About 20% of the US population visits the ER every year. There has been focus on the cost of these visits and of the possibly unnecessary hospital admissions or other treatment that result from the visit. There has been less focus on what happens if someone is sent home from the ER when maybe they shouldn’t have been. Research published in the British Medical Journal aims to fill this gap. (BMJ Article) The researchers used Medicare data from 2007-2012 and death certificate information to identify the rate of patients who had an ER visit, were sent home and died within seven days of that visit. Various patients were excluded from the analysis if they had obvious serious illnesses, were over 90 and for other reasons. A number of hospital and patient factors were explored to see what might be correlated with early death after ER discharge. About 16 million ER visits were examined. 37% of these visits resulted in either admission to the hospital. For those sent home, about .12% died within seven days or around 10,000 annually. There was a slight rate of decline in deaths over the study period.
The most common causes of early death appeared to be heart disease and heart attacks and COPD. For hospitals that had the highest rate of admitting patients from ER, early mortality was relatively low. Conversely, for those hospitals that had the lowest rates of admission from an ER, early mortality was relatively high. That alone suggests perhaps some diagnostic shortcomings among the low-admission ERs. Academic hospitals had the highest admission rates and the lowest early mortality. Those patients who died early were more likely to be white, male and live in poor areas. Hospitals with high numbers of Medicare patients had fewer early deaths, as did those with high ER prices. The variation in admission rates may reflect differences in resource availability at a hospital or in a geographic area. But it suggests that there may be some patient-specific factors which could help triage those ER patients who may need to be admitted or at least closely followed when they leave the ER. And we might want to be careful about too aggressively trying to discourage ERs from admitting patients to the hospital.