Emergency department readiness: navigating rising acuity and coverage shifts
Emergency department (ED) patient acuity is continuing to rise in 2025. Building on our 2024 Data on the Edge report Emergency Department Patient Acuity Will Not Abate in the Future, this year's update confirms growing ED patient acuity and the increasing need for operational and strategic readiness. As volumes for emergent visits increase and urgent cases remain stable, health systems must prepare for greater complexity in ED care delivery.
Leveraging Vizient's clinical, operational and demand projections, this refresh features an updated performance dashboard (Figure 1) and detailed analyses to guide resource optimization for a growing ED population that requires more specialized care and is more likely to be admitted for inpatient (IP) services.
Historical trend: Emergent visits growing and urgent visits slowing
While adult ED visits have risen over the last three years, the growth rate has slowed from 6% to 4% year-over-year. Over the next decade, ED volumes are projected to grow by 5%, largely driven by rising clinical acuity and barriers to timely care access.
A closer look at visit types (Figure 2) reveals divergent trends: emergent visits increased by 6% while urgent visits remained flat over the past four quarters compared to the previous year. Emergent cases accounted for 65% of all ED visits from Q3 2024 to Q2 2025. While urgent visits have stabilized, continued efforts to redirect low-acuity patients to alternative care sites remain essential to improving ED throughput and preserving capacity for higher-acuity cases.
Implications of ED length of stay trends
The ED average length of stay (ALOS) is a critical performance metric that reflects both operational efficiency and care delivery effectiveness. Variation across volume cohorts and between emergent and urgent visits underscores throughput challenges and highlights the need for resource allocation considerations. As shown in Figure 3, ALOS for emergent visits notably remains 2.2 times higher than for urgent visits at 5.3 hours and 2.4 hours, respectively. Facilities with more than 25,000 annual visits consistently report longer stays than those with fewer visits. However, those with volumes between 25,000 and 65,000 still maintain an ALOS lower than the overall average. Understanding ED ALOS and identifying targeted strategies is critical to reduce delays, streamline patient flow and strengthen overall ED performance.
Evaluating ED throughput also requires understanding its interdependence with other areas of the hospital. While the percentage of ED patients admitted to inpatient care has held steady at about 23% over the past three years, the rise in total ED visits has driven a higher volume of admissions from the ED, with 67% of inpatient admissions in the most recent four quarters originating from the ED. These dynamics illustrate how ED ALOS is directly shaped by hospital-wide capacity, particularly in inpatient units’ capacity to meet admits from the ED, making cross-department coordination essential to managing flow and mitigating bottlenecks.
Looking ahead: Factors impacting ED utilization
Over the next decade, ED utilization is expected to shift in both volume and type, with emergent visits projected to grow by 8% while urgent visits remain about the same. Population growth and epidemiologic factors, such as rising behavioral health needs and persistent health disparities, are key drivers of this growth across both visit types. At the same time, policy shifts, particularly those affecting public payer coverage, may create challenges in access.
Figure 4 shows factors that affect the Sg2 Impact of Change® National Demand Forecast. However, the impact will vary by market, underscoring the need for hospitals to model scenarios locally. Understanding how changes in payer mix, policy and resource availability play out in specific markets will be critical to anticipate demand and shape strategies to manage future ED volumes effectively.
Trends in ED payer mix
Overall payer mix for ED visits, both emergent and urgent, stayed the same as last year, with 40% of visits covered by Medicaid and other coverage including self-pay and uncompensated care (see Figure 5). The payer mix difference between ED and all inpatient discharges is noticeable, specifically for Medicare, where Medicare patients represent 29% of ED visits but half of IP admissions. Commercial and Medicaid patients demonstrate a reverse utilization trend and represent a higher proportion of utilization in ED care (urgent and emergent) and a lower proportion in the inpatient setting. The payer mix trends will evolve as coverage shifts.
Tori Richie, Danni Park and Ivy Zhu
To speak with one of our experts about emergency department and urgent care strategies, email membercenter@sg2.com.
Why it matters
The ED has always been and will continue to be a front door to the health system and a critical cornerstone for patient care. As patient mix changes and acuity continues to rise, the clinical care and operational models needed to support these changes require a thorough evaluation of utilization, performance metrics and future growth.
- Widen planning for operations and resource investment to look at the interplay between IP and ED. Assessing the capacity equation for both will help balance the impact of rising acuity and changes in patient mix to ensure the ED is adaptable and capable to mitigate emergency department boarding issues caused by lack of inpatient bed capacity.
- Redefine the ED within the broader ambulatory portfolio to improve lower-acuity access, such as implementing virtual triage, extending operating hours for urgent care centers and primary care clinics and increasing remote patient monitoring. Systems with a robust portfolio have already seen an accelerated decline in urgent ED volumes and a reduction of boarding in the emergency department. Depending on local market dynamics, systems may also need to strategize on the impact of market- and competitor-based freestanding EDs and microhospitals.
- Make use of alternative care sites, such as EmPATH units and behavioral health urgent care, to address local behavioral health needs and gaps and to manage access, decreasing the need for patient visits to the ED for behavioral healthcare.
- Improve coordination within the hospital walls, including inpatient and observation units, to alleviate upstream and downstream capacity constraints, accelerate speed to care, reduce ED length of stay and manage rising acuity within these units.
- Use advanced analytics and AI to anticipate surges, identify high-risk patients and optimize staffing and resource allocation. These capabilities improve ED reliability, reduce length of stay and support proactive care strategies.
- Understand the impact of social determinants of health for patients who use the ED as a primary access point. Connect patients with the appropriate resources to advance health equity and reduce repeat ED visits.