Alcohol Abuse, Mental Health Top List of Avoidable ED Visits

The top 3 “avoidable” International Classification of Disease, ninth revision (ICD-9) diagnoses of visits to US emergency departments (EDs) are alcohol abuse, depressive disorders, and dental disorders.

A study examining 424 million visits to US EDs by patients aged 18 to 64 years from 2005 to 2011 defined “avoidable” ED visits as visits that “did not require any diagnostic or screening services, procedures or medications, and were discharged home,” finding that 3.3% of all ED visits met the definition (95% CI: 3.0—3.7).

Using the National Hospital Ambulatory Medical Care Survey, they found that 14% of ED patients arrived by ambulance.

While EDs are not fully unequipped to treat dental disorders, emergency physicians are not effectively trained to treat patients for substance abuse and mental health issues, according to the study’s authors, Renee Hsia (pictured), MD, and Matthew Niedwiecki, PhD, of the Department of Emergency Medicine at UC San Francisco.

In total, alcohol-related disorders and mood disorders accounted for 6.8% (95% CI: 5.7—8.0) of “avoidable” visits, suggesting a need to ease the pressure of ED physicians by reducing the gaps in available provisions for treatment of mental health and dental care. On their own, alcohol abuse accounted for 3.0% of total visits, while mood disorders covered the remaining 3.8%.

Of the alcohol-related disorders in ED visits, 10.4% (95% CI: 7.7—13.1) were considered "avoidable," while 16.9% (95% CI: 13.5–20.2) of mood disorders were tagged with an avoidable designation.

“Our findings serve as a start to addressing gaps in the US healthcare system, rather than penalizing patients for lack of access, and may be a better step to decreasing ‘avoidable’ ED visits,” Hsia and Niedwiecki wrote.

The top 5 complaints outside the ICD-9 diagnoses considered “avoidable” ED visits were toothache, back pain, headache, symptoms/problems related to psychosis, and throat soreness.

Additionally, the study authors "also excluded visits where tests or procedures were blank/missing and those that did not receive care, including patients who left before triage, medical screening, or being seen, walked out, were not seen by a physician, left against medical advice, were not authorized to received treatment, were transferred to another facility, or saw another specialist."

The findings were published online in the International Journal for Quality Health Care.

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