ED overutilization: Changing patient habits with AI-powered solutions

Unless a person has a severe or life-threatening health concern, the ED should not be a patient’s first port of call for healthcare advice or treatment. Plus, with analysis by Premier suggesting avoidable ED visits cost as much as $8.3 billion per year, it begs the question — Why are patients heading directly to the ED? And what can healthcare organizations do to help?

In this article, we take a closer look at patient behavior prior to a visit to understand why patients with low-acuity complaints are seeking care in a setting designed to treat emergencies. We will also discuss ways to encourage change in patient habits using digital solutions and AI-powered technology.

A recent study by Accenture found that 41% of US consumers had, what is considered to be, low healthcare literacy. The report suggests that, due to the complexity of the healthcare system, these patients tended to default to the ED as the path of least resistance when seeking medical attention. In addition to this, in a study by the Journal of General Internal Medicine, ED patients indicated that the limited availability of primary care appointments was a driving factor in their choice to visit the ED. 

Another leading factor for visiting the ED is pain. In one study, pain represented 78% of emergency department appointments, with up to 16% of ED patients complaining of chronic pain; the latter statistic being suggestive of poor chronic illness management — an issue that could potentially be mitigated by improved primary care.

Uncertainty about the severity of a healthcare condition is also a top reason for visiting the ED. Oftentimes, when a patient cannot identify the cause of their symptoms, they choose to visit the ED for reassurance that their condition isn’t serious. This is a major factor concerning unnecessary ED visits, with research showing that without medical guidance 3 in 4 patients would not know the appropriate level of care they require.

A good point of reference when considering why patients head to the ED is to look at the most common health complaints they present with. The chief problems patients present with at EDs with % of total avoidable ED visits are:

• Toothache — 3.1%

• Back pain — 2.8%

• Headache — 2.7%

• Other symptoms/problems related to psychosis — 2.5%

• Throat soreness — 2.4%

• Skin rash — 2.0%

• Abdominal pain, cramps, spasms — 1.9%

• Injury — 1.8%

• Earache — 1.8%

• Anxiety and nervousness — 1.8%

So why are patients presenting at the ED with these seemingly non-urgent problems? Let’s look at the habits and reasoning behind these visits.

So what are patients doing prior to their arrival in the ED? Occasionally, someone might wake up with a severe headache, a strange lump, or any other symptom with an unknown cause and decide to head directly to the emergency department. However, one study found that in the week prior to an ED visit, 53% of patients had conducted Google searches directly related to their chief complaint.

This evidence indicates a lack of patient knowledge related to their symptoms, and can further suggest a lack of access (or at least knowledge about access) to reputable healthcare advice.

Another study concluded that patients often doubted the capability of their primary care provider to offer urgent care due to issues with capacity, further commenting that this doubt stemmed from past experiences of seeking care. These patients now have it ingrained in them that the ED is their best option for seeking immediate care, even though they are aware that their condition is not necessarily deemed to be an emergency. In this instance, aside from addressing patients’ behaviors, it’s also important to look at the challenges at primary care clinics; some of which could be alleviated by reducing administrative burdens using technological solutions.

A study of Medicaid patients published in the Patient Experience Journal found that cultural and educational factors played a huge part in the decision-making process for this patient set. “Providers commented that many Medicaid patients had grown up using the ED as their main source of care, and suspected that these patients were not aware of other avenues to access healthcare.”

We’ve established that patient habits, expectations, knowledge, and experiences play a vital role in the decision to visit an emergency department. The next question is, how can healthcare providers, telemedicine companies, insurers, and other healthcare organizations assist their patients/customers in order to reduce unnecessary ED usage?

This is where technological solutions can help organizations to provide clinically-validated healthcare information directly into the hands of patients.

Digital solutions enable and foster:

• Symptom analysis on the go: AI-powered digital triage tools allow patients to complete preliminary symptom assessment at home, at work, or on the go. Providing patients with this tool allows them to get a better understanding of their condition, and the severity of it — remember, many patients are already googling their symptoms, why not give them medically-reliable information on which they can base their decision of where to access care?

• Better patient navigation: Digital tools help to triage patients to the most appropriate care setting for their needs. This might be self-care at home, a visit to a primary or urgent care setting, or for serious cases, a trip to the emergency department. One study shows that 50% of patients who intended to go to the ED changed their minds after utilizing digital solutions.

• Patient education: In addition to the initial symptom analysis and triage recommendation, digital solutions can also provide vital information about healthcare concerns; giving patients the essential peace of mind they crave, informing them of changes in their condition they should be vigilant of, and offering advice on things they can do to manage their symptoms.

• Preventative care: Digital tools can be employed to remind patients to attend annual checkups or routine screenings, stay up-to-date on vaccines, and other preventative care measures — all steps that can help identify potential risks and detect and treat certain conditions that could otherwise become severe.

• Easier and integrated paperflow for clinicians: With tools such as Intake, organizations can ease the flow of data transfer between patients and clinicians. This helps both parties to prepare for the visit ahead of time; therefore improving the overall efficiency of the journey, allowing physicians to increase the capacity of care they can deliver, and helping to alleviate patient doubt. What’s more, when these solutions are integrated with EHRs, the amount of time clinicians spend on paperwork can be significantly reduced; a driving factor that contributes to physician burnout

It’s important to note that digital solutions, like the AI-powered Medical Guidance Platform, not only help to triage low-acuity cases away from EDs, but they also help to detect genuine circumstances in which emergency care is needed. 

One report in the Annals of Internal Medicine indicated that only 19% of patients who presented with possibly life-threatening cardiac conditions sought assistance in the appropriate level of care acuity, i.e. to call emergency medical services.

In these instances, digital solutions can help in the early detection of symptoms that need emergency medical care or have the potential to evolve into sudden cardiac arrest, or even death.

Access to care is crucial and digital front doors are a vital first step in empowering patients to access an appropriate healthcare setting when they need it. Healthcare organizations need to take responsibility for providing these services to their consumers in order to drive better patient engagement, with the potential to lead to better patient outcomes and possible financial savings compared to when patients require more expensive care further down the line.

Overutilization of emergency departments is costly, both financially and for population health. Patients’ habits related to their use of healthcare services are a major contributor to this problem, yet the onus is not solely on the patients to alleviate the burden.

Healthcare organizations have a responsibility to provide adequate services, education, and care in order to address the root causes of ED misuse. When executed correctly, technological solutions can provide the access to care that many patients are currently lacking, and help to mitigate the strain on EDs by navigating patients to more appropriate care settings.

Get in touch with our team to discuss digital solutions opportunities in your organization!

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