Health policy and clinical practice/original research
A Profile of US Emergency Departments in 2001

Presented as a poster at the Society for Academic Emergency Medicine annual meeting, May 2004, Orlando, FL.
https://doi.org/10.1016/j.annemergmed.2006.08.020Get rights and content

Study objective

Emergency departments (EDs) provide round-the-clock emergency care but also serve as a health care “safety net.” We seek to determine the number, distribution, and characteristics of US EDs, with a long-term goal of improving access to emergency care.

Methods

We created an inventory of nonfederal nonspecialty US hospitals using 2001 data from 2 independent sources. Hospitals that did not report ED visit data, or with large changes in visit volume by 2003, were contacted to obtain or verify visit volume (n=437; 9% of all hospitals). EDs were divided into 2 groups: those with at least 1 patient per hour, 24 hours per day, 7 days per week (≥ 8,760 visits/year) and those with fewer visits.

Results

Of 4,917 hospitals, 4,862 (99%) reported an ED. These EDs collectively received 101.6 million visits. One in 3 EDs (n=1,535) received less than 8,760 visits per year; the national median was 15,711 visits per year. Excluding the low-volume EDs, the remaining 3,327 reported 95.2 million annual visits. The typical higher-volume ED received approximately 28,000 visits per year; 28% (n=922) were in a nonurban setting. Among all EDs, per-capita visits varied by state, with the highest ED visit rates in Washington, DC; West Virginia; and Mississippi.

Conclusion

Significant variation exists in the distribution and use of US EDs. One third of EDs have an annual visit volume less than 8,760 and, together, they account for 6% of all visits. The United States should consider classifying EDs, as it does trauma centers, to clarify the type of care available in this heterogeneous clinical setting and the distribution of different types of EDs.

Introduction

The emergency department (ED) provides round-the-clock emergency care and also serves a “safety net” function for many individuals in the United States.1 Given this dual role, the ED has become the focus of a growing number of public health initiatives. Despite this attention, a great deal of basic information about EDs remains unknown. The number, distribution, and basic usage patterns of US EDs have not been well characterized. Previous studies have focused on emergency services within a localized area2, 3 or have had national scope but lacked geographic specificity.4, 5, 6 Despite the importance of answering essential questions about the current status of US EDs, the task has largely been overlooked.

The need for a more rigorous study of emergency care in the United States was formally stated in a 1995 Josiah Macy Jr. Foundation report titled “The Role of Emergency Medicine in the Future of American Medical Care.”7 In particular, the report suggested the adoption of a classification system with which to categorize, and thus assess, emergency care in the United States. Since 1995, several recommendations from the Macy report have been addressed, but the recommendations about ED classification have received less attention.8 In 1999, the Society for Academic Emergency Medicine Emergency Center Categorization Task Force developed a classification system directed toward academic medical centers.9 Even among academic centers, however, few accepted the “challenge” to get certified because certification provided no tangible benefit.10 Thus, classification of US EDs has not been achieved, and consequently, the capabilities of US EDs remain unknown.

To address this information gap, the Emergency Medicine Network (EMNet) at Massachusetts General Hospital created a comprehensive database of US EDs. The database, called the National Emergency Department Inventory, accounts for every hospital in the nation, as of 2001. Similar inventories have been created for trauma centers but, to our knowledge, never for EDs.11 We created the National Emergency Department Inventory to determine the number, distribution, and other basic characteristics of US EDs, with a long-term goal of determining the general capabilities of all US EDs and improving access to emergency care.

Section snippets

Data Collection and Processing

The National Emergency Department Inventory was developed by integrating data from 3 sources: the SMG Marketing Group’s Hospital Market Profiling Solution Database Fourth Quarter 2001 Release (referred to hereafter as the SMG Database), the 2001 American Hospital Association Annual Survey of Hospitals (referred to as the AHA Annual Survey), and information collected independently by EMNet staff.

The SMG Database is a commercially available data set widely used for health care research in both

Results

Of the 4,917 hospitals studied, 4,862 (99%) reported having an ED. Among these EDs, there were a reported 101.6 million total visits in 2001 and a median annual visit volume of 15,711 (IQR 6,787 to 29,458). Annual visit volume varied greatly among EDs (Figure 1). EDs in the lowest quartile received less than 6,789 visits per year, whereas EDs in the second quartile received between 6,789 and 15,711 visits. EDs in the third quartile received between 15,712 and 29,457 visits, and those in the

Limitations

The National Emergency Department Inventory has several potential limitations. At this point, we have only limited data available about each ED. Our long-term goal is to perform simple, short surveys to enhance the database and to monitor ED changes over time. Furthermore, the National Emergency Department Inventory alone cannot answer causal questions about observed differences in ED use. We do not know, for example, if there is high per-capita ED use in southern states because there are many

Discussion

The 2001 National Emergency Department Inventory provides a profile of 4,862 EDs in the United States and reveals substantial diversity in ED distribution and usage. An overview of the National Emergency Department Inventory data, including state-specific ED statistics (total number of EDs, median number of ED visits, IQR, and total number of ED visits), is available at http://www.emnet-usa.org/nedi/nedi_usa.htm. These EDs collectively received 101.6 million total visits in 2001. This total

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    Supervising editor: Brent R. Asplin, MD, MPH

    Author contributions: CAC conceived the study and obtained research funding. BSA, DJP, RWS and CAC designed the study. AFS, SC, and CAC supervised study implementation, including data collection. IBR and CJA conducted data collection. SC analyzed the data. AFS drafted the article, and all authors contributed substantially to its revision. CAC takes responsibility for the paper as a whole.

    Funding and support: Supported by a grant from EMF Center of Excellence Award, Dallas, TX; and Agency for Healthcare Research and Quality R01 HS13099, Rockville, MD.

    Publication dates: Available online October 27, 2006.

    Reprints not available from the authors.

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