Unscheduled short-term return visits to the emergency department (ED) are commonly tracked as measures of hospital performance. The rates at which return visits take place have been used to gauge the quality of emergency care. 

To examine in-hospital clinical outcomes among patients who are hospitalized during an unscheduled return visit to the ED, Amber Sabbatini, MD, MPH, from the University of Washington, and colleagues completed a retrospective analysis of adult ED visits to acute care hospitals in Florida and New York in 2013, using data from the Healthcare Cost and Utilization Project, and published their findings in the Journal of the American Medical Association.

The authors identified outcomes of patients with index ED visits for return visits within seven, 14, and 30 days. They found that patients with ED visits who are initially discharged, and are then admitted after a return visit, have better clinical outcomes that those hospitalized at the index ED visit without a return visit,

Among the 9,036,483 index ED visits to 424 hospitals in the study sample, 1,758,359 patients were admitted to the hospital during the index ED visit. The 86,012 patients discharged from the ED and admitted to the hospital during a return ED visit within 7 days had significantly lower rates of in-hospital mortality (1.85%) compared with the 1,609,145 patients who were admitted during the index ED visit without a return ED visit (2.48%) (odds ratio, 0.73 [95% CI, 0.69-0.78]), lower rates of intensive care unit (ICU) admission (23.3% vs 29.0%, respectively; odds ratio, 0.73 [95% CI, 0.71-0.76]), lower mean costs ($10,169 vs $10,799; difference, $629 [95% CI, $479-$781]), and longer lengths of stay (5.16 days vs 4.97 days; IRR, 1.04 [95% CI, 1.03-1.05]). Similar outcomes were observed for patients returning to the ED within 14 and 30 days of the index ED visit.

Patients discharged from the ED and admitted to the hospital after a return visit within seven days had significantly lower rates of in-hospital mortality, ICU admission, lower mean costs, and longer length of stay than patients who were admitted during the index emergency department visit without a return visit. 

Summary and Clinical Applicability

Unscheduled short-term return visits to the emergency department (ED) are monitored as a hospital performance measure, and have been proposed as a measure of the quality of emergency care. In the US, there is a perception that patients who have repeated ED visits are at higher risks of having poor outcomes. This study sought to verify if the return visit rate to the ED can be used as a measure of ED quality. They found that patients who were readmitted to the hospital after a return visit to the ED had lower in-hospital mortalities, ICU admission rates, and in-hospital costs as compared to patients hospitalized during index hospital visit.. 

“Hospital admissions associated with return visits to the emergency department may not adequately capture deficits in the quality of care delivered during an emergency department visit,” the authors write.

Reference

Sabbatini AK, Kocher KE, Basu A, Hsia RY. In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department. JAMA. 2016;315(7):663-71.