Study Links Hospital Admissions to Seniors’ ER Use

Medicare beneficiaries have the highest rates of hospitalization admission from emergency departments than any other payor group, and it’s likely assisted living residents have an even higher utilization rate, researchers say. 

Emergency departments (EDs) play a pivotal role in the delivery of acute ambulatory and inpatient care, according to RAND researchers in a new report, “The Evolving Role of Emergency Departments in the United States,” requested by the Emergency Medicine Action Fund. 

“Use of hospital emergency departments is growing faster than the use of other parts of the American medical system,” said Dr. Art Kellermann, the study’s senior author and a senior researcher at RAND, a nonprofit research organization. “While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions.”

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Between 2003 and 2009, inpatient admissions to U.S. hospitals grew at a slower rate than the population overall. However, nearly all the growth in admissions was due to a  17% increase in unscheduled patient admissions from EDs, RAND found. 

“This growth in ED admissions more than offset a 10% decrease in admissions from doctors’ offices and other other patient settings,” says the report’s executive summary. “This pattern suggests that office-based physicians are directing to EDs some of the patients they previously admitted to the hospital.”

With emergency physicians increasingly serving as a major decision maker for about half of all hospital admissions, RAND finds, there are “important financial implications” for the nation’s healthcare system. 

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Physicians and nurses agree that assisted living communities are often less able than nursing homes to address medical needs on premises, according to a 2010 Kaiser Family Foundation report. As a result, preventable emergency room visits and hospitalizations are more common among assisted living community residents. 

Assisted living residents frequently are sent to emergency departments as a precautionary measure by providers seeking to manage risk, Kellermann confirms.

Data cited by the RAND researchers indicate that most ambulatory patients do not use EDs for the sake of convenience, but rather because they perceive no viable alternative exists—or because a healthcare provider has sent them there. 

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Although RAND’s recent report on EDs does not track where the patients came from—whether a private home or a community-based setting—it does find that Medicare beneficiaries account for more inpatient admissions from EDs than any other payor. 

“In light of the fact that assisted living residents tend to be in more fragile health, it would be logical to expect they’d have a higher rate of ED visits and admissions than Medicare beneficiaries in general,” Kellermann told SHN.

He says he’s “quite confident” that assisted living residents’ rate of utilization for EDs as a precautionary measure is substantially more common than for Medicare beneficiaries across the board. 

“EDs are being used with increasing frequency to conduct complex diagnostic workups of patients with worrisome symptoms,” the report finds. “Despite recent efforts to strengthen primary care, the principal reasons patients visit EDs for non-emergent outpatient care is lack of timely options elsewhere, and EDs may be playing a construction role in preventing some hospital admissions.”

Access the RAND report’s executive summary

Written by Alyssa Gerace