For the third straight year, Parkland Health treated the most emergency department visits in the country, according to fiscal year 2022 data compiled by Becker’s Hospital Review. While the hospital’s 226,178 visits in 2022 were less than the pandemic-inflated 2020’s 241,968 visits, it was an increase of more than 15,000 visits compared to 2021.
Parkland has led the second-busiest hospital, Lakeland Regional Medical Center in Florida, by more than 20,000 visits for the last three years. Other North Texas hospitals to make this year’s list are John Peter Smith Hospital in Fort Worth (No. 14 with 125,812 visits) and Texas Health Harris Methodist Fort Worth (No. 27, 109,424 visits). Becker’s compiled the data based on individual hospital submissions.
“Our ED’s high patient volume has driven a focus on optimizing patient flow through innovative workflow enhancements and strong collaboration with our medical team,” says Dawn Marchetto, a Parkland Health senior vice president. “Our dedicated staff and leadership has risen to the challenge and their ability to perform under pressure has benefited our patients and families in need.”
While it leads the country in ED visits, Parkland doesn’t crack the top 15 in hospital size nationwide, and that level of efficiiency is a point of pride for the staff. “We are proud to provide a much-needed service to our community, which is reflected in the number of patients,” says Dr. Jeff Metzger, chief of emergency services at Parkland Health. “It speaks to all the different areas in the hospital that work to move that number of patients.”
Parkland Health’s reign as the busiest emergency room likely has to do with the perfect storm of being the only safety net hospital in a highly populated area (Dallas County) in a state with the nation’s worst health insurance rates. By some measures, Dallas is likely among the least insured big cities in the country.
According to Kaiser Health News, Texas leads the nation in uninsured population by a wide margin at 18 percent, which is more than double the national average and more than four percentage points above the second-least insured state, Oklahoma. Texas also has the worst uninsured rate for children in the nation, according to the think tank Every Texan. Parkland says that about one-third of the care provided is charity care, meaning it never receives payment for the care provided.
Texas is one of the few states that has yet to expand Medicaid and insure around one million working Texans. This would give the state access to additional federal funding to ameliorate some of the costly charity care Parkland and other hospitals provide. Research shows it is a money-maker for the state because preventative care would decrease the number of medical issues treated only when they were in later stages and more expensive.
The 983-bed Parkland hospital sees high numbers of Medicare, Medicaid, and uninsured patients. These hospitals make it their mission to serve poor and uninsured residents and won’t turn away patients who can’t pay. Parkland has also previously held the record for most emergency visits in one day (during the Omicron surge of the COVID-19 pandemic) and most births per year (16,597 in 2001).
While Houston has similar conditions, Harris County has two public safety net hospitals, which divides potential patients between Ben Taub and Lyndon B. Johnson hospitals.
When residents don’t have health insurance, they often don’t have a primary care physician who can detect issues before they become emergencies. Without a medical home or insurance to pay for care, uninsured residents go to the Parkland emergency room for many medical needs, even if they aren’t an emergency. These conditions result in high healthcare costs, poor outcomes, and over-utilization of the emergency department. A study from the Western Journal of Emergency Medicine found that around 1/3 of emergency department visits are not urgent.
The hospital was ranked by Washington Monthly as one of the top health systems for the people, meaning it is accessible and has high outcomes. Parkland was also named “high performing” by U.S. News and World Report for maternity. However, it received a “D” in Leapfrog’s latest safety ranking (Parkland does not submit voluntary data to Leapfrog). It also received only two stars from the Centers for Medicare and Medicaid Services. This ranking has been critiqued for being unfair to hospitals that see significant numbers of uninsured and poor patients.
As the hospital approaches pandemic-level emergency visit numbers, Metzger says the staff feels that level of busyness, especially given the changes to procedures caused by the pandemic that have hurt efficiency. While the conditions that have forced such a large population to use the emergency room are unfavorable, the ED providers and staff remain focused on what they can control. “We work to mitigate some of those problems as much as we can, but we recognize that we are the front door to the health system,” Metzger says.
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