Picture an American visiting an emergency room every single second of the day: that relentless pace is the reality behind the staggering 131 million ER visits recorded in 2021, a number that masks dramatic shifts from pandemic plunges to alarming surges in mental health crises, senior care, and urban overcrowding.
Key Takeaways
- In 2021, U.S. emergency departments recorded 131.0 million visits, a 4.5% decrease from 2019 pre-pandemic levels
- Emergency room visits among adults aged 65+ increased by 3.2% annually from 2016-2020, reaching 22.4 million in 2020
- Pediatric ER visits (under 18) totaled 28.6 million in 2019, with 15% classified as non-urgent
- In 2021, falls caused 3.2 million ER visits among seniors 65+, 32% of their total visits
- Traumatic brain injuries led to 2.8 million ER visits in 2020, 70% mild concussions
- Motor vehicle crash ER visits: 2.4 million in 2021, with 25% involving alcohol
- National average ER wait time for low-acuity patients was 28 minutes in 2022
- Median door-to-doctor time in ERs: 21 minutes for 2021, varying by region 15-35 min
- Boarding time for admitted patients averaged 4.3 hours in 2022 urban ERs
- Average RN staffing in ER: 2.8 per 1,000 visits nationally 2022
- Physician coverage: 24/7 in 85% of hospitals, but 1:2,500 visits ratio in rural
- ER nurse turnover rate: 19.5% annually 2022, highest in urban
- Average ER cost per visit: $2,600 in 2022, up 12% from 2020
- Uncompensated care in ERs: $42 billion annually 2021
- Medicare ER reimbursement rate: 80% of costs, average $1,800 per visit
Emergency room visits remain high post-pandemic with growing demands from seniors and mental health crises.
Costs and Outcomes
- Average ER cost per visit: $2,600 in 2022, up 12% from 2020
- Uncompensated care in ERs: $42 billion annually 2021
- Medicare ER reimbursement rate: 80% of costs, average $1,800 per visit
- 30-day mortality post-ER admission for MI: 5.2% in 2021
- Sepsis mortality from ER: 15.8% in-hospital 2022
- ER-admit readmission rate 30 days: 15.4% national average
- Average charge for ER chest pain workup: $4,100 uninsured 2022
- Opioid prescribing at discharge: 5% of visits, down 40% since 2016
- Infection rate from ER procedures: 0.3% for lacerations 2021
- Survival to discharge for out-of-hospital cardiac arrest arriving ER: 10.4% 2022
Costs and Outcomes Interpretation
The emergency room is a staggeringly expensive, taxpayer-supported casino where your life is the bet, the house always wins, and the payout for survival still comes with a bill that can break you.
Injury and Illness
- In 2021, falls caused 3.2 million ER visits among seniors 65+, 32% of their total visits
- Traumatic brain injuries led to 2.8 million ER visits in 2020, 70% mild concussions
- Motor vehicle crash ER visits: 2.4 million in 2021, with 25% involving alcohol
- Heart attack ER presentations: 805,000 annually, 45% STEMI cases
- Stroke ER visits: 795,000 per year, with 87% ischemic type
- Appendicitis ER diagnoses: 250,000 cases yearly, 7% perforated at arrival
- Sepsis ER admissions: 1.7 million annually, 20% mortality post-ER
- Asthma exacerbations in ER: 2.1 million visits yearly, 10% requiring ICU
- Pneumonia ER visits: 1.3 million in adults 18+, 15% hospitalized
- Diabetic emergencies (hypo/hyperglycemia): 500,000 ER visits yearly
- Kidney stone ER presentations: 1 million annually, 60% requiring imaging
- Migraine ER visits: 1.2 million yearly, 75% female patients
- Cellulitis/soft tissue infections: 2.5 million ER visits in 2019
- Allergic reactions/anaphylaxis: 200,000 ER visits yearly, 50% food-triggered
- Abdominal pain ER chief complaint: 7.1 million visits annually, 40% female
- Chest pain ER evaluations: 8.9 million yearly, 10% ACS confirmed
- Shortness of breath ER visits: 3.8 million annually, 30% respiratory cause
- Fever in children under 2: 2 million ER visits yearly
- Laceration repairs in ER: 9 million annually, 20% facial
- Sprains/strains: 2.1 million sports-related ER visits for ages 5-24
- Burn injuries: 1.1 million ER visits yearly, 70% minor thermal
- Poisoning exposures: 2.4 million calls to poison control leading to 100,000 ER visits
- Drowning near-drownings: 7,000 ER visits yearly in kids under 5
- Assault-related ER visits: 1.5 million annually, 40% females
- UTI ER visits in women: 3 million yearly, 25% requiring antibiotics IV
- Gout flares: 1.5 million ER visits annually, mostly males over 50
- Pancreatitis ER admissions: 250,000 yearly, 50% alcohol-related
- Diverticulitis ER diagnoses: 200,000 annually, 30% perforated cases
Injury and Illness Interpretation
These numbers paint a picture of an ER that's less a single clinic and more a sprawling, chaotic city under one roof, where the grand waltz of humanity's frailty—from the tragic stumble to the reckless crash, the silent heart attack to the screaming kidney stone—plays out in millions of acts every single year.
