Alternative Dispositions for Emergency Department Patients

Bukhman, Alice; Baugh, Christopher W.; Yun, Brian J.

doi:10.1016/j.emc.2020.04.004

Cited by 4 publications

(2 citation statements)

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“…Current efforts to improve care coordination following ED encounters is an active area of policy interest: ensuring patients receive appropriate follow-up while also preventing unnecessary hospitalizations and improving health care value. 1,[3][4][5][6][7][8] Telehealth-the use of synchronous telephone and video technologies and services to provide health care from a distance-underwent rapid adoption since 2020 and now represents 30% of all outpatient care and 34% of all primary care visits. 9,10 While telehealth may increase availability of follow-up appointments and decrease risk of exposure to communicable diseases, it is possible that telehealth visits may provide suboptimal evaluation in certain scenarios and paradoxically increase the rate that patients return to the hospital.…”

Section: Introductionmentioning

confidence: 99%

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Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

et al. 2022

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ImportanceFor patients discharged from the emergency department (ED), timely outpatient in-person follow-up is associated with improved mortality, but the effectiveness of telehealth as follow-up modality is unknown.ObjectiveTo evaluate whether the rates of ED return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care.Design, Setting, and ParticipantsThis retrospective cohort study included adult patients who presented to either of 2 in-system EDs of a single integrated urban academic health system from April 1, 2020, to September 30, 2021; were discharged home; and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days).ExposuresIn-person vs telehealth post–ED discharge follow-up within 14 days.Main Outcomes and MeasuresMultivariable logistic regression was used to estimate the odds of ED return visits (primary outcome) or hospitalization (secondary outcome) within 30 days of an ED visit based on the modality of post–ED discharge follow-up. Models were adjusted for age, sex, primary language, race, ethnicity, Social Vulnerability Index, insurance type, distance to the ED, ambulatory billing codes for the index visit, and the time from ED discharge to follow-up.ResultsOverall, 12 848 patients with 16 987 ED encounters (mean [SD] age, 53 [20] years; 9714 [57%] women; 2009 [12%] Black or African American; 3806 [22%] Hispanic or Latinx; and 9858 [58%] White) were included; 11 818 (70%) obtained in-person follow-up, and 5169 (30%) obtained telehealth follow-up. Overall, 2802 initial ED encounters (17%) led to returns to the ED, and 676 (4%) led to subsequent hospitalization. In adjusted analyses, telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 [95% CI, 11.3-45.3] more ED returns per 1000 encounters) and hospitalizations (10.6 [95% CI, 2.9-18.3] more hospitalizations per 1000 encounters).Conclusions and RelevanceIn this cohort study of patients in an urban integrated health care system, those with telehealth follow-up visits after an ED encounter were more likely to return to the ED and be hospitalized than patients with in-person follow-up. The use of telehealth warrants further evaluation to examine its effectiveness as a modality for continuing care after an initial ED presentation for acute illness.

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Section: Introductionmentioning

confidence: 99%

“…Appropriate follow-up may influence decisions on whether patients should be hospitalized. Current efforts to improve care coordination following ED encounters is an active area of policy interest: ensuring patients receive appropriate follow-up while also preventing unnecessary hospitalizations and improving health care value …”

Section: Introductionmentioning

confidence: 99%

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

et al. 2022

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Receipt of Telepsychiatry and Emergency Department Visit Outcomes in New York State

et al. 2021

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Telepsychiatry has made psychiatric care more accessible to emergency department (ED) patients. To date, most telepsychiatry studies have focused on specific populations or small groups of EDs. This study sought to examine the potential role of telepsychiatry across a wider range of EDs by comparing visit dispositions for psychiatric visits in EDs that did (versus did not) receive telepsychiatry services. ED telepsychiatry service status was identified from the 2016 National ED Inventory-USA and then linked to psychiatric visits from the 2016 New York State Emergency Department Databases/State Inpatient Databases. Unadjusted analyses and multivariable logistic regression models were used to evaluate associations between an ED’s telepsychiatry service status and two clinical outcomes: use of observation services and ED visit disposition. Across all psychiatric ED visits, 712,236 were in EDs without telepsychiatry while 101,025 were in EDs with telepsychiatry. Most (99.8%) visits were in urban EDs. In multivariable logistic regression models, psychiatric visits in EDs with telepsychiatry services had lower odds (adjusted odds ratio 0.30) of using observation services compared to visits in EDs without telepsychiatry. The receipt of ED telepsychiatry is associated with lower usage of observation services for psychiatric visits, likely reducing the amount of time spent in the ED and mitigating the ongoing problem of ED crowding. An overwhelming majority of visits in EDs with telepsychiatry services were in urban hospitals with existing psychiatric services. Factors affecting the delivery and effectiveness of telepsychiatry services to hospitals lacking in psychiatric resources merit further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-021-09886-y.

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Practical alternative to hospitalization for emergency department patients (PATH): A feasibility study

et al. 2021

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Alternative Dispositions for Emergency Department Patients

Cited by 4 publications

References 63 publications

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department

Receipt of Telepsychiatry and Emergency Department Visit Outcomes in New York State

Practical alternative to hospitalization for emergency department patients (PATH): A feasibility study

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