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Many patients bounce back to ER after hospital discharge

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WASHINGTON - Nearly one-quarter of all patients discharged from the hospital end up right back there as emergency patients, yet are not counted as hospital readmissions unless they are subsequently admitted as inpatients. A study published last Thursday in Annals of Emergency Medicine highlights a segment of patients who are being missed in tallies of hospital readmissions within 30 days of discharge ("Emergency Department Visits After Hospital Discharge: A Missing Part of the Equation") http://tinyurl.com/bwmwowu.

"Many patients return to the hospital, via the emergency department, within 30 days of discharge from the hospital but are not being counted in measurements of readmissions," said lead study author Kristin Rising, MD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pa.  "Unless they are readmitted to the hospital through the ER, these patients are invisible. The Centers for Medicare and Medicaid has invested heavily in preventing hospital readmissions within 30 days, but by limiting the focus only to inpatient-to-inpatient events and omitting ER visits, they are missing a substantial source of healthcare utilization that is managed solely in the emergency department."

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 emergency department 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 emergency department 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," said Dr. Rising. "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."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit www.acep.org.


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