Operational Metrics
- National average ER wait time for low-acuity patients was 28 minutes in 2022
- Median door-to-doctor time in ERs: 21 minutes for 2021, varying by region 15-35 min
- Boarding time for admitted patients averaged 4.3 hours in 2022 urban ERs
- Triage accuracy rate: 92% correct acuity assignment in Level 1-5 scale
- Left without being seen (LWBS) rate: 2.1% nationally in 2021, higher in urban 3.5%
- Average ER length of stay: 2.7 hours for discharged patients in 2022
- Overcrowding days per year: 45 in average urban ER, per 2021 survey
- Bed turnover rate: 4.2 patients per bed per day in high-volume ERs
- CT scan usage in ER: 15% of visits, median time to scan 2.1 hours
- Lab turnaround time average: 45 minutes for stat CBC in 2022
- Telemedicine ER consults: 12% of visits in 2023, reducing transfer by 25%
- Pain score documentation rate: 98% compliance in Joint Commission accredited ERs
- Hand hygiene compliance in ER: 82% during 2022 audits
- Readmission within 72 hours from ER: 3.4% rate nationally
- Ambulance diversion hours: reduced to <1% post-2010 mandates
- Patient satisfaction score ( Press Ganey): 78/100 average for ERs in 2022
- Throughput time for stroke code: 45 minutes door-to-needle in certified centers
- Sepsis bundle compliance: 75% within 3 hours in 2021 ERs
- Average wait for Level 3 (urgent) patients: 45 minutes median 2022
- Diversion for psych holds: 15% of ER time in urban areas 2022
- Electronic health record usage: 96% of ERs fully implemented by 2023
- Nurse-to-patient ratio peak hours: 1:4 average in 2022 surveys
- Code blue response time: 2.5 minutes average in ERs 2021
- Medication error rate in ER: 0.9 per 100 orders 2022
Operational Metrics Interpretation
While the ER appears efficient at getting low-acuity patients seen relatively quickly and documenting their pain with near-universal diligence, this brisk front-door velocity masks a system stuck in a gridlock of its own making, where patients who are sick enough to be admitted languish for hours in hallways, key diagnostics like CT scans take longer than the average visit itself, and overcrowding forces one in every thirty urban patients to simply give up and leave before being seen, revealing a system straining to manage its vital signs.
