Variation in Emergency Department Admission Rates Across the United States

Abstract

There were more than 19 million hospitalizations in 2008 from hospital-based emergency departments (EDs), representing nearly 50% of all U.S. admissions. Factors related to variation in hospital-level ED admission rates are unknown. Generalized linear models were used to assess patient-, hospital-, and community-level factors associated with ED admission rates across a sample of U.S. hospitals using Healthcare Cost and Utilization Project data. In 1,376 EDs, the mean ED admission rate, when defined as direct admissions and also transfers from one ED to another hospital, was 17.5% and varied from 9.8% to 25.8% at the 10th and 90th percentiles. Higher proportions of Medicare and uninsured patients, more inpatient beds, lower ED volumes, for-profit ownership, trauma center status, and higher hospital occupancy rates were associated with higher ED admission rates. Also, hospitals in counties with fewer primary care physicians per capita and higher county-level ED admission rates had higher ED admission rates.

Variation in Emergency Department Admission Rates in US Children’s Hospitals

“…The lack of access to primary care physicians in the local community has been found to be associated with higher ED admission rates, as have greater ED volume, trauma designation, metropolitan location, and teaching status. 7,9,23 At the ED level, physicians appear to be strongly influenced by local standards of care in their decision-making as well as by personal attitudes toward risk tolerance and malpractice fear. 7,[24][25][26] One study examining physician level variation in admission rates in adult EDs found a greater than twofold variation in admission rates within single institutions.…”

“…[2][3][4][5][6] Some of the variation in care may be related to patientlevel differences in clinical presentation as well as to hospital-level factors, such as local availability of primary care physicians, hospital occupancy, or access to certain health care services. [7][8][9] The wide variation in clinical management raises concerns about whether every patient is receiving the optimal care and whether the lack of a standardized approach is contributing to unnecessary health care costs. [10][11][12] Additional testing and treatment have not necessarily been found to correlate with more effective care, improved patient outcomes, or higher patient satisfaction.…”

Variation in Chest Pain Emergency Department Admission Rates and Acute Myocardial Infarction and Death Within 30 Days in the Medicare Population

“…Recent studies have demonstrated wide variation in admission rates among emergency physicians and across hospitals. [3][4][5] Factors such as risk tolerance and malpractice fear have been identified as important explanatory factors at the physician level. [6][7][8] Patients who are treated and released, but subsequently return with serious causes for chest pain, are a particular concern because patients with "missed" acute myocardial infarction (AMI) have worse outcomes.…”

Ethical Issues in the Response to Ebola Virus Disease in United States Emergency Departments: A Position Paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine

“…It is estimated that 50% of admissions to hospitals in the United States are initially assessed and treated in EDs. 20 The ED is also the only access point in the U.S. acute health care system available to patients 24 hours per day, 7 days per week. In the United States there is a legal obligation under EMTALA to provide a medical screening examination for an emergency medical condition and treatment until the emergency medical condition is resolved or stabilized to the extent of that hospital's capability (until appropriate transfer), regardless of insurance status or other socioeconomic factors.…”