According to a new study published in JAMA Internal Medicine, as the number of people relying on emergency medical care increases, emergency departments (EDs) are admitting fewer patients and mortality rates post-ED visits are improving.

Data from the study reveal that among Medicare beneficiaries receiving ED care in the U.S., mortality within 30 days of an ED visit appears to have declined in recent years, particularly for patients with the most severe illnesses, even as fewer patients are being admitted from an ED visit.

The study found that mortality rates of patients within 30 days of being sent home from the ED improved 23 percent—a trend visible across patient populations, but greatest for the patients with the most severe emergencies. That translates to 200,000 fewer deaths in 2016 than if mortality rates stayed the same as 2009. This improvement occurred as more patients were sent home rather than being admitted to the hospital.

New Jersey hospitals are seeing similar outcomes.

Dr. Shereef Elnahal, president and chief executive officer of University Hospital in Newark, said the results of the study published in JAMA come as no surprise.

“I think it speaks to the versatility and enhanced ability and training of our ER docs over time,” Elnahal said.

“There could be any number of reasons why we are seeing reduced mortality,” he added. “These are professionals that literally have to address anything that walks through the door and because over time the criteria for admission to the hospital has become more strict ED docs have had to deal with more and be trained in a much deeper level of care in the care trajectory of a patient.”

Technology, Elnahal noted, has also played a big role in decreased admissions.
“Our technology capabilities have been enhanced over time. There is more access to diagnostic equipment at the point of care now. That’s improving the ability for our ERs to respond to conditions in real time. These trends have resulted in great outcomes.”

Another example, said Elnahal, is the increased use of bedside ultrasound, which is a way at getting at a diagnosis more accurately, more quickly and with more positive effects on patients.

“The other thing that we are seeing in ERs is the rise of things like getting treatment for opioid addiction. More and more ERs are inducing patients with Buprenorphine,” Elnahal said.

He pointed out that ERs are better equipped to handle patients now than they were 20 to 30 years ago.

“But it can also be because there is a trend in direct admissions for sicker patients that doesn’t necessarily come through the ER.”

Quality and safety

Dr. Kenneth Sable, regional president, southern market at Hackensack Meridian Health, told NJBIZ that there has been an increased focus on quality and patient safety.

“In the past several years we have seen an increased trend in high-reliability organizations. Many organizations are taking an approach toward high reliability and increased efforts in patient quality and safety. For example, they are standardizing – evidence based protocols. We are seeing the fruits in our outcomes,” Sable said.

He said that in the last decade there has been advanced training in critical care. In addition to residency training in emergency medicine, there are now fellowships that provide advanced training in critical care medicine and ultrasound, for example.

There has also been a greater focus on geriatrics in the ER, with clinicians who are dedicated to geriatric patients.

“We are training practitioners on how to better care for the geriatric population,” Sable said. That’s important because data mortality in the elderly – patients age 65 and older – is higher and Medicare beneficiaries make up a population that is at greater risk for mortality.

Sepsis is another area that has been receiving increased scrutiny.

“We educate and train ER docs to recognize and intervene sooner with the goal of providing patients with high quality care.”

Practitioners are also increasingly focused on ED operations – for example, reducing boarding time; that is, the time between the individual’s admittance to inpatient status and when he or she leaves the ER to go to a bed.

Ultimately, admitting fewer patients and reducing mortality rates post-emergency room visits can also affect the bottom line.

“If an investment in patient quality and safety is a priority, it comes back to us because it improves the reputation of our brand and services. If we want to grow, we need to show that we can provide quality services,” Sable said.