Hospitals vary widely on admissions after ER visits

This article was originally published in the San Francisco Chronicle on September 17, 2014.

 Photo: Michael Short, Special To The Chronicle
Photo: Michael Short, Special To The Chronicle

If you’ve ever been to an emergency room, you’ve probably wondered whether your condition will be deemed serious enough to be admitted to the hospital. Now, a new study reveals the answer often varies – a lot – from one hospital to another.

Those who come to the ER with a potentially fatal medical condition – like a heart attack, acute kidney failure or sepsis – are almost always admitted, researchers at the University of Michigan found. But hospitals around the U.S. have very different rates of admission for conditions – like asthma, skin infections, urinary tract infections and bronchitis – that are serious but rarely life threatening.

The biggest difference was seen in patients who came to the ER complaining about chest pain unrelated to a heart attack. Hospitals with the highest admission rates for that symptom admitted patients more than six times as often as hospitals with the lowest chest pain admission rate. Scientists discovered this after reviewing 2010 data from 28.5 million emergency visits to 961 U.S. hospitals.

“Finding ways to determine which patients with less-serious emergency symptoms have the highest risk of dying or serious complications, and therefore the most need for hospitalization, should be a priority as we seek to make the best decisions about emergency admissions and individualized care,” Dr. Amber Sabbatini, the study’s first author, said in a statement. Narrowing admissions gaps, she said, could result in overall lower medical costs.

Here are the numbers:

350,000

The approximate number of patients who come to emergency rooms every day in the U.S., according to the University of Michigan study published in the journal Health Affairs.

15%

The percentage of 2010 emergency room visits that resulted in patients being admitted to the hospital. The average charge for a hospital stay was $34,826.

30%

Care for patients admitted for hospital stays accounts for 30 percent of U.S. medical spending, making it the country’s biggest health expenditure.

6.5x

Some hospitals in the study were 6 1/2 times more likely than others to admit patients who came to the ER with chest pain unrelated to a heart attack. Certain hospitals were three times more likely than others to admit patients with asthma flare-ups or skin and tissue infections, or twice as likely to admit people with urinary tract infections or chronic obstructive pulmonary disease symptoms.

$1 billion to $5 billion

The amount that could be saved in national medical spending annually if U.S. emergency departments could close the hospital admission gaps for those five conditions (described in previous item), the study estimates.