Emergency Department Visits
The national estimates presented in this section of Fast Stats are from the HCUP Nationwide Emergency Department Sample (NEDS). The NEDS is the largest all-payer emergency department (ED) database in the United States, yielding national estimates of hospital-owned ED visits. Hospital-owned EDs are limited to community hospitals, which are defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). The NEDS includes specialty, pediatric, public, and academic medical hospitals. Excluded are long-term care facilities such as rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals.
The NEDS is sampled from the HCUP State Emergency Department Databases (SEDD), which capture information on ED encounters that do not result in an admission (i.e., treat-and-release visits and transfers to other hospitals), and the HCUP State Inpatient Databases (SID), which contain information on patients initially seen in the ED and then admitted to the same hospital. The NEDS approximates a 20 percent stratified sample of U.S. hospital-owned EDs. The NEDS is stratified on the following hospital characteristics: U.S. Census region, trauma center designation, urban-rural location of the hospital, ownership, and teaching status. The NEDS is currently available for data years 2006-2018. Since the initial release of the NEDS, State participation has grown from 24 States in 2006 to 36 States and the District of Columbia in 2018.
Unit of Analysis
The unit of analysis is an ED visit, not a person or patient. This means that a person who visits the ED multiple times in one year is counted each time as a separate visit in the ED. Counts are summarized by discharge year. Transfers to another acute care hospital or ED are included.
ED Visit Types
Three ED visit types are reported in this section of Fast Stats.All ED visits
Includes treat-and-release ED visits and ED visits resulting in admission to the same hospital.Treat-and-release ED visits
Includes ED visits that did not result in admission to the same hospital and ED visits transferred to another hospital or ED.ED visits resulting in admission to the same hospital
Includes ED visits for patients initially seen in the ED and then admitted to the same hospital.
Rate of ED Visits per 100,000
Population-based rates are presented for ED visit trends overall and by age, sex, community-level income, and patient location. Population-based rates are not reported by expected payer because currently there is no data source of national population insurance estimates that aligns with HCUP's definition of expected primary payer. The rate of ED visits includes the HCUP number of ED visits in the numerator and the U.S. resident population in the denominator (with a multiplier of 100,000). For all characteristics, the denominator is consistently defined with the numerator (i.e., rates for females use HCUP counts and population counts specific to females). Population data are obtained from Claritas, a vendor that produces population estimates and projections based on data from the U.S. Census Bureau. Claritas estimates intercensal annual household and demographic statistics for geographic areas.
Age refers to the age of the patient at admission to the ED. ED visits missing age are excluded from results reported by age.
All nonmale, nonfemale responses are set to missing. ED visits with missing values for sex are excluded from results reported by sex.
The "expected payer" data element in HCUP databases provides information on the type of payer that is expected to be the source of payment for the ED bill. Information is reported by the following expected primary payers: Medicare, Medicaid, private insurance, and self-pay/no charge. Patients identified as self-pay/no charge have an expected primary payer of self-pay, no charge, charity, or no expected payment. More information on expected payer coding in HCUP data is available in HCUP Methods Series Reports by Topic "User Guide - An Examination of Expected Payer Coding in HCUP Databases" (multiple documents; updated annually). ED visits missing expected payer are excluded from results reported by expected payer.
ED visits with the following expected primary payers are not reported in Fast Stats reporting by expected payer for national trends in ED visits: other Federal, State, and local programs; missing; or invalid. In 2016, these excluded ED visits represented 4 percent of all ED visits.
The total reflecting the number of ED visits across all expected payers (including those groups not presented in the graphs) is provided in the underlying data tables ("Show Underlying Data Tables") by expected payer by ED visit type. These totals are the same as the counts obtained for the overall characteristic selection for the respective ED visit type.
For comparison against the total described above for all expected payers, the Excel download file also provides the sum of the displayed expected payers (i.e., the sum of the expected payer counts of ED visits across the expected payers that are displayed in the graphs).
Community-level income is based on the median household income of the patient's ZIP Code of residence. Quartiles are defined so that the total U.S. population is evenly distributed across four groups. The cut-offs for the quartile designation are determined annually using ZIP Code demographic data obtained from Claritas, a vendor that produces population estimates and projections based on data from the U.S. Census Bureau. Claritas estimates intercensal annual household and demographic statistics for geographic areas. The value ranges for the national income quartiles vary by year. Income quartile is missing if the patient is homeless or foreign. ED visits missing the income quartile are excluded from results reported by community-level income.
Patient location is based on the six-category, county-level scheme developed by the National Center for Health Statistics (NCHS) to study the relationship between urbanization and health:
Use this export feature to download all of the underlying data for national trends in ED visits (all measures and characteristics) in Microsoft Excel (.xls) format.
|Internet Citation: HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP). April 2021. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/faststats/national/inpatienttrendsED.jsp.|
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