Many avoidable visits to the emergency department are related to mental health and dental conditions, according to data published in the International Journal for Quality in Health Care.

Renee Y. Hsia, MD, and Matthew Niedzwiecki, PhD, from the University of California at San Francisco, conducted a retrospective analysis of “avoidable” visits to the emergency department using data from the National Hospital Ambulatory Medical Care Survey from 2005 to 2011. The researchers defined “avoidable” visits as any discharged emergency department visits not requiring any diagnostic tests, procedures, or medications.

The analysis included a total of 115,081 records, representing 424 million emergency department visits made by patients between 18 and 64 years of age. Results showed that 3.3% of all emergency department visits were avoidable. Additionally, the top 5 complaints included toothache, back pain, headache, other symptoms related to psychosis, and sore throat. The top 3 ICD-9 diagnoses of avoidable visits were alcohol abuse, dental disorders, and depressive disorders.

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The investigators note that alcohol-related and mood disorder diagnoses, including depression and anxiety, accounted for 6.8% of all avoidable visits. Disorders of the teeth and jaw accounted for 3.9%.

“Our most striking finding is that a significant number of avoidable visits are for conditions the [emergency department] is not equipped to treat,” the authors wrote. “Emergency physicians are trained to treat life- and limb-threatening emergencies, making it inefficient for patients with mental health, substance abuse, or dental disorders to be treated in this setting. One potential mechanism to more appropriately direct limited healthcare resources could be to increase access to mental health and dental care, which have traditionally been treated as separate categories of healthcare.”


Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point [published August 31, 2017]. Int J Qual Health Care. doi:10.1093/intqhc/mzx081