Patient Volume
- In 2021, U.S. emergency departments recorded 131.0 million visits, a 4.5% decrease from 2019 pre-pandemic levels
- Emergency room visits among adults aged 65+ increased by 3.2% annually from 2016-2020, reaching 22.4 million in 2020
- Pediatric ER visits (under 18) totaled 28.6 million in 2019, with 15% classified as non-urgent
- Urban ERs handled 72% of all national visits in 2022, averaging 45,000 visits per facility
- During 2020 COVID peak, ER visits fell 42% in March-April compared to 2019 baseline
- Rural ERs saw 12.3 million visits in 2021, up 2.1% from 2020 despite closures
- ER visits for mental health crises rose 18% from 2019-2022, totaling 7.2 million annually by 2022
- Weekend ER visits comprised 28% of total annual volume, peaking at 11 PM on Saturdays
- In 2023 Q1, national ER visits rebounded to 140 million annualized rate post-Omicron
- Females accounted for 55.3% of all ER visits in 2021, with higher rates for abdominal pain
- ER visits by uninsured patients dropped 15% from 2019-2021 due to Medicaid expansions
- Night shift (8 PM-4 AM) ER visits averaged 35% of daily total in urban hospitals
- Seasonal peak in ER visits occurs December-February at 108% of annual average
- ER visits via ambulance transport: 16.2 million in 2020, 12% of total visits
- In California, ER visits reached 10.2 million in 2022, led by LA County at 2.1 million
- New York State ERs logged 8.7 million visits in 2021, with NYC at 65% share
- Texas ER network handled 11.5 million visits in 2022, averaging 92,000 per 100k population
- Florida's ER visits totaled 9.8 million in 2021, spiking 25% post-hurricanes
- Veterans Affairs ERs saw 2.3 million visits in FY2022, up 8% from 2021
- Military ER visits (TRICARE) averaged 4.1 million annually 2018-2022
- Tribal health ER visits: 1.2 million in 2021, with 40% injury-related
- Prison ER visits per 1,000 inmates: 450 annually in 2020 federal system
- College campus ER visits: 150,000 annually nationwide, 25% alcohol-related
- Workplace injury ER visits: 900,000 in 2021 BLS data
- Sports-related ER visits: 2.7 million yearly for ages 5-24
- Heat-related ER visits: 250,000 annually average 2001-2020
- Opioid overdose ER visits: 1.1 million in 2021, up 30% from 2019
- Gunshot wound ER visits: 85,000 in 2022, highest on record
- Animal bite ER visits: 800,000 yearly, 50% dog-related
- Food poisoning ER visits: 128,000 annually from known pathogens
Patient Volume Interpretation
America's emergency rooms are seeing a return to their baseline chaos, with the silver-haired surge, a rising tide of mental health crises, and the relentless nightly influx revealing a system perpetually in triage.
Staffing and Capacity
- Average RN staffing in ER: 2.8 per 1,000 visits nationally 2022
- Physician coverage: 24/7 in 85% of hospitals, but 1:2,500 visits ratio in rural
- ER nurse turnover rate: 19.5% annually 2022, highest in urban
- Capacity utilization: 112% average occupancy in overcrowded ERs 2021
- Number of ER beds per 100,000 pop: 25.3 nationally, 18.2 rural
- ED physicians FTE: 45,000 nationwide in 2022, shortage of 10%
- PA/NP usage in ER: 30% of visits staffed by midlevels 2023
- Ventilator capacity in ERs: average 4 per department, 85% occupied peak COVID
- Surge capacity activation: 72% of ERs in 2022 flu season
- Training hours for ER nurses: 120 annually required, compliance 91%
- Locum tenens usage: 25% of ER shifts in rural 2022
- Burnout rate among ER docs: 60% in 2022 survey
- Total ERs in US: 5,200 in 2023, down 7% since 2010
- Observation unit beds: present in 60% ERs, averaging 8 beds
- Fast-track area utilization: 45% of low-acuity volume in equipped ERs
- Ancillary staff (techs): 1.5 per RN average 2022
- Psychiatrist on-call availability: 24/7 in 40% ERs 2022
- Trauma surgeon response time: <15 min in Level 1 centers, 95% compliance
- Social worker consults: 15% of ER visits, average response 45 min
- Pharmacy satellite hours: 18/24 average in large ERs
Staffing and Capacity Interpretation
The statistics reveal an emergency room system stretched so thin it's practically gossamer, where the heroic efforts of its overworked and fleeing staff are the only things preventing it from becoming a public health ghost town.
