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Want To Avoid Unnecessary Tests? Stick To One ER, Researchers Say

Dec 13, 2010

On a recent Friday night at the Boston Children's Hospital ER, Dr. Fabienne Bourgeois was having difficulty treating a 17-year-old boy with a heart problem. The teen had transferred in  from another hospital, where he had already had an initial work-up – including a chest X-ray and an EKG to check the heart's electrical activity. But by the time he reached pediatrician Bourgeois, she had no access to those records so she gave him another EKG and chest X-ray. He was on multiple medications, and gave her a list of them. But his list differed from the one his mother gave doctors, neither of which matched the list his previous hospital had sent along. 

Because it was nearly 10 p.m., the doctors couldn't get in touch with the teen's pharmacy or previous clinicians. It wasn't until the next morning that the doctors confirmed which medication he was on and were able to insure that he had the correct drugs for his condition. Bourgeois says the best her team could do was care for him that night with medications "we hoped would be safe" and treat his symptoms.

That is not an isolated incident. Nearly one in three Massachusetts adults with multiple ER trips visited separate hospitals -- some upwards of five -- creating a host of dangerous and costly problems because full health information is not always shared between hospitals, according to a study published today by the Archives of Internal Medicine. The reasons for choosing different facilities vary, sometimes patients move or change insurance between visits, while others get transferred between facilities like Bourgeois' patient.

In the first state-wide study of its kind, the researchers, including Bourgeois, looked at 3.5 million adults – who made 12.7 million visits to emergency rooms -- in the state between 2002 and 2007. An individual's visits could be for the same problem or for different illnesses.  

Patients who visit multiple ERs are "exposed to the risk of medical errors, adverse events, duplication of testing, as well as delays in their treatment," Bourgeois said in an interview.

People with psychiatric disorders and dementia are especially at risk of error or unnecessary treatment because they can't always accurately convey what previous care they've had.

What's more: patients who visited more than two different sites racked up nearly twice the bill ($12,050 on average) compared with patients who went to the same sites ($7,465).

The federal government has repeatedly pledged to invest in health technology and has provided incentives to doctors and hospitals to move to electronic records that could be easily accessed by other qualified providers. In measuring the level of care fragmentation and the lack of information that is transferred, "we were able to confirm a very fundamental assumption that underpins a good fraction of [the government's] $48 billion investment in health information technology," says Dr. Kenneth Mandl, also a co-author of the study who is on the faculty at Boston Children's and part of the hospital's program to develop a health information technology system. And a new report called for even more federal government involvement in electronic health records.

It is clear, though, that bettering health technology is only one piece of a complicated care puzzle – in response to the committee's report, the American Hospital Association said, "The true test of any health information technology is whether it improves care at the bedside."

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