Between 2009 and 2018, ED visits per 100,000 people remained relatively stable, only with minor fluctuations. The types of visits also matched this trend, with amounts of treat-and-release, admission, and mental health/substance use disorder visits remaining relatively unchanged throughout the same period. Adults over 65 were one of the most likely groups to report to the ED, as well as young adults ages 18 through 24.
Despite a decade of stability in the number of ED visits, the Covid-19 pandemic dramatically decreased the number of people presenting to the ED in search of care. At the lowest point, hospitals experienced only 50% of historical volumes and have only recovered to 75% since. Despite lower visit rates, hospitals had as many as 55% more admissions than expected, indicating that while fewer people presented to the ED, those who did had more severe illnesses. Even low-acuity conditions like conjunctivitis and dermatitis saw substantially more admissions than the amount predicted.
Predictions on when patient volume may return to normal often contrast with each other. Dr. Anthony Fauci predicts that things may return to normal by the end of the year, should enough people get vaccinated to achieve herd immunity. Further analyses suggest it will be a while before volume returns to pre-pandemic levels, with 2021 a continuation of low patient volumes of 2020. Given the demographics most likely to present to the ED, the latter prediction makes sense. Patients over 65 are more likely to suffer severe complications of Covid-19 infections, making them less likely to put themselves at risk for infections by visiting an ED. Data suggests that patients are waiting longer to seek treatment or avoiding treatment for cases they deem to be mild.
Pre-pandemic, relatively stable patient volume made it easier to predict and plan for patient demand. However, Covid-19 has made it difficult for hospitals to maintain operational balance and financial viability. Many states, enacting restrictions on nonessential and elective services, contributed to the challenges faced by hospitals. Without those services and procedures, it eliminated an additional revenue stream that hospitals rely on.
To combat the effects of fluctuations in patient census levels, hospitals can turn to ED management partners to address patient care needs and implement innovative technologies to further improve care delivery. Before the pandemic, ED management companies were often relied on to recruit physicians, especially in rural areas where there is a limited number of providers. While some ED management companies have turned to their hospital partners for subsidies to recoup lowered profits, hospitals have been reluctant to pay without financial transparency.
However, smaller ED management companies can be better equipped to meet the diverse needs of their hospital partners. By providing partner hospitals with complete financial transparency, smaller ED management companies have a strong track record of providing physician stability for local hospitals retaining great providers and implement proven ED process improvement methodologies. In addition, an experienced ED management company can help partner hospitals efficiently implement additional technologies to improve care delivery.
Hospitals can improve patient care by implementing telehealth-enabled remote patient monitoring. Providers can triage, assess, and monitor patients at home, improve patient satisfaction and introduce additional sources for reimbursement to the hospital. After discharge, providers can follow up with patients at home to ensure treatment regimens are being followed and how these two tie together, maybe separate points physicians can see more patients in the ED. Telehealth and remote patient monitoring allow vulnerable patients to stay safe from Covid-19.
ED management companies are also well-equipped to implement technologies that improve throughput, a common pain point for patients and providers alike. EDs commonly have backlogs of patients waiting to be seen, causing stress, long waits, and overcrowding. Throughput technologies allow providers to get a picture of the patients waiting to be seen in the ED and request a hospitalist to evaluate them for admission. These technologies are particularly useful in increasing communication between providers and hospitalists and improving patient satisfaction and outcomes.
With a strong partnership with an ED management company, hospitals can better address the changes in demand while implementing new strategies to improve care. There is still uncertainty as to when patient volumes will return to pre-pandemic levels. However, with vaccination efforts underway and states beginning to relax Covid restrictions, it is only a matter of time before hospitals can regain stability.
Photo: pablohart, Getty Images