Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Jeffrey J Guterman; Scott R Lundberg; Geoffrey P Scheib; Sandra G Gross-Schulman; Mark J Richman; Chien-Ju Wang; David A Talan

doi:10.5811/westjem.2016.7.30832

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Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Journal article

Open access

Peer reviewed

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Jeffrey J Guterman, Scott R Lundberg, Geoffrey P Scheib, Sandra G Gross-Schulman, Mark J Richman, Chien-Ju Wang and David A Talan

The western journal of emergency medicine, Vol.17(5), pp.561-566

09/2016

DOI: 10.5811/westjem.2016.7.30832

PMCID: PMC5017840

PMID: 27625720

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Abstract

Attending physician judgment is the traditional standard of care for emergency department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days), and quality indicators (15- and 30-day ED returns; delayed hospital admissions). We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0%) and correlated with Medicaid denied-payment day rates (p=0.038). There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission). There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.

United States

Emergency Service, Hospital - economics

Humans

Medicaid - economics

Outcome Assessment (Health Care)

Patient Admission - economics

Physicians

Quality of Health Care - economics

Retrospective Studies

Details

Title: Subtitle: Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality
Creators: Jeffrey J Guterman - Los Angeles County Department of Health Services
Scott R Lundberg
Geoffrey P Scheib - Los Angeles County Department of Health Services
Sandra G Gross-Schulman - Los Angeles County Department of Health Services
Mark J Richman - University of California, Los Angeles
Chien-Ju Wang - Los Angeles County Department of Public Health
David A Talan - Los Angeles County Department of Health Services
Resource Type: Journal article
Publication Details: The western journal of emergency medicine, Vol.17(5), pp.561-566
DOI: 10.5811/westjem.2016.7.30832
PMID: 27625720
PMCID: PMC5017840
NLM abbreviation: West J Emerg Med
ISSN: 1936-900X
eISSN: 1936-9018
Language: English
Date published: 09/2016
Academic Unit: Emergency Medicine; Internal Medicine
Record Identifier: 9984296966902771

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9 Times Cited - Web of Science