Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission.

Jesse Brennan,James Killeen,Edward Castillo,Theodore Chan

doi:10.5811/westjem.2015.8.26157

Jesse Brennan, James Killeen + Show 2 more

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https://doi.org/10.5811/westjem.2015.8.26157

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Abstract

IntroductionInpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission.MethodsThis was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits.ResultsThere were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%.ConclusionApproximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions.

Highlights

Inpatient hospital readmissions have become a focus for healthcare reform and costcontainment efforts
Little research has focused on emergency department (ED) visits following an inpatient admission
Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted

Summary

Introduction

Inpatient hospital readmissions have become a focus for healthcare reform and costcontainment efforts. The odds of a Medicare patient being readmitted within 30 days may be as high as one in five,[1] and closer to one in four for patients 65 years and older with common chronic conditions such as congestive heart failure.[2,3] In recent years, there has been an increased effort to decrease hospital readmissions to reduce associated costs and as a purported measure of care quality These efforts have included care coordination for high readmission conditions and patients, enhanced discharge planning, and self-management and education during the post-discharge transition period.[4,5,6,7,8,9] little research has focused on emergency department (ED) visits following an inpatient admission. Prior studies suggest that nearly half of all 30-day return visits from an inpatient stay might be Volume XVI, no. 7 : December 2015

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