Office-based physicians making more patient referrals to ER

(HealthDay)—Emergency departments (EDs) have become an important source of admissions to U.S. hospitals and are increasingly being used to conduct complex work-ups, according to a report published by the RAND Corporation.

Kristy Gonzalez Morganti, Ph.D., and colleagues from the RAND Corporation in Santa Monica, Calif., used qualitative and quantitative methods to examine the evolving role of the ED in the U.S. health care system.

The researchers found that nearly all the growth in inpatient admissions from 2003 to 2009 was due to a 17 percent increase in admissions from EDs, which more than outweighed a 10 percent decrease in hospital admissions from doctors' offices. Office-based physicians increasing rely on EDs to evaluate complex patients, and EDs provide support for handling overflow, after-hours, and weekend demand for care. Increasingly, emergency physicians are serving as the major decision-maker for about half of all hospital admissions. Most patients in the ED are ambulatory, and the majority present to the ED because a health care provider sent them or because they perceive there is no viable alternative. Compared with other payers, Medicare accounts for the most inpatient admissions from EDs. EDs may prevent some inpatient admissions, particularly those with "potentially preventable admissions," which have not increased over the past decade.

"Policymakers, third party payers, and the public should be aware of the various ways EDs meet the health care needs of the communities they serve and support the efforts of ED providers to more effectively integrate ED operations into both inpatient and outpatient care," the authors write.