Do Available Beds Influence Admission Decisions in the ER?

Recently released research shows that hospital admission rates are higher in hospital emergency departments as compared to freestanding emergency departments. Surprisingly, the research also shows that the higher admission rates for hospital EDs have more to do with the facilities themselves than locum tenens staffing and other personnel-related concerns.

The Cleveland Clinic research looked at 2015 hospital admission rates for a variety of conditions. The compiled data represented 3,230 patients, 53% of whom visited a hospital ED compared to the 47% that visited a freestanding ED. Patients were treated for chest pain, COPD, asthma, and congestive heart failure.

Researchers discovered that patients seeking care at hospital EDs were 20% more likely to be admitted to the hospital. As a percentage of the total visits, patients visiting hospital EDs were also admitted at higher rates. The data shows that 49% of the hospital ED patients were admitted while just 42% of the freestanding ED patients were sent to hospitals.

With the hard numbers out of the way, obvious questions arise. What is it that leads to a higher incidence of hospital admissions among patients who seek care at the hospital emergency department? Researchers offer two suggestions, beginning with the need to turn over beds.

Available Beds Are in Demand

If there’s one thing we know about emergency medicine, it is the fact that your average ED is a fairly busy place most of the time. During the busiest shifts, available beds can be in short supply. That leaves ED doctors facing a full waiting room with decisions to make on every patient being treated. Furthermore, it doesn’t matter whether the doctor is a permanent staff member or a temporary emergency medicine locum. The demand for beds is the same.

When beds are in short supply, doctors have to consider whether it’s better to free up a bed by admitting a particular patient to the hospital. In the hospital ED setting, the temptation to do so is fairly high. In the freestanding ED setting though, there is less incentive – and less need for that matter – to recommend hospital admission.

The reality is that freestanding EDs tend to be less busy day-to-day. Any shortage of available beds is not nearly as acute, even during the busiest shifts. Therefore, doctors have less of a need to pay attention to bed turnover.

Facility Treatment Capabilities

Hand-in-hand with the bed turning decision is the question of whether patients would have better access to care by being admitted to the hospital as a regular patient. For instance, would an admitted patient be taken for diagnostic testing more quickly than an ED patient?

It is reasonable to assume that hospitals with greater resources, like level 1 and 2 trauma centers, would see higher admissions because they can more effectively treat patients once they have been admitted. The data seems to back that up.

By contrast, the amount of time and effort it takes to transfer from a standalone ED to a hospital may negate any benefits hospital admission might offer, especially if the facility is not pressed for beds. Patients in a standalone ED might get treated just as quickly and effectively as they would have been by being admitted to the hospital.

The Cleveland Clinic study is intriguing. It shows that emergency medicine doctors are more likely to admit patients who visit hospital EDs as opposed to standalone facilities. And the number one reason could be how the facilities themselves operate. In the end, it doesn’t much matter as long as patients receive the kind of care they need.

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