title: Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study.
abstract: BACKGROUND
  Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions.
  
  
  OBJECTIVE
  To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED.
  
  
  METHODS
  Cross-sectional study of hospital admissions at a single academic medical center.
  
  
  METHODS
  Non-critically ill adult patients admitted to the hospital (n = 297) and the admitting emergency medicine physicians (n = 34).
  
  
  METHODS
  A patient survey assessed non-medical factors, including primary care access and utilization. A physician survey assessed clinical and non-medical factors influencing the decision to admit. Based on physician responses, admissions were characterized as "strongly acuity-driven," "moderately acuity-driven," or "weakly acuity-driven." Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED.
  
  
  RESULTS
  Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission.
  
  
  CONCLUSIONS
  Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.
authors.affiliation: Department of Medicine and Pediatrics, UCLA Medical Center, Los Angeles, CA, USA. alewishunter@mednet.ucla.edu.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Lewis Hunter
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, CT, USA.|Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.|Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.|Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000208:Acute Disease / Q000453:epidemiology / Q000628:therapy*; D016638:Critical Illness; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: access to care; care transitions; decision making; emergency medicine; health care delivery; hospital admission decision; medical decision making; non-medical factors; severity of illness; socioeconomic factors; utilization