What is the admission rate at your shop?

[Foster23]

I recently found out we have a 15% admission rate, which I originally thought it was a "good" percent since that means the ED is doing a great job of screening and only admit the medically necessary patients. Then we hear from the administration that we have to get the admission rate up (aiming for 20%???) since the hospital is losing big time money cause of the low admission rate.

The comical part to all of this is the internal attendings have always openly criticize the ED for too many soft admits. Often time, they have rejected admission because patient can be treated outpatient.

So, my question is what is your 2011 stat on admission rate? (empirical data please, no estimating base on personal admission volume)

What have you done to improve that number? better yet, are you under pressure to bring it up?

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[Apollyon]

(empirical data please, no estimating base on personal admission volume)

Good luck with that. There are a few ED administrators around here, but most people can't tell you this.

 

[EctopicFetus]

My group runs 3 hospitals.. at one it is ~30%, #2 is 25% and #3 is around 10%.

This is from my group and not just my own data.

 

[Greenbbs]

We see 120k a year. We admit between 25 and 30%, but my personal rate of admission is around 40%.

 

[painfan]

45K
23%
community ED

 

[EMmotherhen]

>60K
up to 30% admit

 

[tkim]

community, 40K

rates vary amongst my group from 15% to 30% - mine is 15% and is considered 'low'. but that's the way i was trained - to be a wall. but i've had some spectacular bouncebacks, and am adjusting upward. as i've been told - there's really no downside to admitting people on the fence.

 

[zinjanthropus]

Academic tertiary care center
~70K volume Adult
Adult admission rate ~35%

 

[jendc08]

Community 60k 30%

 

[deleted109597]

40K community site.
35% admission rate.
Average age walking (rolling) in the door pushes 60 in this population.

 

[Foster23]

WOW!!!! so... I'm guessing our 15% is horrible!???

Do ALL (or most?) of these people meet admission criteria? it's impossible to get a patient to the floor without a full admission criteria, even if your "sixth sense" tell you this is a keeper. That, and the fact that internal medicine's reflex is to block admission, it explains our low rate. But wow, working at a place that allows 30-40% admission must be heaven.

 

[tkim]

But wow, working at a place that allows 30-40% admission must be heaven.

With an increasing admit percentage comes harder sells to the admitting service. The higher the percentage, the 'softer' they think some of the admits are, the more they think that an admission is not so much to treat and monitor as it is someone's else name besides yours as the last physician who touched the patient.

 

[SoCuteMD]

WOW!!!! so... I'm guessing our 15% is horrible!???

Do ALL (or most?) of these people meet admission criteria? it's impossible to get a patient to the floor without a full admission criteria, even if your "sixth sense" tell you this is a keeper. That, and the fact that internal medicine's reflex is to block admission, it explains our low rate. But wow, working at a place that allows 30-40% admission must be heaven.

A lot depends on your population. There are places in the country where the majority of patients have private insurance, a PMD, and access to outpatient services when they are needed. Thus, they only show up at the ER when they need to be there, often after seeing an outpatient physician. Those places are going to have a higher rate of admissions because they have a higher acuity.

 

[Arcan57]

A lot depends on your population. There are places in the country where the majority of patients have private insurance, a PMD, and access to outpatient services when they are needed. Thus, they only show up at the ER when they need to be there, often after seeing an outpatient physician. Those places are going to have a higher rate of admissions because they have a higher acuity.

My previous shop had an overall admit rate of 30%, and the docs probably pushed 70% since the MLPs saw most dischargeable patients. We also functioned as a tertiary care receiving center (all of which came to the ED first) for a 3-state region and none of our community docs direct admitted (in fact we had several years of data showing improved mortality if a patient came in through the ED vs. as a direct admit/transfer).

My current shop is 26% for a 56k volume. Attempted blocks are extremely rare (admissions=$$), but dumping onto medicine by subspecialists and surgeons is endemic.

 

[southerndoc]

A lot depends on your population. There are places in the country where the majority of patients have private insurance, a PMD, and access to outpatient services when they are needed. Thus, they only show up at the ER when they need to be there, often after seeing an outpatient physician. Those places are going to have a higher rate of admissions because they have a higher acuity.

