A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings

• Published in: Military medicine 2022-08, Vol.187 (9-10), p.e1153-e1159
• Main Authors: Tapia, Ashley D, Howard, Jeffrey T, Bebo, Natasha L, Pfaff, James A, Chin, Eric J, Trueblood, Wesley A, April, Michael D, Long, Brit J, Long, Adrianna N, Fernandez, William G, Schauer, Steven G
• Format: Article
• Language: English
• Subjects: COVID-19; Patients; Primary care
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usab553

ABSTRACT Background Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center—the largest hospital in the Department of Defense—to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting. Materials and Methods We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances. Results During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent. Conclusions Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.