Emergency department physicians vary widely in their decisions about whether to admit a patient, and individuals hospitalized by physicians with higher readmission rates are more likely to be discharged within 24 hours, according to a new study led by researchers at Los Angeles-based UCLA Health.
While previous research highlighted differences in emergency department physicians' likelihood of admitting patients, this study is among the first to link those variations to patient outcomes.
The study analyzed EHRs from U.S. Department of Veterans Affairs patients between 2011 and 2019. Researchers reviewed data from 2,100 physicians at 105 EDs, covering over 2.1 million visits for conditions such as chest pain, shortness of breath and abdominal pain.
Three key findings:
- About 41% of ED visits resulted in a hospitalization, with 19% of patients discharged within 24 hours.
- Patients treated by physicians with a higher likelihood of admitting were nearly twice as likely to be hospitalized compared to those seen by physicians with a lower propensity to admit, even when their health status was similar.
- Patients hospitalized by physicians with a higher propensity to admit were more likely to be discharged within 24 hours and no less likely to die within a one-year follow-up period, suggesting many admissions may have been unnecessary.
"Physicians, just like professionals in other domains, differ in their abilities and decisions, which has consequences for how much care you might receive, including, in this case, your likelihood of being hospitalized," Dan Ly, MD, PhD, study co-author and assistant processor of medicine at University of California Los Angeles' David Geffen School of Medicine, said in a Dec. 23 news release. "Some physicians may order more tests and hospitalize more of their patients, but this doesn't appear to translate to better health."
The full study was published Dec. 23 in JAMA Internal Medicine and can be found here.