• Jesse M Pines, Jessica E Galarraga, Michael Granvosky, Ori Litvak, Samuel Davis, and Leah Honigman Warner.
• 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.
• Am J Emerg Med. 2017 Jul 1; 35 (7): 970-973.

Study ObjectiveEmergency physicians often work in multiple hospital emergency departments (EDs). We study how emergency physician admission decisions vary in different settings.MethodsWe 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.ResultsIn 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%).ConclusionIn 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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