1 in 5 Older Adults End Up in ER after Surgery

Nearly one in five older adults who have common operations will end up in the ER within a month of their hospital stay, finds a new study from the University of Michigan Medical School, with funding from the National Institutes of Health.

Researchers also found wide variation among hospitals, with some having four times the rate of post-surgery emergency care for their patients than others, and suggest that hospitals could be graded based on their performance on this measure.

But, they note in their paper, which appears in the September issue of the journal Health Affairs, that further study is needed before post-surgical ED visits join such measures as hospital readmissions and infections in assessing the quality of hospital care.

Researchers analyzed Medicare data from nearly 2.4 million adults who had at least one of six common operations in a three-year period: angioplasty or other minimally invasive heart procedures, coronary artery bypass, hip fracture repair, back surgery, elective abdominal aortic aneurysm repair, and colectomy or removal of part of the colon, such as for colon cancer. Just over 17 percent had one, and more than 4 percent had two or more ED visits within 30 days of leaving the hospital. More than half of the patients who sought emergency care ended up being readmitted to the hospital directly from the ED. There was also a lot of variation depending on what the surgery was for, researchers found. For colon surgery, the rate of post-hospital emergency visits ranged from one in four patients treated at some hospitals, to one in 14 treated at others.

The most common issues that brought patients to the ED were cardiovascular and respiratory conditions, infections, complications with the site of their surgery or procedure incision, and abdominal or gastrointestinal problems.

Since Medicare now pays hospitals less if they have high readmission rates, and reports those rates publicly, health teams are ramping up their efforts to reduce readmissions.

Emergency department visits by surgical patients signifies a problem in the transition of care from the hospital to the outpatient setting, the report notes. Emergency visits by post-surgery patients can be used to re-establish coordination of care, and deliver treatment and create management plans to prevent readmission.

At the University of Michigan Health System’s (UMHS) adult ED, for instance, adult ED patients have access to a care manager to coordinate patients’ care across UMHS sites, and a free phone-based service that assists them in getting outpatient appointments to follow up on their health needs. UMHS also has clinical relationships with local skilled nursing facilities, to help coordinate patients’ post-hospital care.

Integrating care across all settings might help hospitals reduce their post-surgery emergency care rates. And as readmission penalties mount, hospitals may begin to focus more on emergency physicians’ decision-making process regarding readmitting a patient from the ED.

But further research on the reasons for these emergency visits, the impact of hospital-discharge education and planning on post-surgery ED visits, and the reasons why emergency patients are readmitted from the emergency department, is needed, researchers say. Social and family support reasons, not just medical considerations, may play a big role.

Source: University of Michigan Health System , September 9, 2013


2012 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable information from 134 healthcare organizations on their efforts to reduce inappropriate ED visits, and presents year-over-year trends and suggests how to engage the primary care physician, urgent care centers and patient education tools in these efforts.

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