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Rickie Brawer, PhD, MPH

Al Crawford, PhD, MSIS, MBA

Melissa McCarey

Nancy Chernett, MA, MPH

Valerie Pracilio, MPH


The Emergency Department (ED) is a place where disaster preparedness, public health surveillance, and in many cases, ambulatory primary care is provided. The increase in ED visits, combined with expanded services, has led to overcrowding and significant strains on resources. The purpose of this study was to conduct a retrospective data analysis of emergency department utilization in the Thomas Jefferson University Hospital (TJUH) community benefit areas in North Philadelphia and to determine if patients were utilizing the ED for conditions which could have been treated in the outpatient setting. A comprehensive literature review was conducted. The review focused on studies related to ED utilization and on trends by demographics and other factors. Variables identified for analysis included age, sex, race, insurance status, primary diagnosis, discharge disposition, and acuity. Data from the TJUH finance department on patient visits in FY 2011 and 2012 were merged with ED clinical data, and a sample of more than 70,000 patient visits was generated. Frequency distributions and cross tabulations were done to explore associations between the different variables. Blacks seemed to use the ED more frequently than whites and Hispanics. In the Transitional neighborhood, black represent 18% of the population, but made up 37.9% of the visits. In the Lower North neighborhood, blacks represent 65% of the population, but made up 84.5% of the visits. Overall, the uninsured seemed more likely to use the ED for non-urgent conditions. Based on the top 20 discharge diagnoses, visits from the Transitional neighborhood were associated with more acute injuries, compared with primary care diagnoses in the Lower North neighborhood. Our study findings indicate that the current problem of ED use for non-urgent conditions will expand with healthcare reform, unless barriers to primary care are reduced.