ArticleAnnals of emergency medicine2012
Toward understanding the difference between using patients or encounters in the accounting of emergency department utilization.
Article in Annals of emergency medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- Randomized comparison of universal and targeted HIV screening in the emergency department.Journal of acquired immune deficiency syndromes (1999) · 2013Trial
- Exploring the relationship between neighborhood walkability and mental health: A study of urban areas in Texas.Heliyon · 2025Article
- Clarifying the volume of estimated need for public health and prevention services within an emergency department population.Journal of the American College of Emergency Physicians open · 2020Article
- Health Service Utilization and Poor Health Reporting in Asthma Patients.International journal of environmental research and public health · 2016Article
- A practical method for predicting frequent use of emergency department care using routinely available electronic registration data.BMC emergency medicine · 2016Article
- Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.PloS one · 2016Article
- HIV Care Continuum for HIV-Infected Emergency Department Patients in an Inner-City Academic Emergency Department.Annals of emergency medicine · 2015Article
- Patients who use multiple EDs: quantifying the degree of overlap between ED populations.The western journal of emergency medicine · 2015Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
STUDY
objectiveDescriptions of emergency department (ED) census often do not differentiate between patients and encounters, and there is no guidance about which unit of analysis is most appropriate. We explore differences between patient- and encounter-level accounting of ED utilization.
methodsData extracted from hospital databases were used to identify all registered patients at 3 different but geographically proximate EDs: urban academic, urban community, and suburban community. Data were available from 2000 to 2009 for the academic ED and for all 3 EDs from 2003 to 2007. For each ED, we calculated number of encounters, proportion of encounters for "annual new patients" (ie, not seen previously that year), and number of "new patients" (ie, not seen previously during study period). We also determined the annual number of encounters per patient for each ED.
resultsAt the academic ED, there were 890,397 encounters involving 256,805 patients. Annual encounters (≈89,000) and patients (≈49,000) remained relatively stable over time. Patients were new in 36.1% (95% confidence interval [CI] 35.8% to 36.4%) of year 2 encounters, 25.3% (95% CI 25.1% to 25.6%) of year 5 encounters, and 22.4% (95% CI 22.1% to 22.7%) of year 10 encounters. For community EDs, 50.9% (95% CI 50.4% to 51.5%) and 53.7% (95% CI 53.1% to 54.2%) were new in year 2, and by the fifth year, 35.0% (95% CI 34.5% to 35.5%) and 36.2% (95% CI 35.7% to 36.7%) were new. In the academic ED, 56% of patients had a single encounter during 5 years and less than 6% had more than 8 encounters during that period. In community EDs, 62% of patients had a single encounter during 5 years and less than 3% had more than 8 encounters overall.
conclusionEDs provide care to a relatively static population, with truly new patients composing only a minority of encounters. Although multiple encounters per patient are common, highly frequent use occurs for only a minority of ED patients, and then only for a discrete period. Encounters and patients are not equivalent units of analysis, and policymakers and researchers should determine which is most appropriate for their decisionmaking.
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