Emergency department capacity and demand varies widely across California counties and "one-size-fits-all" solutions to emergency service problems may do more harm than good, according to the latest Emergency Services Project report commissioned by the California HealthCare Foundation and conducted by the USC Center for Health Financing, Policy and Management.

The report, Emergency Departments in the Health Care System: Use of Services in California Counties, analyzed factors such as beds per 100,000, population growth, severity of patient illnesses, and the number of uninsured to understand county differences in emergency department (ED) system capacity and demand for the period 1990 - 2000. Seven representative counties were selected for analysis using publicly available data: Contra Costa, Los Angeles, Sacramento, San Diego, San Francisco, San Luis Obispo, and Santa Clara.

According to lead researcher Glenn Melnick, Ph.D., the study reveals wide variations among counties in ED system capacity and ability to keep pace with a growing population. The authors point out that the county analysis sheds light on turbulent capacity and demand scenarios that are masked when emergency service data is analyzed based on statewide data alone.

Summarizing the state of emergency care in each of the counties studied, the report includes a capsule description of each county: Los Angeles — complex and constrained; Sacramento — non-acute, relatively stable; San Diego — growing population but more limited ED access; San Francisco — small system, big impact; San Luis Obispo — small, stable, non-urgent; Santa Clara — population outpacing ED growth; and Contra Costa — changing and evolving.

• The total number of visits to EDs grew statewide by 8% between 1990 and 2000, though ED visits actually decreased in San Francisco and Contra Costa Counties.

• San Francisco ED patients were sicker than average and were hospitalized more often, and therefore may have required more ED time, which may in turn account for its lower number of visits per ED bed.

• Los Angeles County lost 21% of its EDs during the study period, but actually increased net bed capacity by 9%.

• From 1990 through 2000 the total number of licensed EDs decreased from 405 to 364.

• In spite of ED closures in most counties, those studied increased their actual supply of ED beds between 1990 and 2000. Increases ranged from 3 to 25%. Statewide ED bed capacity increased 19%, outpacing population growth of 15%.

• The number of beds or EDs in a county does not necessarily indicate whether it has the capacity to meet the demand for emergency services. Meeting demand depends on a variety of additional factors, such as availability of physician and nursing resources, demographics (e.g., age mix, numbers of uninsured), patient acuity, or the types of beds — medical/surgical or critical — actually available.

• Use of an ED is influenced by physician supply in a community, such as in San Luis Obispo County where a shortage of primary care physicians reportedly has caused patients to seek routine care at the ED or in urgent care centers.

• Patient acuity — or severity of illness — as measured by visits resulting in a hospital admission has increased in all counties measured, except Los Angeles and Sacramento, where there was a slight dip.

• Combined urgent/emergent visits to EDs (another measure of acuity) increased as a percent of total visits while non-urgent visits declined in all counties, except San Luis Obispo and Santa Clara.

  The report, including details on each of the counties analyzed, is available through the link below.

  Also below is a link to the Emergency Services Project, established to provide context for the complex factors that affect emergency department capacity, access, use, and financial performance. It has focused on key assumptions about the instability of the emergency department system to determine whether a crisis exists, and to provide an analysis of state and county trends to policymakers and other concerned stakeholders in the health care system.