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“Avoidable” ED Visits Tend to Fall Into Mental Health, Dental Categories

A study looking at more than 400 million visits to U.S. emergency departments (EDs) over a six-year period determined that 3.5% of them were “avoidable.”

An article published in the International Journal for Quality in Health Care listed the top three discharge diagnoses falling into that category. Researchers from the University of California, San Francisco report that the patients were most likely to be diagnosed with alcohol abuse, dental disorders, and mood disorders such as anxiety or depression.

What is the solution? The authors suggest a first step might be to increase access to dental and mental health facilities.

To come to that conclusion, the study team reviewed 424 million ED visits by adults up to age 64 from 2005 to 2011. For purposes of the study, “avoidable” was defined as cases where there was no requirement of diagnostic or screening services, procedures, or medications, and the patients were discharged home.

Results indicate that 6.8% of all avoidable visits were caused by alcohol-related or mood disorders, and 3.9% of all avoidable visits were related to disorders to the teeth and jaw. Interestingly, 14% of avoidable visits involved patients delivered by ambulance.

“The top five chief complaints included toothache, back pain, headache, other symptoms/problems related to psychosis, and throat soreness,” study authors note. “Alcohol abuse, dental disorders, and depressive disorders were among the top three ICD-9 discharge diagnoses.”

The researchers suggest their efforts to “better characterize and understand the nature of a very conservative definition of ‘avoidable’ emergency department (ED) visits in the United States” can help policymakers develop interventions to decrease nonurgent ED visits.

“A significant number of ‘avoidable’ ED visits were for mental health and dental conditions, which the ED is not fully equipped to treat,” they conclude. “Our findings provide a better understanding of what policy initiatives could potentially reduce these ‘avoidable’ ED visits to address the gaps in our healthcare system, such as increased access to mental health and dental care.”