As many as one in four patients discharged from the hospital end up right back there as emergency patients, but are not counted as hospital readmissions unless they are admitted as inpatients, says a study from the Perelman School of Medicine at the University of Pennsylvania, and published in the Annals of Emergency Medicine.
These patients are returning to the hospital via the ER within 30 days of discharge, but are not being counted in measurements of readmissions, researchers note. They are falling through the cracks because CMS 30-day readmission rules concentrate on inpatient-to-inpatient admittances and overlook ER visits. Because of this they are “missing a substantial source of healthcare utilization that is managed solely in the emergency department,” researchers note.
Researchers examined 15,519 patient discharge records over a five-month period in 2010. Nearly one-quarter (23.8 percent) of these discharges resulted in at least one ED visit within the subsequent 30 days although over half (54 percent) of the subsequent emergency visits did not lead to hospital readmission.
The primary discharge diagnosis with the highest number of discharges linked to an ER visit within 30 days was non-specific chest pain. However, non-hypertensive congestive heart failure was the diagnosis with the highest rate of return ED visits (31.8 percent of discharges) and the highest rate of 30-day readmissions (82.6 percent).
“Emergency physicians are increasingly filling voids left by difficult or unsuccessful transitions of care,” says lead study author Kristin Rising, MD. “Excluding a return to the emergency department from initiatives aimed at reducing recurrent hospital utilization misses over 50 percent of all returns to the acute level of care following discharge. Including emergency department visits will give a more accurate assessment of where care transitions can be improved and how recurrent hospital utilization can potentially be avoided.”
Source: American College of Emergency Physicians (ACEP): April 9, 2013
2012 Healthcare Benchmarks: Reducing Avoidable ER Visits, is designed to meet business and planning needs of hospitals, health plans, physician practices and others by providing critical benchmarks that show how the industry is working to reduce avoidable hospital ED visits. this second annual collection of data points on this aspect of ER utilization management presents year-over-year trends and suggests how to engage the primary care physician, urgent care centers and patient education tools in these efforts.