A common assertion is that heavy and inappropriate use of hospital emergency departments (EDs) in the United States contributes to waste and inefficiency. One estimate suggests that overuse of the ED costs $38 billion annually.1 This issue is certainly compelling, but the underlying notion is not necessarily new. Discussions of ED overuse and misuse have been ongoing for more than 4 decades.2,3 Although ED use, overuse, and misuse have been long-standing policy priorities, even specifically highlighted by Presidents Johnson, Clinton, Bush, and Obama, the number of ED visits in the United States has continued to increase almost unabated from approximately 44 million patients per year in 1968 to approximately 134 million annual visits more recently.4- 6
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