Short-stay admissions via emergency departments: Potential observation unit cases?

Objective: This study assesses the association of payment source and hospital ownership with the percentage of short-stay admissions (2 days or less) via emergency departments (EDs). These factors serve as proxies for the role economic incentives may play in influencing admission decisions from the ED to the hospital for “observation” purposes and, potentially unnecessary admissions.

Methods: This study examines the 2.4 million admissions in 2007 to 201 acute care general, medical-surgical hospitals located in Florida, of which 35 percent were short-stay admissions. The data come from all-payer discharge information from Intellimed. Short-stay admissions from the ED (regardless of insurance coverage) were examined as a percentage of all ED admissions with the second analysis stratifying by payment category. Standard least squares analyses were used to determine associations.

Results: Medicaid patients were more likely to be admitted via the ED as short-stay admissions. For-profit ownership was positively associated with both commercial and Medicaid short-stay admissions.

Conclusions: This study highlights the significant flow of ED admissions into short-stays and the importance of assessing the role ED observation units could play in minimizing admissions to inpatient beds that could otherwise be used for higher acuity patients.