This is one of a series of articles by Huddy HealthCare Solution’s experts on ED analytics, planning and design.   Each article offers insights to you as an ED physician leader on how to position your emergency department for architectural design success.

Future ED Volumes

One of our previous articles covered five key issues that you need to consider when projecting your future ED volumes and when planning for a new facility it certainly is important to understand where future ED volumes may be going – but should it be of greater concern where future ED admission rates may be goingl? Potentially, yes – that may have a bigger impact on boarding issues in the ED. Frequently, one of the first steps in a renovation or expansion ED project is to determine what the future ED volumes may be and then design appropriate processes and facilities that will be able to support to those volume targets. However, often overlooked is the changing acuity levels and potentially increased percent of ED admissions which may, even more so than increasing volumes, impact ED boarding and capacity. Now more than ever it is vitally important to understand potential changes that may occur with the admitted population in addition to projecting future volumes.   There are a few key reasons for this, outlined below and on the following pages.

Aging Population

One of the key issues discussed when projecting overall future ED visits was to not only understand trends in total population but also the trends for the senior (65+ years old) population and especially the 75+ population.   As mentioned in the prior article, the 75+ population visits the Emergency Department about 1.5 times more frequently than the under 75 population (ED Use Rate of 644 for 75+ compared to 421 for under 75+ population)1. Between 2018 and 2023 the total population of the United States is projected to grow about 3.5% from 326.5 million up to almost 338 million people2.   However, the strongest growth is projected to be in the senior population with both the 65-74 age group and the 75+ segment are projected to see double digit growth over the next 5 years (chart below shows entire US projected population by age between 2018-2023).


Along with the changes in growth and utilization there are tremendous differences in the admission rate. The charts below are an actual example and we have seen this with all our clients – the admit rate for all patients will typically range between 16%-24% with the 65+ admission rate ranging from 40%-50+%.



More Admissions with Increased Volumes or Increased Admissions

The issue with increased admissions is obviously the impact it has on crowding in the ED. The ACEP Task Force on Boarding covered several potential solutions for ED overcrowding but clearly identified the holding (or boarding) of ED admits as the primary cause of ED overcrowding3. So, the question becomes what will cause future ED admits to increase more – an increase in volumes only or an increase in ED admit rates? Let’s look at a 50,000 ED visit ED with a current 16% admit rate. What would have a bigger impact on the number of ED admissions – a increase of 10,000 ED visits with no change in Admit Rate or having the ED Admit Rate jump to 20% with no change in volumes? With the Admit Rate holding steady but an increase in volumes to 60,000 you would end up with 9,600 ED admits. Yet if volumes stayed at 50,000 but the Admit Rate jumped to 20% you would have 10,000 total ED admits (see table below).


Obviously, you typically will see changes in both but all to often we experience a focus purely on what the total overall ED volumes may be with little regard given to changes in ED admission rates.

Impact on Capacity

Although overall volumes will have an impact on capacity in the Emergency Department it is just as important to understand how acuities and admission rates will impact capacity, particularly if you already have a boarding issue in your current department due to lack of inpatient beds or inefficient processes. Volumes will not be the sole driver for increases in ED admissions.

More Information

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