High-intensity emergency department visits increased in California, 2002-09

Area of Science:

• Health Services Research
• Emergency Medicine
• Healthcare Policy

Background:

• Emergency department (ED) utilization is rising globally.
• Limited data exists on the severity and distribution of ED visits, especially across different hospital types.
• Understanding trends in high-intensity ED visits is crucial for resource allocation and patient care.

Purpose of the Study:

• To analyze the trends and characteristics of high-intensity emergency department visits.
• To compare the changes in high-intensity ED visits between safety-net and non-safety-net hospitals.
• To investigate the distribution of severe illnesses treated in emergency departments.

Main Methods:

• Retrospective analysis of California emergency department data from 2002-2009.
• Defined high-intensity ED visits by advanced imaging, specialist consultations, multi-system evaluation, and complex decision-making.
• Compared visit rates, intensity levels, and admission patterns across hospital types.

Main Results:

• Total ED visits increased by 25%, while high-intensity visits nearly doubled (87% increase).
• The proportion of high-intensity ED visits rose from 9% to 13%.
• Safety-net EDs experienced a 157% increase in high-intensity visits versus 61% in non-safety-net EDs.

Conclusions:

• A significant trend toward care intensification in emergency departments is evident.
• Safety-net hospitals are disproportionately experiencing increases in high-intensity ED visits.
• These findings highlight potential access-to-care disparities and the evolving role of EDs for severe conditions.