Emergency medicine physicians are poor at predicting hospital admissions

  • Am J Emerg Med

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Only 52% of inpatient admissions are accurately predicted at the time of triage by emergency medicine (EM) physicians, but more discharges from the ED are accurately predicted.

Why this matters

  • Better predictive capacity could decrease time spent in ED for patients ultimately admitted, increasing efficiency.

Study design

  • Prospective cohort study of 35 EM physicians (with ≥5 years postresidency) who made predictions on 398 patients using nursing notes, vital signs, and electronic medical record (EMR) charts.
  • Physician predictions were compared against the full EMR.
  • Sensitivity was defined as the proportion of actual admissions that were accurately predicted.
  • Specificity was defined as the proportion of actual discharges that were accurately predicted.
  • Positive predictive value (PPV) was the proportion of admission predictions resulting in admission.
  • Negative predictive value (NPV) was the proportion of discharge predictions resulting in discharge.
  • Funding: HealthPartners Institute.

Key results

  • Sensitivity of predicting admission was 51.8% for the entire cohort.
  • Specificity was 89.1%.
  • PPV was 56.4%.
  • NPV was 87.2%.
  • Sensitivity was increased to 61.5% and specificity was increased to 95.7% when predictions were made with a confidence level of >90%.
  • For physicians who accurately predicted admission, the admitting service was correctly predicted 88.6% of the time.

Limitations

  • Single-center study.

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