Thirteenth International Conference on Health, Wellness & Society

Abstract

Emergency department (ED) misuse at Veterans’ Affairs (VA) hospitals is a subject that is not well understood. Characterizing ED use and misuse in the veteran population, can reveal systems-level successes/shortcomings that can inform future health policies regarding patient management. This study characterizes the patient profiles of veterans seeking care at the James A. Haley Veterans’ Hospital (JAHVH) ED and their respective spatiotemporal relationships to primary care centers during the 2022 fiscal year. The Emergency Severity Index (ESI)–an algorithm used to quantify the acuity and resources needed by a patient–helped define the term “misuse” as an ED visit ranked as ESI 4 or 5 with no record of a performed procedure during the encounter. Visits that did not include any procedure conducted by the ED are likely concerns that could be manageable by the patient’s primary care provider (PCP). Mapping the complex spatiotemporal relationships between PCP and patient via ArcGIS Pro can identify barriers to the ideal flow of care. Encounters at the JAHVH ED were collected using the VA’s Data Access Service. The visits were then classified as “appropriate use”, or “misuse” based on the previous definition. Analysis of the two cohorts identified the clinical and demographic characteristics of both groups including the age, gender, the time of the visit, the patient’s address, ICD-10 code associated with the visit, mode of arrival, Differential cost at ED/PCP, and spatiotemporal PCP-Patient relationships. This characterization can inform future policies that further investigate and remedy ED misuse at VA hospitals.