Systems Challenge: ER Avoidable Use

Issue Overview

Nowadays, the overall system of the emergency department working patterns requires some revision in terms of avoidable visits. According to the researchers, the term “avoidable” can be defined as the visits that did not require further medical intervention (Hsia & Niedzwiecki, 2017). As for the current situation in the medical field, the issue is quite relevant, claiming more than 50% of all visits to be potentially non-urgent. Among the most frequently avoidable diagnoses, toothache, back pain, and mental- and alcohol-related issues might be outlined. In the course of this paper, an attempt will be made to estimate specific reasons for such misuse, along with their possible solution.

Impact on Healthcare

When dealing with the notion of avoidable ER visits, one may subconsciously correlate this definition with the notions of non-urgent or inappropriate. Although it may seem true, the healthcare system is to face the challenge of defining which cases are, in fact, non-urgent. In order to deal with the issue, healthcare representatives have to reconsider their available visit equipment as well as qualifications when it comes to mental and dental concerns. Moreover, the presence of avoidable visits may potentially worsen the overall statistics of ER efficiency. Hence, it is quite important for the healthcare system to reconsider its emergency approaches to cope with such an impact.

Individual Impact

Besides the considerable impact on the national healthcare system, individual patients are also affected by ER misuse. According to medical convictions, individual patients feel no support in emergency care due to the increasing statistics of ER misuse. Apart from a tremendous stress level and considerable overcrowding of the premises, people struggle financially. With a financial gap of $580 between emergency and office-based visits, healthcare tends to invest money in the wrong direction, losing $38 billion annually (Kirkpatrick, 2017). Thus, they are at risk of increasing the average costs in order to be able to provide the facilities with the equipment necessary to sustain patients.

Primary Care Limited Access

One of the most widespread reasons behind ER misuse concerns the absence of full-scope primary care for the patients. With healthcare providers being overextended in terms of patient base, people frequently are deprived of the opportunity to have a timely appointment with their doctor. In the case of the ED visit, however, doctors are obliged to treat patients regardless of the time they are delivered to the department. Hence, it is now of great frequency for the patients to turn directly to the ED with any health issue in order not to be rejected or have their appointments postponed due to doctor’s inability t provide primary care.

Rapid Demand Increase

Another important reason considering the problem is related to the medical staff’s incompetence in terms of rapid demographic modification. The population aging serves as one of the most impressive contributors to ED overcrowding (Graham & Campbell, 2017). It goes without saying that the elderly may be entirely misguided in terms of the emergency visit policy. Unlike other social groups, older people often do not have the opportunity to wait for primary care appointments. As a result, being deprived of the chance to deal with office-based medical care, this social group is urged to utilize emergency facilities for healthcare.

ED Hospitalization Abuse

Finally, another crucial concern deals with the issue of hospitalization continuity in terms of ED. Quite often, once people come to the ER facilities and provided with healthcare, the duration of their overall stay at the hospital is rather contradictory (Rosehart et al., 2016). The issue is even more evident when comparing the percentage of cases that were potentially avoidable. As a result, the priority system within ED units is distorted by a defined mechanism of emergency care patterns. Bearing in mind the financial struggle of the healthcare system, there is little chance of finding the required financial support to enhance the premises to be able to suit more patients in the ED in the future.

Direct Primary Care Model

Over the past years, a series of strategies were introduced in order to combat the issue of ER avoidable use. However, one of the most beneficial in terms of the discussion can be considered the strategy of Direct Primary Care (DPC) model implementation. This strategy presupposes patients are paying relatively affordable monthly payments to the healthcare facility in order to use their help (Cole, 2018). This fee might constitute approximately $80 per month, leaving behind the formerly accepted “pay-for-performance” system. In such a way, the vast majority of patients would be able to obtain access to primary care without the urge of ED misuse. Moreover, the absence of the third party in the communication process enhances the quality of the patient-provider relationship.

Solving the Issue

DPC implementation will become beneficial in terms of a decline in ER misuse due to the availability to reconsider the patterns of medical appointments. Moreover, with stable patient fees and the absence of expenses on the ED, medical facilities will obtain the opportunity to enhance the equipment quality, hence increasing the cost efficiency and sustainable equipment service. Once the rush subsides, there will be an opportunity to provide both medical staff and patients with exhaustive education tools on the subject of primary and emergency care. Hence, the strategy of implementing DPC into the national healthcare would make it possible to not only address but to resolve the issue of ER misuse.

Resources Required

In order to properly operationalize the strategy, some of the basic resources are to be utilized. First of all, it is of crucial importance to conduct a full-scale survey in order to estimate the most widespread health issues in terms of primary care so that the major financial basis would be utilized for the sake of these departments. Moreover, human resources working in various departments are to be relocated to prevent overcrowding. To fulfill these goals, the healthcare legislature should be provided with financial support from the government, along with the transition plan to develop without “pay-for-performance” funding patterns.


Taking everything into consideration, one may conclude that the current system of ER misuse is causing much economic and quality damage to national healthcare. In the course of the discussion, it was estimated that the major reasons behind the issue concern the lack of primary care accessibility, increasing healthcare demand, and emergency department hospitalization abuse. In order to combat the issue, the model of Direct Primary Care should be introduced to the system. Future implications of the research concern pragmatic ways of the model transition.


Cole, E. S. (2018). Direct primary care: applying theory to potential changes in delivery and outcomes. The Journal of the American Board of Family Medicine, 31(4), 605-611.

Graham, E., & Campbell, S. (2017). Reducing avoidable emergency department attendances through bespoke education. Nursing Older People (2014+), 29(10), 32.

Hsia, R. Y., & Niedzwiecki, M. (2017). Avoidable emergency department visits: a starting point. International Journal for Quality in Health Care, 29(5), 642-645.

Kirkpatrick, W. (2017). The consequences of emergency department overuse. Web.

Rosehart, Y., Flanagan, T., Ballinger, G., Byrnes, M., Liu, L., Osien, G., & Alqatami, H. (2016). Family medicine forum research proceedings: Effect of continuity of care in primary health care on hospitalization and emergency department use. Canadian Family Physician, 62(2), S1-S66.

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NursingBird. "Systems Challenge: ER Avoidable Use." September 17, 2022.