Trends in Emergency Department Capacity and Utilization (2005 -2022): An Update from California, Pre- and Post-COVID-19
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Abstract
This study investigates long-term trends in hospital emergency department (ED) capacity and utilization in California, focusing on the impact of the COVID-19 pandemic. Utilizing data from the California Department of Health Care Access and Information (HCAI) and the U.S. Census Bureau, we analyzed trends over an 18-year period (2005-2022), segmented into pre-pandemic (2005-2019), pandemic (2020-2021), and post-pandemic (2022) phases. Adjusting for population growth, our findings indicate a 7.3% decrease in total admissions and a 14.0% reduction in total inpatient days. Conversely, ED visits increased by 16.1%. Despite an 8.5% decrease in the number of hospitals with EDs, ED treatment stations expanded by 36.3%. The average number of ED visits per treatment station decreased by 10.2%, suggesting improved capacity utilization. Additionally, the number of hospitals with designated trauma centers increased by 11.5%.
The COVID-19 pandemic significantly disrupted these trends, initially causing sharp declines in ED visits and total admissions in 2020. However, by 2022, ED visits and inpatient days rebounded close to pre-pandemic levels. The pandemic also accelerated the adoption of telehealth, which partially offset the burden on EDs. Despite this, the average inpatient length of stay increased, indicating more complex or severe cases requiring longer hospitalization.
Overall, our study highlights the critical role of EDs in hospital operations, with a growing reliance on EDs for hospital admissions, which rose from 43% in 2005 to 68% in 2022 for non-maternity patients. These findings underscore the need for strategic planning to enhance ED capacity and efficiency, ensuring resilience against future public health emergencies. The economic implications of rising healthcare costs and the essential nature of ED services in contract negotiations with commercial health plans are also discussed, emphasizing the strengthened bargaining position of hospitals due to the indispensable nature of emergency services. Further research is needed to explore alternative care models and payment schemes to improve efficiency and reduce healthcare costs.
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