title: National Study of Non-urgent Emergency Department Visits and Associated Resource Utilization.
abstract: BACKGROUND
  Reducing non-urgent emergency department (ED) visits has been targeted as a method to produce cost savings. To better describe these visits, we sought to compare resource utilization of ED visits characterized as non-urgent at triage to immediate, emergent, or urgent (IEU) visits.
  
  
  METHODS
  We performed a retrospective, cross-sectional analysis of the 2006-2009 National Hospital Ambulatory Medical Care Survey. Urgency of visits was categorized using the assigned 5-level triage acuity score. We analyzed resource utilization, including diagnostic testing, treatment, and hospitalization within each acuity categorization.
  
  
  RESULTS
  From 2006-2009, 10.1% (95% confidence interval [CI], 9.2-11.2) of United States ED visits were categorized as non-urgent. Most (87.8% [95% CI, 86.3-89.2]) non-urgent visits had some diagnostic testing or treatment in the ED. Imaging was common in non-urgent visits (29.8% [95% CI, 27.8-31.8]), although not as frequent as for IEU visits (52.9% [95% CI, 51.6-54.2]). Similarly, procedures were performed less frequently for non-urgent (34.1% [95% CI, 31.8-36.4]) compared to IEU visits (56.3% [95% CI, 53.5-59.0]). Medication administration was similar between the 2 groups (80.6% [95% CI, 79.5-81.7] vs. 76.3% [95% CI, 74.7-77.8], respectively). The rate of hospital admission was 4.0% (95% CI, 3.3-4.8) vs. 19.8% (95% CI, 18.4-21.3) for IEU visits, with admission to a critical care setting for 0.5% of non-urgent visits (95% CI, 0.3-0.6) vs. 3.4% (95% CI, 3.1-3.8) of IEU visits.
  
  
  CONCLUSIONS
  For most non-urgent ED visits, some diagnostic or therapeutic intervention was performed. Relatively low, but notable proportions of non-urgent ED visits were admitted to the hospital, sometimes to a critical care setting. These data call into question non-urgent ED visits being categorized as "unnecessary," particularly in the setting of limited access to timely primary care for acute illness or injury.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Honigman
authors.affiliation: University of Colorado School of Medicine, Department of Emergency Medicine, Denver, Colorado.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wiler
authors.affiliation: University of Colorado School of Medicine, Department of Emergency Medicine, Denver, Colorado.
authors.forename: Sean
authors.initials: S
authors.lastname: Rooks
authors.affiliation: University of Colorado School of Medicine, Department of Emergency Medicine, Denver, Colorado.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde