Emergency Physicians Vary in How Many Patients They Admit

Emergency Physicians Vary in How Many Patients They Admit

Daniel J. Pallin, MD, MPH reviewing Abualenain J et al. Ann Emerg Med 2013 Jun.

This study reveals that physicians working in the same system behave very differently.

Variability in medical care can indicate opportunities for cost savings or quality improvement. Increasingly, variability is becoming a topic for research and may soon be a target of incentives and penalties. These authors analyzed a large sample of emergency department (ED) encounters at three Washington, D.C.–area hospitals in the same system, to measure variability in emergency physicians' admission decisions.

The data analyzed covered 89 physicians and nearly 400,000 ED visits. The authors controlled for potential confounders, including hospital, mode of arrival, triage acuity rank, and physician characteristics. They found that physician's admission rates varied from 21% to 49%.

COMMENT

Although these authors used sophisticated methods, they could not control for every confounder, and it remains likely that some of the observed variability in admission rates was due to patient characteristics, not inconsistencies in the care provided. All the same, variation of over 100% clearly represents an opportunity for improvement: Increasingly, patients and payers will ask for consistency in making expensive healthcare decisions, and no decision is more expensive than a decision to admit.

 Editor Disclosures at Time of Publication

CITATION(S):

1. Abualenain J et al. Emergency department physician-level and hospital-level variation in admission rates. Ann Emerg Med 2013 Jun; 61:638. (http://dx.doi.org/10.1016/j.annemergmed.2013.01.016) 

   
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