Variation in Emergency Department Physician Admitting Practices and Subsequent Mortality

IMPORTANCE: An emergency department (ED) physician’s decision to admit a patient to the hospital plays a pivotal role in determining the type and intensity of care that patient will receive. ED physicians vary widely in their propensity to admit patients to the hospital, but it is unknown whether higher admission propensities result in lower subsequent mortality rates. OBJECTIVE: To measure the variation in ED physicians’ admission propensities and estimate their association with patients’ subsequent mortality rates. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationwide Veterans Affairs electronic health record data from January 2011 to December 2019, comparing physicians practicing within the same ED. The study population was composed of patients visiting the ED with 1 of the 3 most frequent chief complaints in US EDs (chest pain, shortness of breath, and abdominal pain). The data analyses were performed from May 2022 to October 2024. MAIN OUTCOMES AND MEASURES: The main outcomes were variation in physicians’ adjusted admission rates, short inpatient stays (