A new study published in The BMJ has shown that about one in every five Americans goes to the emergency room each year and depending on the one they visit, the consequences could mean life or death.

While not everyone has a choice about which ER they visit, the study found that those who were admitted to big academic hospitals had better outcomes than those who visited private and non-academic ER’s. In fact, the latter were more likely to die within a week of being discharged from a private ER.

From the article:

“Past research has shown that these hospital admission rates don’t make much of a difference for patient outcomes, Obermeyer says, making the lower cost model more attractive. But Obermeyer and his colleagues wanted to look at a question seldom asked in the research: What happens to ER patients who didn’t get admitted in that first critical week after they’re sent home? They analyzed Medicare claims from generally healthy adults who had visited the emergency room from 2007-2012 to find out.

‘We restricted the sample to people who shouldn’t be dying,’ Obermeyer says. ‘People who are generally healthy, who don’t have serious illnesses like cancer, who aren’t [old].’ And they found that about 10,000 people die each year in that first week after being sent home from the ER—the majority of them after visiting hospitals that admitted the least number of patients.”

Researchers found that patients weren’t sicker, they were actually healthier. So, why were they dying?

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While the team found the contributing factors to be complicated they believe that outcomes are a reflection of how difficult the job is and the fact that many of the smaller hospitals are in rural areas where there are less likely to be doctors. It also follows that those hospitals don’t have in-house doctors who are able to admit patients from the ER. This fact means that sometimes people fall through the cracks.

Dr. Ziad Obermeyer, assistant professor in the departments of emergency medicine and health care policy at Harvard Medical School (who also led the study) hopes that this study will encourage more research.

Source: Time