Emergency department visits have been steadily rising in the United States, increasing by nearly 20 percent to 115.3 million annually from 1995 to 2005. Despite commonly held assumptions, this is not primarily driven by individuals who are uninsured or without primary care physicians. In fact, dependence on the ED appears high across all payer categories and includes a significant number of patients who are insured or already have an assigned primary care physician. Further, countries with universal coverage are experiencing similar trends in ED use.

Retrospective review identifies that as many as 50 percent of all ED visits could have been avoided by care in other settings. However, from the perspective of the individuals who present to the ED for care, these visits are unavoidable at the time as alternatives are not known, not available, or do not exist. Alternatives to prevent such future ED visits must extend beyond medical care alternatives to community resources that promote and support health. Reduction in excess ED care may represent a significant cost savings opportunity.

IHI is launching a prototyping initiative, under the umbrella of our Triple Aim initiative, focused on reducing these avoidable ED visits and seeks interested and capable organizations to join this effort.