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The following is a summary of “Clinician-level variation in admission practices for common conditions in Veteran Affairs emergency departments,” published in the March 2025 issue of Academic Emergency Medicine by Janke et al. 

Researchers conducted a retrospective study to examine variations in hospital admission practices as a potential target for improving the efficiency and quality of emergency care within the Veterans Affairs (VA) Healthcare System.  

They analyzed data from 113 VA emergency departments (EDs) from October 1, 2015, to June 8, 2023. The ED visits were included if the primary diagnosis matched 1 of 535 ICD-10 codes within the previously developed admission intensity measure, covering 16 clinical conditions with known admission variations and outpatient management opportunities. The primary outcome was the standard deviation (SD) of clinician-level, risk-adjusted admission rates per condition, estimated using multilevel hierarchical models adjusting for patient sociodemographic and clinical factors. They summarized the SD of clinician admission rates based on total admission volume at VA. Pearson correlation coefficients assessed the relationship between clinician admission intensity and 72-hour ED return visits leading to hospitalization, a safety indicator.  

The results showed that 18.5 million ED visits were recorded across 9,350 clinicians, with 38,150,94 visits (20.6%) having primary diagnoses matching 1 of the 16 clinical conditions in the admission intensity measure. The mean (±SD) age of individuals was 63.3 (SD 15.4) years, and 89.9% were male. Among the conditions, chest pain had the highest number of admissions (2,29,507) and the greatest variation in clinician-level admission rates (SD ±14.7%), while nephrolithiasis had the lowest variation (SD ±4.6%). No significant association was found between clinician admission rates and 72-hour ED return visits (Pearson correlation 0.018).  

Investigators concluded that a prior admission intensity measure highlighted potential areas for improving hospitalization practices in VA EDs, with chest pain identified as the most prevalent condition exhibiting the greatest variation in clinician admission decisions. 

Source: onlinelibrary.wiley.com/doi/epdf/10.1111/acem.70020