As the population gets older, and the baby boomers begin to enter their 60’s and 70’s, one might assume that the number of trips to the emergency department will also increase. This is contradicted by new research from Brigham and Women’s Hospital (BWH), which shows that population aging will not cause the number of emergency department (ED) visits to increase between now and 2050. However, visits will become longer and hospitalizations will become more frequent. This research will appear in the July issue of Health Affairs.

“With US emergency care characterized as ‘at the breaking point’, we wanted to study how the aging of the U.S. population would affect the demand for emergency department services and hospitalizations in the coming decades,” explained Daniel J. Pallin, MD, MPH, director of research in the Department of Emergency Medicine at BWH and lead author of this study. “We found that demographic change will not cause the number of ED visits to increase, but visits will get longer and there will be more hospitalizations.”

To study the effect of aging on demand for ED services, the researchers quantified the number of visits that would occur if the structure of the U.S. population changed, but everything else remained the same. They used 2009 as the baseline to model the expected ED use for each age and race subgroup. They then applied these visit rates to the population the US Census Bureau expects to exist in future years, through 2050. The main outcome measure was the ratio of the rate of increase in ED visits to the rate of increase in total population. Researchers were surprised – and reassured – to find that the number of ED visits would increase only at the same rate as the population increased. However, they also found that the aggregate amount of time patients spend in EDs nationwide will increase 10 percent faster than population growth, due to longer visits. More worrisome still, they predict that hospital admissions from the ED will increase 23 percent faster than population growth.

“Our analysis predicts that the total amount of time spent by patients in EDs across the country will increase 1.1 times faster than population growth as the population ages,” explained Pallin. “This means that the United States will need 10 percent more ED resources per capita than available today.” Pallin says the most important take home message for this research is that since the length-of-stay and number of hospitalizations are predicted to increase, the process of moving patients from the ED into the hospital needs to be as efficient as possible.

Researchers note that the principal limitation of this investigation is the scope of the research. The researchers only predicted changes in healthcare based on demographic change, and assumed that all other factors would remain stable (like whether a given person will choose to visit the ED instead of a doctor’s office). Also, they did not analyze hospitalizations that come from anywhere else besides the ED; other hospitalizations account for roughly 55 percent of the total.

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This research was supported by a seed grant from the Brigham and Women’s Hospital Department of Emergency Medicine.

Brigham and Women’s Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs more than 15,000 people. The Brigham’s medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving nearly 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $625 million in funding. BWH continually pushes the boundaries of medicine, including building on its legacy in organ transplantation by performing the first face transplants in the U.S. in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses’ and Physicians’ Health Studies, OurGenes and the Women’s Health Initiative.

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Jessica Maki
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Brigham and Women’s Hospital