Heart failure patients who visit smaller hospitals are more likely to end up back in the hospital within 30 days, a new study based on Ontario data suggests.
The study, conducted by researchers from Women’s College Hospital, the Peter Munk Cardiac Centre and the Institute for Clinical Evaluative Sciences (ICES), analyzed data from more than 89,000 patients’ emergency department visits taking place between April 2004 and March 2010.
Patients who went to hospitals with low admission rates, which tended to be smaller hospitals, were 30 per cent more likely to return to the hospital within 30 days and were more likely to be hospitalized for heart failure or cardiovascular disease.
“Every time a heart failure patient ends up in the emergency room or ends up getting admitted, their life expectancy lowers,” said the study’s lead author, Dr. Sacha Bhatia.
Patients visiting the smaller hospitals with the lowest of admission rates also tended to be at a greater risk of receiving insufficient followup.
Bhatia described the current decision process in emergency rooms to admit patients to hospitals as “haphazard” and said that objective tools ought to be used when making a decision.
“There’s no formalized mechanism to decide who gets admitted,” said Bhatia. “It’s all sort of the eyeball of the clinician.”
He points instead to a scoring tool available online that was developed by one of the study’s researchers. The tool takes into consideration a variety of factors and can indicate higher-risk patients who ought to be admitted to hospital.
“It’s reasonably easy to extrapolate from this study and from other studies that multiple times visiting the emergency room or being admitted to hospital . . . as opposed to just the initial time may have a longer-term impact on somebody’s health.”
Larger community and academic hospitals are more likely to have better access to specialty physicians, diagnostic testing and bed availability, said Bhatia.
“A lot of these smaller hospitals are quite rural and they’re remote and they don’t necessarily have access to all of the resources that, say, you might have in downtown Toronto.”
The study, “Outcomes in patients with heart failure treated in hospitals with varying admission rates: population-based cohort study,” was published Wednesday in British Medical Journal Quality and Safety.