title: Direct admission to the hospital: An alternative approach to hospitalization.
abstract: Appropriate use of emergency departments (EDs) is a focus of national healthcare reform efforts, and patients requiring hospital admission account for a substantial proportion of ED utilization. Despite this, little attention has been paid to evaluating direct admission to the hospital as an alternative to hospital admissions beginning in the ED. In this Perspective, we discuss the role of hospital medicine in the changing epidemiology of hospital admissions, the potential risks and benefits of direct admission to the hospital, and the need for research to evaluate the safety and effectiveness of this admission approach. We propose that transitions of care research and quality improvement, historically focused on hospital-to-home transitions, be expanded to address transitions into the hospital.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: JoAnna K
authors.initials: JK
authors.lastname: Leyenaar
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.|Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.|Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010343:Patient Admission / Q000191:economics / Q000592:standards*; D010360:Patient Transfer / Q000191:economics / Q000379:methods* / Q000592:standards*