Healthcare forecasting experts are projecting a modest 1-2% annual growth in emergency department (ED) visits over the next decade. However, hospital systems across the country are experiencing a starkly different reality.

From 2021-2024, many of our clients realized 2-4% annual increases in ED volume coupled with longer visit durations (+5%) and rising numbers of behavioral health patients.

This fundamental disconnect between projection and practice is creating a dangerous planning gap that threatens to leave hospital systems unprepared for the growing demand ahead.

Understanding the Drivers

Several converging factors fuel this surge: post-pandemic healthcare patterns with delayed care creating complex presentations, primary care access challenges pushing patients to EDs, evolving consumer desires and behaviors that shun traditional patient physician relationships, a behavioral health crisis with EDs serving as crisis intervention entry points, and aging population complexity requiring longer evaluation periods than originally projected.

The Strategic Implications and New Paradigm

This forecasting gap has profound implications. Hospital systems planning based on conservative growth projections are finding themselves chronically understaffed for actual demand levels, operating at or above capacity consistently, and unable to maintain quality metrics under volume pressure.

The Paradigm Shift: From Conservative Planning to Growth-Ready Infrastructure

Hospital systems must fundamentally recalibrate their strategic planning assumptions. Healthcare leaders who continue to plan for 1% annual volume growth while experiencing 5-8% increases in visit hours are setting their organizations up for operational failure and compromised patient care and ultimately a loss in market share or consumer preference. The new paradigm requires bold infrastructure investments, innovative care delivery models, and technology solutions that can scale with actual—not projected—demand.

Recommendations: Preparing for the New Reality

Enhanced Care Delivery Models: Implement enhanced fast track protocols for lower-acuity patients, deploy point-of-care diagnostics and imaging to accelerate decision-making, and develop specialized behavioral health protocols with dedicated resources.

Technology-Enabled Force Multipliers: Enable voice charting systems for nurses to document while maintaining patient interaction, use predictive analytics for capacity and staff planning, and implement automated bed management systems.

Strategic Capacity Planning: Plan for multiple growth scenarios including higher-growth reality, develop flexible staffing models that adapt to varying demand, and prioritize ED infrastructure investments based on realistic projections. Know what the next development pathway (facility, technology, staffing) is to address increased needs to maintain an optimal delivery chassis.

Conclusion

The disconnect between ED volume forecasts and actual trends signals a fundamental shift in healthcare utilization that demands recalibration. Healthcare leaders who recognize this shift and plan accordingly will be better positioned to deliver quality care while maintaining operational sustainability. The question is not whether ED volumes will continue to grow beyond conservative projections, but whether hospital systems will adapt their strategies to match the reality their staff experience every day.