Potentially avoidable emergency department use by patients discharged to skilled nursing facilities

Abstract

One‐third of patients discharged from hospitals to skilled nursing facilities (SNF) are sent back to the Emergency Department (ED) within 30 days. Little is known about those patients who are discharged from the ED directly back to SNF. We considered these ED visits as potentially avoidable since they did not result in observation or hospitalization stay. Using a retrospective chart review of 1010 patients with ED visits within 14‐days of discharge to SNF from University of Pennsylvania health system (UPHS) in 2020–2021, we identified 202 patients with potentially avoidable ED visits among medical and surgical patients. The most common reasons for these ED visits were mechanical falls (17.3%), postoperative problems (16.8%), and cardiac or pulmonary complaints (11.4%). Future interventions to decrease avoidable ED visits from SNFs should aim to provide access for SNF patients to receive timely outpatient lab and imaging services and postoperative follow‐ups.

Many (un)happy returns: Challenges and opportunities for potentially avoidable ED visits after discharge to a skilled nursing facility

“…Reasons for ED visits were not captured. However, head injuries, urinary tract infection (UTI), and chest pain were the most frequent diagnoses for SDD ED visits, consistent with other studies 2 . In a multivariable analysis, the authors identified chronic conditions (dementia, congestive heart failure, chronic obstructive pulmonary disease), and facility characteristics (rural SNF setting and those with >70% Medicaid patients) as being associated with an SDD ED visit when compared to patients with no ED visit.…”

“…In their study, Tian et al find that among SNF patients sent to the emergency department (ED), 75% are admitted, while 25% are ED same‐day or next‐day discharges (SDD). They explore the epidemiology of and resource utilization associated with ED SDD, based on the notion that this subset of ED visits may be avoidable 2 . Though the cost of alternatives is not presented and may not be known, in aggregate, these visits cost Medicare an estimated $24.6 million annually.…”

Emergency department visits by older adults receiving postacute care in skilled nursing facilities

“…A recent study from a large health system found that 20% of older adults discharged to SNF were sent back to the ED and discharged back to SNF within 2 weeks of SNF admission. 5 ED visits represent a disruption in care and are particularly high-risk for older adults who are vulnerable to adverse events during transitions. However, little is known about the national prevalence and cost of ED visits from SNF that result in same-day discharge back to SNF.…”