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March 25, 1992

Hospital Admission Through the Emergency Department

Author Affiliations

Central Middlesex Hospital London, England

JAMA. 1992;267(12):1609. doi:10.1001/jama.1992.03480120047015

To the Editor.  —We were intrigued by the Editorial1 on hospital admissions through the emergency department (ED). In it, Olson quoted the findings of Stern et al2 that, even with adjustments for diagnosis related groups, severity of illness, age, and income, patients admitted through the ED incurred 13% higher hospital charges, and hospital stays were 27% longer than for patients admitted through other routes.Because National Health Service hospitals do not have the ability to put a price on each hospital stay, we undertook a similar study of 7213 patients and found that persons admitted through the ED stayed 30% longer when using the criteria of Stern et al. We then adjusted the figures taking two factors into account: recovery and disability.Recovery from acute illness or injury is affected by the general fitness of the patient and the presence of associated disease. Bearing this in mind, a