20% of Patients Revisit ED Within 30 Days, UCSF Study Finds
About 8% of patients revisit a hospital within three days of being discharged from the emergency department, according to a UC-San Francisco study published in the Annals of Internal Medicine, the AP/San Francisco Chronicle reports (Neergaard, AP/San Francisco Chronicle, 6/15).
Details of Study
For the study, UCSF researchers culled data from six states -- Arizona, California, Florida, Hawaii, Nebraska and Utah -- between 2006 and 2010. The data came from the Healthcare Cost and Utilization Project, a database maintained by the Agency for Healthcare Research and Quality, which includes records from the State Emergency Department Databases, State Inpatient Databases and additional files between the two.
In all, researchers examined nearly 54 million independent three-day windows of time to analyze revisits.
According to the study, nearly 20% of hospital discharges come back to a hospital ED within 30 days, and 28% of those patients are readmitted at a different facility.
The study also found that of the approximately 8% of patients who revisited a hospital within three days:
- 29% were readmitted; and
- 32% of those readmissions took place at a different location than the initial visit.
In addition, ED revisit rates were higher for patients between ages 18 and 44 -- at 8.2% -- than for patients 65 and older, at 7.8%. However, patients in the oldest age group were more likely to be admitted after a revisit. In addition, patients between ages 18 and 44 were also more likely to revisit an ED at a different location than their older counterparts.
Insurance status also affected the rate at which patients revisited the hospital, according to the study. For instance, Medicaid beneficiaries had a revisit rate of about 10%, compared with a 6.3% rate for patients with private insurance.
The researchers found that 89% of revisits had the same primary diagnosis as the initial ED visit. Skin infections and abdominal pain were found to be the most common revisit diagnoses, according to the study.
In an editorial accompanying the study, researchers Kumar Dharmarajan and Harlan Krumholz of the Yale School of Medicine suggest the reason patients seek follow-up care at a new hospital is that they are "dissatisfied with their initial encounter or are exercising greater discretion in their choice of facility."
Dharmarajan and Krumholz also noted that typical illness indications -- such as being in the ICU during a hospital stay, disjointed nursing care and clinical instability at the time of discharge -- were not associated with readmission rates (Wallan, MedPage Today, 6/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.