RAND study shows that ER has become major portal for unscheduled hospitalizations

More than three-quarters (81.8 percent) of unscheduled admissions to the hospital now come through the emergency department, which is a sharp increase from the previous decade when only 64.5 percent of unscheduled admissions came through the ER. A study, published early online this week in the journal Medical Care, re-confirms recent findings by the RAND Corporation highlighting the growing role emergency physicians play in health care beyond the emergency department ("Changes in the Source of Unscheduled Hospitalizations in the United States").

"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."

Dr. Kocher and his team compared hospital admissions over a 10-year period, from 2000 through 2009, using the Nationwide Inpatient Sample. Admissions through the emergency department increased substantially at the expense of direct admissions from clinics or doctors' offices which declined from 31 percent to 14 percent of unscheduled admissions.

"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."

Source: American College of Emergency Physicians