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Variation in Emergency Department Physician Admitting Practices and Subsequent Mortality
Stephen Coussens1,2, Dan P Ly1,3
1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
JAMA Internal Medicine
|December 23, 2024
Summary
Emergency department (ED) physicians show significant variation in hospital admission rates. Higher admission rates do not reduce patient mortality but may lead to shorter hospital stays.
Area of Science:
- Health Services Research
- Clinical Decision Making
- Patient Outcomes
Background:
- Physician decisions on hospital admission significantly influence patient care.
- There is wide variation in emergency department (ED) physicians' admission propensities.
- The impact of admission propensity on patient mortality is not well understood.
Purpose of the Study:
- To quantify variation in ED physicians' admission rates.
- To assess the association between admission propensity and subsequent patient mortality.
Main Methods:
- Cross-sectional study using nationwide Veterans Affairs electronic health records (2011-2019).
- Included patients with chest pain, shortness of breath, or abdominal pain.
- Compared physicians within the same ED, adjusting for patient health status.
Main Results:
- Significant variation in physicians' adjusted admission rates within EDs.
- Higher admission rates correlated with increased likelihood of short inpatient stays (<24 hours).
- No association found between higher admission rates and reduced 30-day mortality.
Conclusions:
- ED physician admission propensity varies widely, independent of patient health status.
- Higher admission rates are linked to shorter stays but not improved mortality outcomes.
- Findings suggest potential for optimizing admission practices to improve care efficiency and outcomes.
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