Rates of hospital readmission from the emergency department of patients who were recently hospitalized are on the rise, according to an analysis of 2005-2008 data from the National Hospital Ambulatory Medical Care Survey.
"Patients who return to the emergency department within 7 days of hospitalization have both relatively high and increasing rates of readmission. ... Policies and programs aimed at reducing hospital readmissions should consider the role of the ED in determining the disposition of recently hospitalized patients," said Dr. Zachary F. Meisel of the University of Pennsylvania, Philadelphia.
Dr. Zachary F. Meisel
The analysis of the nationwide NHAMCS included all patients aged older than 18 years and excluded only those who were transferred, left against medical advice, or died in the ED. In all, 2.4% of ED visits – an estimated 2.3 million per year – were by patients who had been hospitalized in the previous 7 days. Admission rates for recently hospitalized patients increased for each study year, from 28.6% in 2005 to 38.0% in 2008. In contrast, admission rates for visits by patients who were not recently hospitalized increased only slightly, from 15.7% to 16.2%, Dr. Meisel reported at the annual meeting of the Society for Academic Emergency Medicine.
After adjustment for age and triage acuity, the odds ratio of hospital admission for those who had been hospitalized within the previous 7 days was 2.59, compared with those not previously hospitalized. Older age, higher triage acuity, and visits to hospitals in metropolitan areas were also associated with increased odds of admission but did not confound or modify the interaction between recent hospitalization and admission for any year.
The rising rate of readmission was somewhat surprising, given the recent financial pressures being placed on hospitals to reduce those rates. One possible explanation is that hospitals are now discharging sicker patients. "Even though I adjusted for triage acuity, that doesn’t capture all the factors that make a patient sick," Dr. Meisel said in an interview.
However, he pointed out that even though the percentages of ED patients admitted after recent hospitalization rose by about 10%, compared with the baseline admission rate over the 4-year period, two-thirds of patients who were recently hospitalized are still being evaluated in the ED and discharged rather than admitted. "So, clearly we’re doing something in the ED to mitigate readmissions. Whether it’s pain control, reassurance, addressing questions about prescriptions, arranging follow-up, or other measures, hospitals should be analyzing what’s going on in the ED and our role in preventing hospital readmission."
Dr. Meisel stated that he had no relevant financial disclosures.