Analysis: The public may not be wrong to think of the ED as the ‘front door’ of the hospital

A significant slice of U.S. hospitals saw inpatient volumes rise 3% over the past year. Probably not coincidentally, the share of those patients entering through the emergency department increased, which may suggest that swaths of the public view the ED as the “front door” of the hospital.

The perception is probably more pronounced in community hospital EDs than their academic counterparts. 

The difference may owe to a greater share of inpatient discharges originating from the ED in community settings (78%) compared to academic medical centers (66%), “underscoring the ED as the primary entry point for community hospitals.”

The findings and commentary are from the Vizient consultancy Sg2 Intelligence, which posted an analysis of Vizient’s latest “System of Care” framework May 6. 

Vizient supports some 65% of U.S. hospitals, its aim being to help provider organizations optimize care quality while holding the line on costs, so its cohort of analyzed hospitals is a fairly reliable representation of U.S. hospitals as a whole. 

The May 6 analysis doesn’t concentrate solely on the ED–inpatient pipeline. Other key takeaways include: 
 

1. Patient access shapes utilization patterns. 

Wait times for new patients remain elevated across all top-volume specialties, the authors report. “With overall evaluation and management visits projected to grow at 17% over the next decade,” they add, “expanded access strategies and alternative care models are essential.”

 

2. Driven by emergency visits, ED volumes continue to rise. 

Emergent visits are growing faster than urgent visits, while ED length of stay has declined significantly, Sg2 finds. “This suggests improved throughput, though shifts in patient mix may also be contributing.

 

3. Quality performance is mixed.

Mortality rates continue to improve, but readmissions continue to rise. Meanwhile, “increasing direct costs per case and per day are adding pressure to maintain quality while protecting hospital margins,” the authors observe. “Although inpatient average length of stay declined slightly, cost per stay and per day increased, suggesting rising care intensity and cost pressures despite shorter hospital stays.”

 

4. Post-acute discharges are trending upward. 

As a result, planning strategies should include close collaboration with post-acute providers to ensure adequate capacity—“particularly as demand increasingly originates outside the traditional inpatient discharge process and substantial growth is projected in the coming years.”

5. Cost pressures persist across both community hospitals and academic medical centers. 

However, costs per stay and per day are rising faster at academic sites than at community hospitals. Academic medical center costs remain substantially higher, with about 74% more per stay and nearly 37% more per day, “which likely reflects greater case complexity and resource intensity,” the authors note.

Full report with detailed data here.