THURSDAY, Feb. 2, 2017 -- Each year, about 10,000 generally healthy U.S. Medicare patients die within seven days of discharge from a hospital emergency department, a new study contends.
"We know that hospitals vary a lot in how often they admit patients to the hospital from the ED [emergency department], but we don't know whether this matters for patient outcomes," said lead researcher Dr. Ziad Obermeyer.
He is a staff physician in the Brigham and Women's Hospital department of emergency medicine in Boston.
"The variation in outcomes that we observed may be linked to gaps in medical knowledge about which patients need more attention from physicians," Obermeyer said in a hospital news release.
Geography and socioeconomics may also play a role, he said, adding that "access to resources varies dramatically across hospitals."
The analysis of more than 16 million ER visits showed that the most common causes of death in the following week were heart disease and chronic obstructive pulmonary disease (COPD), said Obermeyer, who is also an assistant professor at Harvard Medical School.
But another major cause was overdose from opioid painkillers like Oxycontin, Percocet and Vicodin, mostly after ER visits for pain and injuries, the study found.
Most of these deaths occurred among patients seen at hospitals that admitted few patients from the ER. Policymakers often regard these hospitals as models due to their low costs, the researchers noted.
However, deaths occurred far less often among patients seen at large, university-affiliated ERs with higher hospital admission rates and higher costs. This was so even though patients at these ERs tended to be less healthy upon arrival at the ER, the study authors said.
Patients at greatest risk for death included those with confusion, shortness of breath or generalized weakness. The researchers found that those with chest pain had a much lower risk of death.
The study looked at ER visits made by seniors between 2007-12 across the United States. It did not include patients with known serious illnesses or diagnoses of life-threatening conditions in the ER, any one over 90, or those receiving palliative care.
"There's a lot of policy interest in reducing unnecessary admissions from the ED," Obermeyer said in a hospital news release.
Obviously, not all patients can or should be admitted to the hospital, he noted.
"But we need to focus on admitting the right patients, rather than admitting more or less," he said. "I'm optimistic that advanced analytics and better data will help physicians with these kinds of decisions in the future."
The results were published Feb. 1 in the journal BMJ.
The American College of Emergency Physicians has more on emergency care.
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