When patients visit the emergency department with seemingly nonthreatening illnesses, hospital staff do what they can to prevent unnecessary admission to the hospital. However, some of these admissions may not be unnecessary after all, judging by patients’ outcomes once they’ve been discharged from the ED.
According to research published in The BMJ, a significant number of patients end up dying within a week of visiting the ED, even if they don’t have life-threatening symptoms.
Researchers at Brigham and Women’s Hospital reviewed data from Medicare claims and discovered that about 10,000 generally healthy patients per year die within seven days of being discharged from the ED.
The most common causes of death in these patients were heart disease and chronic obstructive pulmonary disease (COPD), as stated in a research brief from Brigham and Women’s Hospital. Narcotic overdoses also happened frequently after patients visited the ED due to injuries and pain.
If a patient was discharged from the ED with a diagnosis of generalized weakness, confusion or shortness of breath, the person was more likely to die within seven days. Surprisingly, those diagnosed with chest pain were at much lower risk of dying.
Role of ED admission rates
Researchers noticed that low-volume hospitals with the smallest rates of admitting patients from the ED experienced the vast majority of early deaths among discharged patients. Large academic institutions, which have higher admission rates (and often higher costs) had the best outcomes for these patients – even though most of their patient mix was less healthy to begin with.
Even small increases in ED admissions rates were linked to a lower risk of patients dying within a week of discharge.
These outcomes go to show that low ED admissions rates don’t paint the whole picture when measuring how well a hospital’s treating patients. A hospital might be able to save money if it doesn’t admit patients to the ED, but some patients may need to spend additional time in the hospital. And clinicians shouldn’t overlook their symptoms because they don’t seem dangerous on the surface.
Quality of care shouldn’t be sacrificed for the sake of saving costs. While it’s key to avoid unnecessary hospital stays, it’s also important to keep patients from experiencing avoidable harm. Clinical staff must be careful to strike this balance, using evidence-based guidelines to determine if a patient may need further observation before discharge.
Another option the researchers proposed: Make sure patients fully understand their discharge instructions and that they’re able to receive any required follow-up care and treatment, including testing and monitoring. Encourage patients to see their primary care physicians, if necessary (and be ready to refer patients to a doctor if they don’t see one regularly).
Some negative outcomes may be out of a hospital’s control, but clinical staff must do their part to set patients up for the best recovery possible.