By Pete Mercer
As emergency department utilization grows, Vizient and Sg2 forecasts suggest hospitals must shift how patients access care – using better metrics, smarter staffing and expanded ambulatory options to relieve ER congestion.
According to a recent study conducted by Vizient and Sg2, a Vizient company, emergency departments across the country are facing an increase in patient visits. The Centers for Disease Control and Prevention (CDC) found that patients in America made approximately 139.8 million visits to the emergency department in 2024. Sg2’s 2025 Impact of Change Forecast projects that emergency department volumes will grow 5% over the next decade.
This increase in demand is a significant challenge for the structural and operational infrastructure of hospitals, threatening safety, efficiency, and financial stability. Repertoire Magazine recently spoke to Brianna Motley, the vice president of intelligence strategy and delivery for Vizient, about overcrowding in the emergency department, protecting vulnerable patient groups and what the future for the emergency department looks like.
The dual bottleneck
It’s not news that hospitals are under tremendous strain and pressure – the healthcare industry is constantly in a state of flux and is in many ways still recovering from COVID-19. Now, hospitals are facing what the forecast calls a “dual bottleneck”, where critically ill patients are waiting too long for beds, while low-acuity patients flood the emergency department for conditions that could be addressed in other care settings. The distinction that needs to be made in these scenarios is whether the condition is urgent or emergent.
Motley said, “The biggest difference between urgent and emergent visits is really the acuity level. With urgent visits that are lower acuity, you typically have other care settings that you can get those needs addressed. That would include an urgent care center or primary care clinic. With emergent visits that are higher acuity, there typically aren’t too many other places that you can go to get those needs taken care of outside of the emergency department.”
This dual bottleneck is exacerbating other problems as well, like staffing and supply shortages, creating an unsustainable environment across the board. If hospitals want to meaningfully address these pressures, they have to rethink their entire care delivery system.
Staffing is an important component of the bigger picture. Motley offered a practical solution to meeting patient volume demand, by looking at how schedules are built in comparison to the typical incoming patient surge windows. “One of the classic analyses to compare is, what is the arrival pattern for patients? Do you have the right staff to effectively meet those demands at certain inflection points within a given day?”
Understanding the metrics to build better strategies
Building a better plan for the future requires a deeper understanding of the current challenges, which can be accessed through performance metrics and benchmarks. One of the key metrics found in the Sg2 forecast is the average length of stay, which shows how long patients wait for care in an emergency department setting. This is a key operational metric for hospital systems to understand to develop a better strategy in the future.
The best way to build a strategy that will help the emergency department with metrics like average length of stay is to look at how it compares to other benchmarks or emergency departments of similar sizes.
“Understanding how far out of sync you are with other emergency departments of a similar size, or what we would expect to see, lets you know how acute the problem is,” Motley said. “From there, you need to assess the conditions that are frequently presenting to your emergency department and what strategies you need to get better in line.”
According to Motley, hospitals that are looking to reduce the average length of stay need to look at the metric across the whole continuum. First, hospitals have to make sure that they have the capacity for incoming patients – the open space to be able to move people from the waiting room to an open bed to receive the care they need. Once they are out of the emergency room, hospitals need the right diagnostics to quickly triage and determine the clinical issues. From there, the team can determine whether the patient needs to be admitted and what that admission process looks like.
Having a strategy in place can help hospitals reduce the overall average length of stay, while also improving the workflow and productivity of the emergency department. This will impact the quality of care and the speed with which it’s delivered is one of the most important parts of the hospital.
The next decade of emergency department utility
These projections from Vizient and Sg2 are expecting emergency department utilization to increase over the next decade. This includes more volume and a higher average length of stay for patients, driven by an aging population that has multiple comorbid conditions and access limitations across the rest of the system of care.
How can health systems successfully navigate the next decade of this trend? Motley said, “It really comes down to understanding, at the local level, what the demand is, the type of patients that frequent the hospital, and developing strategies to meet that demand in the appropriate care setting.”
Implementing technology is a great way to streamline the workflow inside the emergency department, especially when triaging patients. Patients can also leverage technology to better understand the resources and care touchpoints that are available in their area, which could help them to decide if the emergency department at the hospital is really the best option for their care needs. If it isn’t, they can find a better option to fit what they need at the moment.
If health systems want to effectively reduce the strain within the emergency department over the next 10 years, there are some adjustments that can be made to make this possible. According to Motley, in a perfect world, the emergency department would no longer be the front door, or the primary access point, to the hospital. Improved access to ambulatory care locations and lower acuity care locations could help to reduce the need for the emergency department. While the emergency department will always be a necessary touchpoint for health systems, there are ways to decrease dependence on the ER and increase utilization across the rest of the care continuum.
ED utilization numbers
New data from Vizient’s Sg2 “Data on the EDGE» report reveals a critical shift in ED utilization, forcing health systems to fundamentally rethink how they allocate resources across the entire hospital.
As patient acuity continues to rise, health systems will need to look for ways to expand care capacity to address the inpatient/ED interplay, deploy AI for surge prediction and staffing optimization, and redefine the ED within their broader ambulatory portfolios, a recent study conducted by Vizient and Sg2, a Vizient company.
Key findings from the report include:
- ED length of stay for emergent cases: 5.3 hours (vs. 2.4 for urgent cases)
- 67% of inpatient admissions now originate from the ED
- Medicare patients represent 29% of ED visits but 50% of inpatient admissions
- Facilities seeing 25K+ annual visits face significantly longer patient stays
- Behavioral health is driving growth making EmPATH units and behavioral health urgent care critical investments.