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The first study to examine patterns of emergency care for an entire state has found that 40 percent of emergency department visits in Indiana over a three-year period were by patients who visited more than one emergency department. This finding challenges conventional wisdom that patients are tightly bound to health care systems and tend to repeatedly visit local facilities.

The Regenstrief Institute study, “All Health Care Is Not Local: An Evaluation of the Distribution of Emergency Department Care Delivered in Indiana” has been honored with a 2011 Distinguished Paper award at the AMIA Annual Symposium. AMIA is a professional society of health care professionals, informatics researchers and thought leaders in biomedicine, health care and science.

The Regenstrief study reports that nearly all emergency departments in Indiana shared patients with nearly every other emergency department. The high degree of connectedness between emergency departments had not been previously recognized at this scale, according to researchers.

The study illustrates that emergency departments need instant access to information from wide swaths of geographic areas to better treat patients.

As patients in the emergency department often forget key details, or are too ill or injured to provide relevant medical history, medications or allergy information, immediate access to their complete medical records is critical to providing appropriate care.

“What may appear to be a simple problem is no longer simple when someone comes in for a second or third ED visit for the same issue,” said John T. Finnell, M.D., M.S., an author of the study who serves as director and associate professor of Health Informatics and is also an emergency medicine physician. “You are no longer thinking earache, you are thinking possible bone infection. Knowing that patient who comes to the ED with chest pain had a recent clear cardiac scan will make a difference in treatment.”

Finnell is also an associate professor of emergency medicine at the IU School of Medicine and research scientist for the Regenstrief Institute.

The researchers were not surprised by the large volume of visits to emergency departments across the state. About 2.8 million patients generated 7.4 million visits over three years. But the wide range of the number of visits per patient – from one to 385 – was unexpected.

“Although the findings were specific to Indiana, ED use in other states is likely to be quite similar because there is nothing particularly unique about emergency care delivery in Indiana,” Finnell said.

Contact: Cindy Fox Aisen, Indiana University School of Medicine, Regenstrief Institute, caisen@iu.edu, (317) 274-7722.