Hospital emergency rooms (ERs) are critical components of the healthcare system, providing essential care for patients experiencing acute illnesses and severe injuries. Equipped with specialized medical professionals and advanced resources, ERs are designed to handle medical emergencies effectively.
However, data reveals a significant trend: a large proportion of emergency department visits are for conditions that are not actually emergencies. Analyzing data from emergency room encounters offers valuable insights for hospitals and healthcare providers to better understand patient needs and optimize resource allocation. This analysis highlights the most Common Emergency Room Diagnosis and the underlying reasons for these visits.
Below is a list of the most frequent diagnoses observed in U.S. emergency rooms, along with their corresponding ICD-10 codes. This data provides a clear picture of the typical medical issues addressed in emergency settings.
| Rank | ICD-10 code | ICD-10 description | % total ER diagnoses in U.S. |
|---|---|---|---|
| 1 | I10 | Essential (primary) hypertension | 3.0% |
| 2 | Z20822 | Contact with and (suspected) exposure to COVID-19 | 2.1% |
| 3 | Z79899 | Other long-term (current) drug therapy | 1.4% |
| 4 | E785 | Hyperlipidemia, unspecified | 1.2% |
| 5 | E119 | Type 2 diabetes mellitus without complications | 1.0% |
| 6 | Z1231 | Encounter for screening mammogram for malignant neoplasm of breast | 0.9% |
| 7 | Z87891 | Personal history of nicotine dependence | 0.7% |
| 8 | R079 | Chest pain, unspecified | 0.7% |
| 9 | K219 | Gastro-esophageal reflux disease without esophagitis | 0.7% |
| 10 | I2510 | Atherosclerotic heart disease of native coronary artery without angina pectoris | 0.6% |
| 11 | R0602 | Shortness of breath | 0.6% |
| 12 | Z23 | Encounter for immunization | 0.6% |
| 13 | U071 | COVID-19 | 0.6% |
| 14 | E039 | Hypothyroidism, unspecified | 0.6% |
| 15 | Z0000 | Encounter for general adult medical examination without abnormal findings | 0.5% |
| 16 | R059 | Cough, unspecified | 0.5% |
| 17 | R109 | Unspecified abdominal pain | 0.5% |
| 18 | F419 | Anxiety disorder, unspecified | 0.5% |
| 19 | R0789 | Other chest pain | 0.5% |
| 20 | R519 | Headache, unspecified | 0.5% |
Fig. 1 Data from Definitive Healthcare HospitalView, analyzed from Atlas All-Payor Claims for calendar year 2022, accessed May 2023.
Leading Emergency Room Diagnoses and Their Implications
Essential (primary) hypertension, commonly known as high blood pressure, topped the list as the most frequent emergency room diagnosis in 2022, accounting for 3.0% of all ER diagnoses. Hypertension is a prevalent chronic condition that significantly elevates the risk of serious health complications, including heart attacks, strokes, kidney failure, and even death.
The increasing presence of chronic conditions like hypertension in emergency room settings, traditionally managed in primary care, is a notable trend. This rise may be attributed to several factors, such as a growing shortage of primary care physicians, limited accessibility to healthcare services, and an increasing prevalence of these chronic illnesses within the population. Patients may resort to emergency departments when they lack timely access to primary care for managing chronic conditions.
Exposure to COVID-19 was the second most common emergency room diagnosis, responsible for 2.1% of ER visits in 2022. The ongoing impact of the pandemic is evident in these figures, highlighting the continued strain on emergency services due to virus-related concerns and exposures.
Following closely, “other long-term (current) drug therapy” was the third most frequent diagnosis, representing 1.4% of all diagnoses. This broad category encompasses patients on various long-term medications, including injectable diabetes drugs, immunosuppressants, and steroids. Its high ranking indicates the complexities associated with managing patients with chronic conditions requiring ongoing medication regimens.
Emergency Room Utilization in Rural vs. Urban Areas
The way patients utilize emergency rooms can differ significantly between rural and urban regions. Rural areas often have fewer urgent care centers and specialist facilities. This scarcity leads rural populations to rely more heavily on hospital emergency departments for a wider range of healthcare needs, including situations that might not be considered emergencies in urban settings.
Chronic care management also frequently falls under the purview of rural ERs due to limited access to specialized care. Patients in rural locations, lacking regular access to specialists, may turn to the nearest hospital ER for prompt symptom relief and treatment, even for ongoing health issues.
Furthermore, rural populations are disproportionately affected by higher rates of uninsurance, which further restricts their healthcare options. Even insured individuals in rural areas may struggle to find in-network providers within a reasonable distance, making the local emergency room the most accessible point of care, regardless of the nature of their medical concern.
Data from a 2019 University of New Mexico study illustrates this disparity. Rural emergency department visits surged by over 70% between 2005 and 2016, increasing from 16.7 million to 28.4 million. In contrast, urban hospital visits grew by just under 19% during the same period. This significant difference underscores the critical role ERs play in rural healthcare delivery, often extending beyond emergency care.
Even in urban centers, emergency departments frequently face overcrowding, resulting in extended wait times for patients, sometimes exceeding two hours. A contributing factor to these long waits is the influx of patients seeking treatment for non-life-threatening conditions, such as chronic pain, sprains, fractures, and other ailments that could be appropriately addressed in urgent care facilities or primary care settings.
Strategies to Alleviate Emergency Room Wait Times
Non-emergency visits to the emergency room can have detrimental consequences, potentially delaying critical interventions for patients with life-threatening emergencies. Often, the public lacks clarity on when to seek emergency room care versus when urgent care or primary care is more suitable. This confusion contributes to the overcrowding issue.
To mitigate wait times and enhance patient care in emergency departments, some hospitals are implementing telehealth solutions. Upon arrival, patients are initially assessed by a nurse practitioner (NP) or physician assistant (PA) to determine their stability. Patients with lower-risk conditions may then be eligible for a virtual consultation with an in-network physician located remotely.
New York Presbyterian Weill Cornell Medical Center (NYPWC) successfully implemented a telehealth service in July 2016. Remarkably, within a year, average emergency department wait times at NYPWC decreased from 150 minutes to just 18 minutes, according to Definitive Healthcare data. The success of this program led NYPWC to expand its telehealth initiatives through the Hauser Institute for Health Innovation in 2019. Telehealth offers a promising approach to streamlining ER operations and ensuring timely care for all patients.
By understanding the most common emergency room diagnosis and the factors driving ER utilization, healthcare systems can develop strategies to improve patient flow, optimize resource allocation, and ensure that emergency departments are primarily serving those with true medical emergencies. Data-driven insights are crucial for navigating the evolving landscape of emergency healthcare and enhancing patient outcomes.
