If you work at a public emergency department (ED), chances are that about one in five of your patients have already been seen at another ED for the same complaint. Most of them will undergo duplicate testing because of inadequate information about their past treatment.

That’s according to a study published recently in Academic Emergency Medicine, which sought to determine how patients end up at another ED — whether they are self-directed or get an implicit referral from the previous facility.

Researchers from Baylor College of Medicine also wanted to examine the effect multiple sites of care had on patients, including the health, social, and financial implications of the visits.

One finding was that 73% of the patients visiting the public hospital ED for the same complaint were referred without the transfer of paperwork or records, leaving the second ED no option but to repeat the tests.

“Duplicating these tests causes increased anxiety in patients and diverts resources from other ED patients, not to mention creates additional costs,” explained lead author Laura Medford-Davis, MD. “While many of the patients we surveyed presented with fractures, other serious, time-sensitive complaints, such as kidney dialysis, cancer care, and a bleed on the brain, came in this way.”

During the 10-week study conducted at a large public ED in Texas, 143 patients were identified as recently presenting to another local ED for the same primary complaint before they came to the public hospital.

Almost all patients, 94%, were uninsured, and 61% of the patients presented with fractures, according to the results. Of those, 27% required admission at the public ED and, even after discharge, 95% of them required outpatient follow-up.

About half of the patients completed a survey, and qualitative interviews occurred with 23 of the fracture patients. Results from those who completed the survey included the following statistics:

• 53% of patients said that staff at the first hospital advised them to go to the public hospital ED.
• 23% reported a referral from a follow-up physician associated with the first hospital.
• 73% said they received the same tests at both EDs.

Based on the interviews, the researchers point out that the patients had to make multiple healthcare visits for the same injury and were worried about complications. They also complained about disrespectful treatment at the first ED, as well as delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain.

“The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety,” study authors conclude.