests
Durand AC E al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. – PubMed – NCBI [Internet]. [cited 2017 Sep 29];Available from: https://www.ncbi.nlm.nih.gov/pubmed/20825838
Your Guide to Choosing Quality Health Care: A Quick Look at Quality [Internet]. [cited 2017 Sep 29];Available from: https://archive.ahrq.gov/consumer/qnt/qntqlook.htm