Corelated ER Visits and Mortality: State-by-State Comparison: Role of Tele-ICU or ER-Intensivist?

Introduction: Overutilization of Emergency Room (ER) puts considerable strain on healthcare systems. ER boarding of inpatients is increasingly associated with delayed care and increased mortality. Study (1) found that frequent ER visitors, in comparison to infrequent users, are more likely to die during their final ED visit (2.6% vs. 1.1%). We hypothesized that higher state-level ER visit rates would correlate with increased mortality.


Methods: After thorough literature search using databases like PubMed Central, National Notifiable Diseases Surveillance System, Wisevoter, Becker’s Hospital Review, and PMC, we identified two credible health-related data sources: "Wisevoter" and "Becker's Hospital Review." We performed a state-to-state comparison (X and Y axes) of ER visits and mortality. Our study was limited by the data update only up to 2023, the potential lingering effect of COVID-19 on ERs, and unreported deaths in each state.


Results: We performed a one-way ANOVA test for independent measures comparing mortality per 100,000 (group 1) & ER visits per 1,000 (group 2) for each U.S. state (n = 51, including Washington D.C.). (∑X2) for each group was 58614354 and 9783682, respectively. SD were 161.3 for mortality and 83.7 for ER visits. The F-ratio was 612.42, with p-value < .00001. We used Tukey HSD to control for error rate. As it can be argued that both X and Y should be considered as variable: we additionally, calculated the Pearson correlation coefficient (r) using the formula: r = ∑((X - My)(Y - Mx)) / √((SSx)(SSy)) where X = ER visits per 1,000 and Y = mortality per 100,000, M = mean, and SS = sum of squares. Our calculated Pearson correlation coefficient (r) = 0.63, signifying a moderate positive correlation between ER visits & mortality. The coefficient of determination (R2) was 0.40, indicating that ER visit rates could explain 40% of the variance in mortality. The p-value remained < .00001, supporting our hypothesis with statistical significance.


Conclusions: States with a higher ER visit burden, including those with floor or ICU boarding patients, tend to have higher mortality rates. Addressing health policy, strengthening outpatient care, and exploring systemic interventions, such as hiring an intensivist in the ER or tele-ICU, could be crucial to improving critical care outcomes across states.