How (ED) admission decisions differ when the same physician works in two different emergency department

• Published in: The American journal of emergency medicine 2017-07, Vol.35 (7), p.970-973
• Main Authors: Pines, Jesse M., Galarraga, Jessica E., Granvosky, Michael, Litvak, Ori, Davis, Samuel, Warner, Leah Honigman
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Attitude of Health Personnel; Child; Child, Preschool; Clinical Decision-Making; Cross-Sectional Studies; Decision making; Economic indicators; Emergencies; Emergency medical care; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Female; Hospitals; Humans; Infant; Male; Medicare; Middle Aged; Patient Admission - statistics & numerical data; Patient admissions; Patient satisfaction; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Regression analysis; Retrospective Studies; United States - epidemiology; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.01.067

Emergency physicians often work in multiple hospital emergency departments (EDs). We study how emergency physician admission decisions vary in different settings. We conducted a retrospective, cross-sectional study over two years (2012−3) in six EDs in three states. Included physicians had ≥200 encounters per site in two different EDs. “Admissions” were ED encounters resulting in admission to the hospital or transfer to another hospital. The primary outcome was the adjusted admission rate difference between the two sites. Hierarchical logistic regression analysis was used to calculate adjusted admission rates for each physician, which were then tabulated for each physician and compared across sites. In 51,807 ED encounters seen by 16 physicians the average admission rate was 20.0%, and unadjusted admission rates differed between sites by 2.9% (range 0–8.4%) for the same physician. The adjusted admission rate was 19.3% and differed between sites by 2.1% (range 0.4%–6.2%). In this sample, some ED physicians made similar admission decisions in different settings while others increased or decreased their admission rates up to 25% when practicing in a different ED.