77 Patterns of Emergency Department High Utilizers at Grady Memorial Hospital

Abstract

Methods: This was a retrospective study of patients presenting to the emergency department (ED) of an urban academic tertiary care center with more than 115,000 annual visits, with an approximate OU volume of 5,000 patients per year. The OU consists of 20 beds with telemetry available and specific pathways for care. Patients admitted to the OU > 18 years of age with an acute medical condition requiring observation < 48 hours during the study period of August 2016 to December 2016 were included. Patients were excluded if they were discharged directly from the ED or admitted to the hospital without a stay in the OU. Trained abstractors utilized a standardized abstraction form to record all data via our hospital-based electronic medical record system (EPIC Systems Corporation; Verona, Wis). Variables collected that might be predictive of hospitalization for OU patients included age, sex, Emergency Severity Index (ESI), and OU admission diagnosis. Association between admission to the hospital from the OU and presenting ESI was assessed by multivariate logistic regression, controlling for age and sex. Further multivariate logistic regressions were conducted to look for associations between hospital admission from the OU and the admitting diagnosis, controlling for age, sex, and ESI. Statistical analysis was done in the R statistical computing software.Results: During the study period, 2264 patients were admitted to the OU and included in the study. 812 patients (36%) were admitted to the hospital and 1452 patients (64%) were discharged. Lower acuity ESI was associated with a 4% decrease in the rate of admission to the hospital from the OU (p¼0.04). Rate of admission to the hospital was also significantly decreased for patients with an OU admitting diagnosis of anemia by 32%, syncope by 25%, and chest pain by 12% (see table ). The hospital admission rate was significantly increased for patients with sickle cell crisis (SCC) by 29%, inflammatory bowel disease (IBD) by 22%, and congestive heart failure (CHF) by 14%.Conclusions: Although our study did not find any correlation with age or sex with hospital admission, a lower acuity ESI was associated with a decreased risk of admission. SCC, IBD, and CHF were associated with an increased likelihood of admission. SCC and IBD patients may require more intensive pain control and may be less likely to improve within a 48 hour OU stay. IBD and CHF patients are often managed by subspecialty services, which could contribute to an increased admission rate. Chest pain, syncope, and anemia were all associated with a decreased risk of hospital admission. This is likely because these diagnoses have specific end points in their treatment plans. In conclusion, the OU admission diagnoses of chest pain, syncope, and anemia were associated with a decreased risk of hospital admission, whereas SCC, CHF, and IBD were associated with an increased risk. Larger prospective studies are needed to determine which factors associated with these diagnoses may make a patient more suitable for hospital v...