Direct admission of children with pneumonia could result in lower hospital costs than admission through the emergency department (ED), new findings published in JAMA Pediatrics suggest. In direct admission, a patient is referred to the hospital by a health care provider and is not seen in the ED beforehand.

To better understand the relationship between outcomes and admissions, the researchers looked at 19,736 children admitted to 278 hospitals that contribute data to the Perspective Data Warehouse, an administrative database. Just over a third of the patients were admitted directly.

The interquartile range for direct admission rates was 11% to 50%, with a median of 33.3%. Direct admission patients were more likely to be white, to have private health insurance, and be admitted to small community hospitals. Their length of stay was 9% longer, while they were 39% less likely to have a high-turnover hospitalization (meaning they spent less than two days as an inpatient). Cost was 12% lower for patients admitted directly than for those admitted through the ED. Rates of nearly all diagnostic tests were also lower among the direct admission patients.

But the study’s authors say more research needs to be done to better understand the settings and circumstances in which direct admission is safe and effective.

“Direct admission may offer benefits over admission through the ED, including reduced costs and improved patient satisfaction, while reducing ED volumes,” they write. “However, direct admission may be associated with delays in initial management, which may have adverse results.”