Continuity of care suffers when ER patients switch hospitals

Until statewide HIEs are set up and in working order, ER patients who hop from hospital to hospital within a state will suffer, according to findings from a new study published in the Archives of Internal Medicine.

Jumping from ER to ER exposes patients to risk of medical errors, adverse events, duplicated tests and delays in treatment, Dr. Fabienne Bourgeois, lead author of the study, told Kaiser Health News. The researchers based their findings on 3.5 million adults in Massachusetts who made 12.7 million ER visits between 2002 and 2007.

Nearly one in three of those adults who made more than one ER trip visited different hospitals, Kaiser Health News reports. Sometimes patients visited up to five different ERs.

For example, on a recent night at Boston Children's Hospital ER, Bourgeois had to give a 17-year-old boy with a heart problem a chest X-ray and EKG, because she could not get access to his records at the hospital from which he transferred. She also discovered that his lists of meds--one which mother gave doctors and another sent by his previous hospital--did not match. The doctor's team was forced to improvise, giving the boy meds they "hoped would be safe" to treat his symptoms. Bourgeois ended up waiting until the next morning to confirm what meds the patient actually was taking.

Patients who go to multiple ERs tend to be younger, are more likely to be male, typically have a primary psychiatric diagnosis, are more frequently hospitalized and run up higher bills than patients who use only one ER. For example, patients who visited more than two different ERs saw bills that were nearly double that of patients who stuck with the same ER ($12,050 vs. $7,465) on subsequent visits.

To learn more:
- read the Kaiser Health News article
- here's the Archives of Internal Medicine abstract

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