Sources & References
- Reference 1CDCcdc.govVisit source
- Reference 2AHRQahrq.govVisit source
- Reference 3PUBLICATIONSpublications.aap.orgVisit source
- Reference 4KFFkff.orgVisit source
- Reference 5RURALHEALTHINFOruralhealthinfo.orgVisit source
- Reference 6SAMHSAsamhsa.govVisit source
- Reference 7JAMANETWORKjamanetwork.comVisit source
- Reference 8FAIRHEALTHfairhealth.orgVisit source
- Reference 9HCUP-UShcup-us.ahrq.govVisit source
- Reference 10NCBIncbi.nlm.nih.govVisit source
- Reference 11EMSems.govVisit source
- Reference 12HCAIhcai.ca.govVisit source
- Reference 13HEALTHhealth.ny.govVisit source
- Reference 14DSHSdshs.texas.govVisit source
- Reference 15FLORIDAHEALTHfloridahealth.govVisit source
- Reference 16VAva.govVisit source
- Reference 17HEALTHhealth.milVisit source
- Reference 18IHSihs.govVisit source
- Reference 19BJSbjs.ojp.govVisit source
- Reference 20NASMHPDnasmhpd.orgVisit source
- Reference 21BLSbls.govVisit source
- Reference 22GIFFORDSgiffords.orgVisit source
- Reference 23NHTSAnhtsa.govVisit source
- Reference 24HEARTheart.orgVisit source
- Reference 25AUANETauanet.orgVisit source
- Reference 26AMERICANMIGRAINEFOUNDATIONamericanmigrainefoundation.orgVisit source
- Reference 27FOODALLERGYfoodallergy.orgVisit source
- Reference 28ACEPacep.orgVisit source
- Reference 29AAFPaafp.orgVisit source
- Reference 30AMERIBURNameriburn.orgVisit source
- Reference 31POISONpoison.orgVisit source
- Reference 32ARTHRITISarthritis.orgVisit source
- Reference 33GASTROJOURNALgastrojournal.orgVisit source
- Reference 34CMScms.govVisit source
- Reference 35JOURNALSjournals.lww.comVisit source
- Reference 36JOURNALSjournals.sagepub.comVisit source
- Reference 37RSNArsna.orgVisit source
- Reference 38CAPcap.orgVisit source
- Reference 39AMA-ASSNama-assn.orgVisit source
- Reference 40JOINTCOMMISSIONjointcommission.orgVisit source
- Reference 41PRESSGANEYpressganey.comVisit source
- Reference 42SURVIVINGSEPSISsurvivingsepsis.orgVisit source
- Reference 43HFMAhfma.orgVisit source
- Reference 44PSYCHIATRYpsychiatry.orgVisit source
- Reference 45HEALTHIThealthit.govVisit source
- Reference 46ENAena.orgVisit source
- Reference 47RESUSCITATIONJOURNALresuscitationjournal.comVisit source
- Reference 48PSNETpsnet.ahrq.govVisit source
- Reference 49AACNaacn.orgVisit source
- Reference 50NURSINGWORLDnursingworld.orgVisit source
- Reference 51COMMONWEALTHFUNDcommonwealthfund.orgVisit source
- Reference 52DEFINITIVEHCdefinitivehc.comVisit source
- Reference 53AAPAaapa.orgVisit source
- Reference 54HEALTHSYSTEMTRACKERhealthsystemtracker.orgVisit source
- Reference 55ASPRTRACIEasprtracie.hhs.govVisit source
- Reference 56STAFFCAREstaffcare.comVisit source
- Reference 57SHEPSCENTERshepscenter.unc.eduVisit source
- Reference 58ANNEMERGMEDannemergmed.comVisit source
- Reference 59EMRAemra.orgVisit source
- Reference 60FACSfacs.orgVisit source
- Reference 61ASHPashp.orgVisit source
- Reference 62MEDICAREmedicare.govVisit source
- Reference 63SCCMsccm.orgVisit source
- Reference 64HEALTHCAREBLUEBOOKhealthcarebluebook.comVisit source
- Reference 65CPRcpr.heart.orgVisit source