Too Much Admission Rate Variation

Anyone and everyone who works in the Emergency Department is aware there is a spectrum of individual practice.  Certainly, any resident currently in training frustratingly knows this all too well, and can easily predict the prevailing culture of their shift in advance depending on their supervising attending.

So, it comes as no surprise this review of 389,120 Emergency Department visits in a three hospital, single-system review shows substantial variation in admission rate.  There was, obviously, variation between hospitals – expected as different hospitals may have variable patient demographics.  But, within hospitals – and across all three sites – there was up to a 2.3-fold (21% to 49%) variation in admission rate.  As with all retrospective, observational studies, there are limitations inherent in the data set.  However, the authors attempted adjustments based on several factors without substantially altering the outcomes.

There is no data on patient outcomes – particularly as relevant to those discharged by physicians with the lowest admission rates.  Considering our culture of over-diagnosis and over-treatment, I expect, with further prospective or cross-sectional study, we would find the physicians with the lowest admission rates to have indistinguishable health outcomes from their peers.  The factors that contribute to this variation – as well as interventions to reduce the variation – require further study.

“Emergency Department Physician-Level and Hospital-Level Variation in Admission Rates”
www.ncbi.nlm.nih.gov/pubmed/23415741‎