Avoiding the ER and arranging a direct admit is not easy

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. Hospitalist who could reasonably direct admit patient, says, ‘better send them to the ER first.’

Or this one, involving cardiology tests: “… patient is having outpatient cardiac catheterization or stress test. The test is positive. The patient has a physician, who could be contacted. The cardiologist says, simply, ’send them to the ER.’ Why is this? Why couldn’t they be admitted directly?”

The reason, of course, is that arranging a direct admission and filling out the necessary paperwork takes time. And when primary care doctors are already seeing 30 patients a day, taking additional time to track down and call the consultant and then fill out order forms needed for a direct admission will only put the doctor further behind schedule.

Contrast that option with, “Go to the ER,” and it’s no wonder why this is happening.

Most doctors realize it’s cost effective to avoid the ER, but with the way our health system is structured and incentivized, there’s little reason to do so.