ED's increasing role in hospital admissions

January 12th, 2015

Hospital emergency departments (EDs) are the most expensive place to get medical care. And with EDs playing an increasing role in hospital admissions, the RAND Corporation, as well as a team out of the University of Michigan set out to study this trend, as EDs were responsible for nearly half of all hospital admissions between 2003 and 2009, according to the RAND study.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," said Art Kellerman, MD, the RAND study's senior author and a senior researcher at RAND. "While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."

According to the study out of the University of Michigan, more than three-quarters (81.8%) of unscheduled admissions to the hospital now come through the ED, which is a sharp increase from the previous decade (64.5%).

“Although generally sicker, patients admitted to the hospital from the emergency department had lower mortality and shorter hospital stays than patients admitted directly from the community,” said lead study author Keith Kocher, MD, MPH, of the Department of Emergency Medicine at the University of Michigan in Ann Arbor, Mich. “The ER was the source of admission for a wide variety of clinical conditions, from medical and surgical disease to mental illness. It was also the source of admission for more vulnerable populations like the elderly, minorities and the uninsured.”

While the RAND study focused on admissions from 2003-2009, the University of Michigan study compared hospital admissions from 2000 through 2009. Admissions through the ED increased substantially, while admissions from clinics or doctors’ offices accounted for only 14% of unscheduled admissions, down from 31%.

“Our study and the RAND study demonstrate that the emergency department has become the major portal for unscheduled hospitalizations,” said Dr. Kocher. “Administrators and policy makers would be advised to focus their attention on physicians and caregivers in the emergency department who make more and more of these decisions to admit. As acute care management continues to evolve away from primary care providers, this trend also has the potential to exacerbate an already fragmented U.S. health care system.”

Researchers say the findings also suggest that office-based physicians are directing some patients to the ED that they would have previously admitted to the hospital themselves. In addition, they found that EDs are supplementing primary care providers by handling overflow, after-hours cases, and weekend demand for medical care.

According the RAND study, these changes mean that emergency physicians now serve as the major decision maker for about half of all hospitals admissions in the United States. Hospital admissions account for most of hospital revenue and inpatient medical care accounts for 31 percent of nationwide health spending, making emergency room physicians a major nexus in influencing health care costs.

Please also check out our blog post MedPAC urges changes to hospital readmissions reduction program for additional information on hospital admissions. http://hospitalreport.blogs.reliasmedia.com/2013/06/19/medpac-urges-changes-to-hospital-readmissions-reduction-program/