Preventive Health Services Offered in a Sampling of US Emergency Departments, 2022-2023

Abstract

Introduction: In the United States, more chronic and preventive healthcare is being delivered in the emergency department (ED) setting. Understanding the availability of preventive health services in the ED setting is crucial. Our goal was to understand the availability of a subset of preventive health services in US EDs and explore how that has changed over time.

Methods: In 2022-2023, using the National Emergency Department Inventory (NEDI)-USA, we surveyed a random 20% (1,064) sampling of all 5,613 US EDs. We asked directors of these EDs about the availability of and preference for 12 preventive health services, social worker availability, self-reported percentage of uninsured ED patients, and measures of ED crowding. We also asked about perceptions of barriers to implementing preventive health services in the ED. We used unadjusted and multivariable logistic regression models to compare service frequency in 2022-2023 to prior findings from 2008-2009 that represented a 5.7% random sampling of all EDs.

Results: Among 302 responders to the 2022-2023 survey (5.4% random sampling, 28.4% response rate), 94% reported offering at least one preventive health service, with a median of five services. The most common service offered was intimate partner violence screening (83%), while the least common was routine HIV screening (19%). Seven services (eg, intimate partner violence, alcohol risk, and smoking cessation screening) had a higher odds of being offered in 2022-2023 than in 2008-2009; findings were unchanged in sensitivity analyses. A small proportion of directors opposed offering preventive health services. However, many expressed concerns that preventive health services in the ED would lead to longer lengths of stay (56%), increased costs to their ED (58%), a diversion of staff time from providing acute care (50%), or that their patients would not have access to adequate follow-up (49%).

Conclusion: Nearly all EDs offer at least one preventive health service. Many offer multiple services; rates were higher than those identified in 2008-2009, in both unadjusted and multivariable models. Although limited by the response rate, this work provides the most recent and comprehensive snapshot of the type and frequency of a subset of preventive health services currently offered in US EDs.

Figure 1.

Availability of preventive health services, 2008–2009 and 2022–2023. The individual preventive health services are sorted by most frequent to least frequent. Hepatitis screening was not included in the 2008–2009 study; values reflect 2022–2023 data. Nearly all the preventive health services were more frequently offered in 2022–2023 than in 2008–2009.

Figure 2.

Ability to offer preventive health services with existing staff and funding in 2022–2023. Emergency department directors were asked whether they had a system in place to routinely provide a particular preventive health service. Those who reported “no” (ie, did not offer a particular service) were further asked whether they could already offer that service routinely given existing staff and funding. The individual preventive health services are sorted by most to least frequently reported as being possible to offer.