We admit about 25% (110k pts/yr) at my main hospital.

I've found that PMD's tend to admit more patients than see them in the office. Patients like to be admitted, and they have a relationship with them that they want to continue. Don't want to irritate them if they choose to follow up as an outpatient instead of managing as an inpatient.

 

[deleted109597]

But wow, working at a place that allows 30-40% admission must be heaven.

Or not. It does mean that they are all sick. Also, because we admit so many, we often have 25-35% of the ED beds taken up by holds, so we end up working out of the lobby.

 

[Rendar5]

I'm surprised medicine has the power to block admissions at your place. 15% may be the appropriate admisison rate or it may be underadmitting patients. If you think it's the latter, you need to bring up a list of every single patient that medicine blocked admission for, and find out their rate of bounce-backs.

You also have the option of telling medicine if they really feel the patient doesn't need admission, to come down and discharge the patient themselves. That at least works at my institution, and it is very rare for this to be done.

 

[deleted109597]

This is actually true at my hospital, which isn't a residency site.
It's actually part of EMTALA. If you have the specialty, and want it taken care of, they have to. Now, they don't have to come in to admit the patient, but if they want them to go home, or have a procedure, they have to come do it. At least, that's my understanding.
Of course, if they refuse, and refuse to come in, then you're stuck, but I've had this happen, and I was told to admit it to a different service (since there is more than one medicine doc).

 

[tkim]

I'm surprised medicine has the power to block admissions at your place. 15% may be the appropriate admisison rate or it may be underadmitting patients. If you think it's the latter, you need to bring up a list of every single patient that medicine blocked admission for, and find out their rate of bounce-backs.

You also have the option of telling medicine if they really feel the patient doesn't need admission, to come down and discharge the patient themselves. That at least works at my institution, and it is very rare for this to be done.

Out in the non-academic, community world, that's refered to as the 'nuclear option'. Once you trot that out, that hospitalist will remember it - whether or not they caved and admitted or came down and discharged, because it basically devolves into a pissing contest. Makes for tense times between the ER and hospitalist docs.

Do it often enough, and things will quickly come to a head.

Haven't had to do it yet, hopefully won't have to do it anytime soon.

 

[Foster23]

when you guys admit a patient, do you have it worked out before the process that patient meets for full admission criteria?
At my shop, it doesn't matter how sick a patient is. If they number doesn't meet the criteria, you have no chance of sending that person to the floor. The good part about this is as a resident, I actually learn about how billing and coding work. The bad part is it's a pain in the ass

 

[WilcoWorld]

Well, tonight I sent home a hypotensive liver failure patient, a patient with a recent hemi-colectomy who a pretty bad looking ileus, and a patient on chemo for bladder cancer who had a UTI. Other than that my admission rate was pretty high.

 

[Apollyon]

Well, tonight I sent home a hypotensive liver failure patient, a patient with a recent hemi-colectomy who a pretty bad looking ileus, and a patient on chemo for bladder cancer who had a UTI. Other than that my admission rate was pretty high.

So, it is one of a few things: either there is more to each story, or your place is bitterly difficult.

 

[WilcoWorld]

So, it is one of a few things: either there is more to each story, or your place is bitterly difficult.

There is more to each story, I arranged follow-up and they were stable.

 

[Apollyon]

There is more to each story, I arranged follow-up and they were stable.

I figured as much. Recall that there is one other option I didn't list, as it was not applicable - that you are an f'up as a doctor!

 

[KYTNOH]

At my institution we see ~70K a year and admit around 30% of our patients (probably 15% of our kids and 35-40% of our adults). The caveat is that we are an academic hospital with numerous transfers that are sent in from outlying centers. We have roughly 1300 stroke admissions a year and around 3300 trauma admissions, a good number of which are transfers. We do heart, liver, lung, kidney, and pancreas (rarely) transplants, and everything but kidney transplants has close to a 100% admission rate. I've never seen one of our LVADs go home. We also admit essentially all of our congenital heart and inborn error kids. We also have to admit most of our chest pain patients because we don't have a chest pain center or protocol.

The community shop I'm going to admits 15% of their patients.