Unnecessary admissions: Many ER patients with chest pain

Healthcare providers that want to avoid unnecessary care and thus reduce healthcare costs may want to focus their efforts on patients who visit the emergency department (ED) for chest pain, a new study suggests.

For the study, published recently in JAMA Internal Medicine, researchers analyzed data from adult patients admitted to three Mount Carmel Health System teaching hospitals in central Ohio from 2008 to 2013 after they visited the ED complaining of chest pain. Of the 11,230 adult patients studied, 20 experienced serious heart problems, but this number slimmed down to four after excluding patients who had abnormal vital signs or test results and were thus unlikely to be sent home from the ED in any circumstance.

The findings indicate that life-threatening heart problems occur in only .06 percent of low-risk patients who are admitted to the hospital, "suggesting that routine inpatient admission may not be a beneficial strategy for this group," the study concludes.

While low-risk patients may in fact benefit from further care after chest-pain-related visits to the ED, this evaluation may be most appropriate in an outpatient rather than an impatient setting, the study authors write, especially given the risks of hospitalizations such as hospital-acquired infections.

"Not only are we probably not gaining anything [by hospitalizing these patients], but we might be actually harming people by doing what we thought was actually helping them," lead researcher Michael B. Weinstock, M.D., told the Columbus Dispatch.

Such an approach could make a big difference in costs as well, as past data indicate that hospitals spent $11 billion on admission and observation of these patients in 2006 alone, according to a Forbes article. The JAMA study, however, raises important questions about how small a benefit is too small, Harlan Krumholz, M.D., a professor of cardiology at Yale School of Medicine, told Forbes. "For example, would one patient benefited for every ~2000 patients be too small to be indicated, [and] how would patients feel about that?" he asks.

To learn more:
- check out the study
- here's the study announcement
- read the Columbus Dispatch article
- here's the Forbes article

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