128 In-Hospital Outcomes After Emergency Department Revisit in Taiwan: A Nationwide Analysis

Abstract

Emergency department (ED) revisits are traditionally used to measure potential lapses in emergency care. However, recent studies focusing on in-hospital outcomes following ED revisits have begun to challenge this notion. To our knowledge, there have been no studies that utilize nationwide data to address this issue. We aimed to examine in-hospital clinical outcomes and resource use among patients who are hospitalized following a return visit to the ED using a national database. This was a retrospective cohort study using the National Health Insurance Research Database in Taiwan. One-third of ED visits from 2011 to 2013 were randomly selected and their hospitalizations were included. The in-hospital outcomes (mortality and intensive care unit [ICU] admission) and resource use (length of stay and cost) were analyzed comparing patients who were hospitalized after a return visit to the ED within 3 days vs. patients who were hospitalized during the index ED visit. Multivariable regression models were used to adjust for differences in patient mix. There were 5,575,044 index ED visits during the 3-year study period. Of them, 1,075,892 (19%) were admitted to the hospital following the index ED visit. Among the 4,499,152 patients who were discharged during the index ED visit, 319,772 had a return visit to the ED within 3 days. Of them, 79,999 (25%) were admitted to the hospital. The in-hospital mortality rates were similar between the two groups (3% in the revisit-admission group vs 3% in the direct-admission group, p=0.79). Compared with the direct-admission group, the revisit-admission group had a lower ICU admission rate (2.5% vs. 3.0%, p<0.001), a shorter mean length of stay (8.4 vs. 8.6 days, p<0.001) and lower mean costs (40,954 vs. 48,146 TWD, p<0.001). After adjusting for age, sex, and 29 comorbidities, the patterns of outcome differences persisted, with similar inpatient mortality between the two groups and slightly better outcomes and lower resource use in the revisit-admission group. Patients who were hospitalized after a return visit to the ED within 3 days did not experience worse outcomes or consume more resources than those who were directly admitted during the index ED visit. Our findings suggest that ED revisit is multifactorial and does not necessarily relate to emergency care quality.