Research reveals what characterizes avoidable and preventable visits to emergency departments

Many patients visit emergency departments for basic care, contributing to longer waiting times and rising health care costs. Recent results shared from a study conducted by Madelyn Schmall, a third-year medical student in The Ohio State University College of Medicine, and colleagues, show that a  survey rates this care as avoidable – meaning care could have been received elsewhere – or preventable, meaning with earlier access to resources, patients may not have needed medical treatment.  

The emergency department (ED) is often inundated with large groups of patients who seek basic care for many reasons: limited access to primary care, concern with severity of symptoms, referral for imaging and testing, financial and insurance barriers and geographic accessibility. The increasing patient load and complex healthcare demands have put a significant strain on ED infrastructures, and existing strategies to categorize visits may overlook patient factors, as many rely primarily on chart data.  

Schmall’s and her colleagues’ cross-sectional study, “Characterizing the Avoidable Emergency Department Encounter,” surveyed patients and medical care providers and asked them to rate whether an ED visit was avoidable or preventable – they then looked at how often they agreed on these ratings. Of the 112 patients enrolled in the study, 80% of respondents had both a complete patient survey and a provider survey to review.  

The study found that: 

• 28% of patients and 54% of providers rated the visit as avoidable, with a 53% agreement rate. 
• Of the patients who reported that they may have been cared for at another location such as at an office visit or in an urgent care facility, they stated they selected the ED due to convenience (40%) and symptom acuity (28%). 
• Patients reported that reasons for requiring the ED were: symptom acuity (29%), referral from another provider (27%), and convenience (23%). By contrast, providers reported reasons patients needed the ED as: need for rapid lab tests (28%), need for rapid imaging (23%), symptom acuity (21%), and referral from another provider (21%). 
• Both providers and patients who stated that care could have been received at another location most often selected urgent care and primary care as the top alternate locations. 
• 12% of patients and 29% of providers rated the ED visit as preventable with earlier resources, with a 72% agreement rate. 
• Patients most identified the following resources that may have prevented their need for care: lifestyle changes (64%), access to medications (36%) and access to primary care (36%). 
• Providers most often identified: access to primary care (50%), other (30%), and improved adherence to treatment plan (20%). 

The study results show that efforts to reduce ED burden should address both clinical and nonclinical factors influencing patient decision-making. Further research by Schmall and the team will review discharge data, chart data, and billing and coding in order to develop more targeted interventions to build strategies for improvements.