Emergency department visits account for large proportion of hospital encounters following discharge

Jan 25th – 18% of hospital discharges are followed by an acute care encounter within 30 days, and 40% of these are ED visits.

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Image: PD

1.     18% of hospital discharges are followed by an acute care encounter within 30 days, and 40% of these are ED visits.

2.    Gastrointestinal disorders and psychosis are the most common reason for 30-day post-hospital discharge visit.

While there has been an emphasis on hospital readmissions, large numbers of treat-and-release visits to the ED also represent a large problem. This study indicates that nearly 18% of hospitalizations require at least 1 hospital-based acute care encounter in the 30 days following discharge (either treat-and-release ED visit or readmission to the hospital). Of these hospital-based acute care encounters in 30 days following hospitalization, nearly 40% were ED visits where the patient were treated and released. High hospital readmission rates and ED visits pose a significant financial burden to hospitals nationwide. Reducing these rates has recently become an important goal for hospitals, especially in the setting of rising financial penalties associated with excess readmissions.

While this study illustrates the burden on emergency departments by recently hospitalized patients, several issues of the study warrant consideration. The analysis only utilizes patient information from 3 states, which raises issues of generalizability since there may be large variation in different parts of the country. In addition, the study only examines hospital-based acute care, so it is unable to account for visits to physician offices, ambulatory care sites, and walk-in clinics which also would be important to understand. Nonetheless, the paper provides an important impression on the scope of hospital-based acute care in the 30 days following hospitalizations. While future research can examine this burden further, decreasing readmission and ED visit rates should be targeted, especially in order to optimize transitional care for patients at an increased risk of seeking care immediately following discharge.

Click to read the study in JAMA

Click to read accompanying editorial in JAMA

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Image: PD

1.     18% of hospital discharges are followed by an acute care encounter within 30 days, and 40% of these are ED visits.

2.    Gastrointestinal disorders and psychosis are the most common reason for 30-day post-hospital discharge visit.

This [population-based prospective cohort] study: This study examined the hospital records of 4,028,555 patients from California, Florida, and Nebraska representing 5,032,254 hospital discharges. 17.9% of the hospitalizations resulted in at least 1 hospital-based acute care encounter in the 30 days following discharge. Visits to the ED comprised 39.8% of the 1,233,402 post-discharge hospital-based acute care encounters. 30 day post-discharge ED treat-and-release rates were highest for digestive disorders and psychoses.

Further reading:

1. Recently discharged inpatients as a source of emergency department overcrowding
2. Physician visits after hospital discharge: implications for reducing readmissions

In sum: While there has been an emphasis on hospital readmissions, large numbers of treat-and-release visits to the ED also represent a large problem. This study indicates that nearly 18% of hospitalizations require at least 1 hospital-based acute care encounter in the 30 days following discharge (either treat-and-release ED visit or readmission to the hospital). Of these hospital-based acute care encounters in 30 days following hospitalization, nearly 40% were ED visits where the patient were treated and released. High hospital readmission rates and ED visits pose a significant financial burden to hospitals nationwide. Reducing these rates has recently become an important goal for hospitals, especially in the setting of rising financial penalties associated with excess readmissions.

While this study illustrates the burden on emergency departments by recently hospitalized patients, several issues of the study warrant consideration. The analysis only utilizes patient information from 3 states, which raises issues of generalizability since there may be large variation in different parts of the country. In addition, the study only examines hospital-based acute care, so it is unable to account for visits to physician offices, ambulatory care sites, and walk-in clinics which also would be important to understand. Nonetheless, the paper provides an important impression on the scope of hospital-based acute care in the 30 days following hospitalizations. While future research can examine this burden further, decreasing readmission and ED visit rates should be targeted, especially in order to optimize transitional care for patients at an increased risk of seeking care immediately following discharge.

Click to read the study in JAMA

Click to read accompanying editorial in JAMA

By [JP] and [RR]

More from this author: Protected sleep periods improve intern alertness and sleep duration, ADHD medication decreases rates of criminality in ADHD patients, Low dose aspirin shows net clinical benefit in patients with first unprovoked venous thromboembolism.

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John Prendergass: John is a 2nd year M.D. candidate at New Jersey Medical School.

 

 

 

 

Rif Rahman: Rif is a 4th year M.D. candidate at Harvard Medical School.

 

 

 

 

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