title: How (ED) admission decisions differ when the same physician works in two different emergency department.
abstract: OBJECTIVE
  Emergency physicians often work in multiple hospital emergency departments (EDs). We study how emergency physician admission decisions vary in different settings.
  
  
  METHODS
  We conducted a retrospective, cross-sectional study over two years (2012-3) in six EDs in three states. Included physicians had ≥200 encounters per site in two different EDs. "Admissions" were ED encounters resulting in admission to the hospital or transfer to another hospital. The primary outcome was the adjusted admission rate difference between the two sites. Hierarchical logistic regression analysis was used to calculate adjusted admission rates for each physician, which were then tabulated for each physician and compared across sites.
  
  
  RESULTS
  In 51,807 ED encounters seen by 16 physicians the average admission rate was 20.0%, and unadjusted admission rates differed between sites by 2.9% (range 0-8.4%) for the same physician. The adjusted admission rate was 19.3% and differed between sites by 2.1% (range 0.4%-6.2%).
  
  
  CONCLUSIONS
  In this sample, some ED physicians made similar admission decisions in different settings while others increased or decreased their admission rates up to 25% when practicing in a different ED.
authors.affiliation: Center for Healthcare Innovation and Policy Research, Department of Emergency Medicine and Health Policy & Management, The George Washington University, Washington, DC, United States. Electronic address: pinesj@gwu.edu.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, United States.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Galarraga
authors.affiliation: LogixHealth, Inc., Bedford, MA, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Granvosky
authors.affiliation: LogixHealth, Inc., Bedford, MA, United States.
authors.forename: Ori
authors.initials: O
authors.lastname: Litvak
authors.affiliation: LogixHealth, Inc., Bedford, MA, United States.
authors.forename: Samuel
authors.initials: S
authors.lastname: Davis
authors.affiliation: Department of Emergency Medicine, Northwell Health, Long Island, NY, United States.
authors.forename: Leah Honigman
authors.initials: LH
authors.lastname: Warner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult