61% of ED visits are emergent: 8 takeaways from Vizient’s scorecard report
A growing share of emergency department visits in the U.S. are considered emergent, meaning they require immediate treatment, according to Vizient and Kaufman Hall’s latest “System of CARE” report, which tracks national trends in patient throughput, access, quality and cost efficiency.
The report, published Aug. 18, uses data from Vizient’s clinical and operational databases, the Association of American Medical Colleges and Vizient’s Clinical Practice Solutions Center, and Sg2 forecasts. It reflects rolling four-quarter metrics ending Q1 2025 across hospital cohorts, with trends broken down by academic medical centers and community hospitals.
In the first quarter of this year, 61% of ED visits were emergent, while 39% were urgent. Hospitals should expect the share of high-acuity, medically complex patients to continue rising, with emergent visits projected to increase another 8% by 2035, according to the report. Urgent visits to the ED are not expected to grow.
This aligns with what emergency medicine leaders have consistently emphasized: Low-acuity patients make up a relatively small share of ED volume and are not the primary source of crowding or boarding. Rather, hospitals are seeing a rise in medically complex patients, driven by an aging population and worsening access elsewhere in the system.
Seven more takeaways from the report:
1. ED throughput nominally improved, but challenges persist: The average ED length of stay for discharged patients fell from 5.0 hours to 4.2 hours year over year. While this points to improvements in operational efficiency, other national data indicate boarding challenges remain widespread and continue to worsen at many hospitals. Over the past three years, more than one-quarter of admitted patients waited four hours or more for a bed even during non-peak months, rising to 35% during the winter, according to a recent study published in Health Affairs.
2. EDs are the main source of inpatient admissions, tightening inpatient flexibility: Nearly 68% of inpatient admissions now originate from the ED. That rate is even higher at community hospitals (76%), underscoring how boarding continues to limit hospitals’ capacity to take on new or elective cases.
3. Specialty access remains strained: Median wait times for new patient visits remain high across multiple specialties, including 41 days for neurology and 24 for cardiology. Less than half of new patients are seen within 10 days across the board. All specialties are projected to see volume growth over the next decade.
4. Direct inpatient costs rise as some quality measures improve: The average cost per inpatient stay increased from $10,365 to $10,860 year over year, while the cost per day rose from $1,873 to $1,977. The mortality rate declined slightly from 2.4% to 2.3%, but 30-day readmissions inched up from 12.0% to 12.3%.
5. Discharges to post-acute care remain flat, though are expected to grow: Just over 30% patients were discharged to post-acute care settings, holding steady year over year. That rate is projected to rise 31% by 2035, raising concerns about capacity across home health, skilled nursing facilities and rehab facilities.
6. ED discharge rates are higher at community hospitals: About 81% of ED patients at community hospitals are treated and discharged, compared to roughly 75% at academic medical centers. The difference likely reflects variations in patient acuity and the types of cases each setting handles.
7. Length of stay remains longer at AMCs: Average inpatient length of stay at academic medical centers was 6.1 days compared to 4.8 days at community hospitals, reflecting the higher acuity and complexity of cases treated at AMCs.
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