Hailey Ruplinger, BS; Nancy Jacobson, MD; Taylor Sonnenberg, MD, MSGH; Lauren Nickel, PhD; Sehr Khan, MD; Ashley Pavlic, MD, MA
WMJ. 2025;124(4):352-356.
ABSTRACT
Introduction: Emergency department (ED) visits have increased steadily since 2021, affecting patients, families, health care workers, and insurance companies through burnout and rising costs. Thus, limiting unnecessary visits is imperative. The first step is to gain better understanding of the patients presenting to the ED for nonemergent services and the reasons behind their visits. The Area Deprivation Index (ADI) is a useful tool to gauge the impact of social determinants of health play on health care decision-making. It measures factors including income, education, employment, and housing quality and uses these data to rank neighborhoods by socioeconomic disadvantage (1 = least disadvantaged, 100 = most disadvantaged). This study reviews the demographics and diagnoses of patients presenting to the ED for nonemergent concerns.
Methods: Data were collected and analyzed in a retrospective cohort study of adults aged 18 and older from a single ED for a week in June and a week in November 2022. Data were filtered to include only unnecessary visits. Each visit was analyzed by 1 reviewer and deemed “unnecessary” based on procedures performed and medications administered. Data were analyzed for patient demographics and top diagnoses and were compared with necessary ED visits during the same time frame.
Results: The most common diagnoses for unnecessary ED visits were generalized pain, abdominal pain, and cold or flu-like symptoms. The average patient age was 39 years (SD, 15.73); most were single, employed full time, and lived in areas with a high ADI. Most patients had a primary care physician on file and were insured through Medicare or Medicaid. A majority of patients were Black and non-Hispanic. Compared with necessary ED visits, there were statistically significant differences in age, race, and employment status. All demographic data were self-reported and entered into patient chart by registration staff. The study site is located next to a children’s hospital; therefore, no pediatric patients were seen in this ED.
Conclusions: This study identified common chief complaints and demographic factors associated with ED encounters that did not require ED-specific resources. Understanding these patterns is the first step in designing education and resources to help patients and outpatient providers reduce unnecessary ED utilization.