Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care

Abstract

Considerable attention is being paid to hospital readmission as a marker of poor postdischarge care coordination. However, little is known about another potential marker: emergency department (ED) use. We examined ED visits for Medicare patients within thirty days of discharge for six common inpatient surgeries. We found that these visits were widespread and showed extensive variation across facilities. For example, 17.3 percent of these patients experienced at least one ED visit within the postdischarge period, and 4.4 percent of patients had multiple ED visits. Among those patients who were readmitted, 56.5 percent were readmitted from the ED. There was substantial variation-as much as fourfold-in hospital-level ED use for these patients across all six procedures. The variation might signify a failure in upstream coordination of care and therefore might represent a novel hospital quality indicator. In addition, the postdischarge ED visit is an opportunity to ensure that care is properly coordinated and is the last best chance to avoid preventable readmissions.

Emergency Department Visits after Kidney Transplantation

“…To place findings in perspective in other settings, Tang et al (26) showed that rates of ED use in the general population increased from 35 to 39 visits per 100 patient-years between 1997 and 2007, with increased rates among underserved Medicaid patients. A national study of Medicare patients receiving surgery (including percutaneous coronary intervention, hip fracture repair, and coronary artery bypass grafting) reported a 30-day ED visit rate of 17% (14). A 2013 study using the SIDs found that 40% of 30-day acute care encounters after hospital discharge were to an ED (10).…”

“…However, controversies exist regarding the exact interpretations of the use of acute care services and the correlation with quality of care (7,(11)(12)(13). Health care delivered through the ED can be associated with lower quality of care, higher costs, and lack of coordinated care (14,15). In the context of kidney transplantation, McAdamsDemarco et al (16) documented a 31% incidence of 30-day hospital readmissions.…”

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge

“…In the U.S., the Centers for Medicare and Medicaid Services (CMS) recently implemented the hospital readmission reduction program (Centers for Medicare and Medicaid Services, 2014) and funded implementation of care coordination interventions (Brock et al, 2013; Voss et al, 2011), based on evidence that readmissions can be prevented with proper transitional support and discharge planning (Coleman et al, 2006; Leppin et al, 2014). Use of emergency departments (ED) could also indicate poor transitions following inpatient care (Baier et al, 2013; Kocher et al, 2013), but has received less attention from policy makers and is not currently monitored as a hospital quality metric. However, previous literature has highlighted many complex patient-level characteristics that may contribute to risk for readmissions and ED visits, such as patient age, gender, or socioeconomic status (Amarasingham et al, 2010; Arbaje et al, 2008), which may not be modifiable characteristics within the control of hospitals.…”

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

“…High rates of 30-day readmission may also indicate poor integration of the health care delivery system, one in which care is poorly coordinated across settings. 16,17 Similarly, post-discharge emergency department visits, which account for about 40% of all acute post-discharge care encounters 8 and contribute a meaningful share of hospital spending, 1,18 have also been proposed as a novel marker of inadequate care coordination. 7,8,18 A portion of all-cause hospital readmissions and post-discharge emergency department visits are deemed preventable.…”

“…16,17 Similarly, post-discharge emergency department visits, which account for about 40% of all acute post-discharge care encounters 8 and contribute a meaningful share of hospital spending, 1,18 have also been proposed as a novel marker of inadequate care coordination. 7,8,18 A portion of all-cause hospital readmissions and post-discharge emergency department visits are deemed preventable. 4,5,19,20 High population rates of such events represent opportunities to improve care and use health care resources more efficiently.…”