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Examining the Timing of ED Return Visits

Examining the Timing of ED Return Visits

In 2012, CMS implemented reimbursement penalties for hospitals with excessive inpatient readmissions for patients with several diagnoses. As a result, many interventions have been developed in an effort to reduce inpatient readmissions. Though there are currently no similar penalties for recurrent ED visits, there has been increasing attention on tracking and reducing 72-hour ED returns. “Return visits within an acute time period after ED discharge warrant a closer look to determine the reasons for the return and which visits may have been preventable,” explains Kristin L. Rising, MD, MS. “We must use care in defining the metrics on which we base our studies. This can start by examining what reasonably qualifies as the ‘acute time period’ during which patients are most likely to have a return ED visit.” Quantifying ED Revisits ED revisits that occur within 3 days of ED discharges are commonly used as a hospital quality metric, but Dr. Rising says there is no clear basis for this time threshold being the most appropriate. “We need to determine the most appropriate time period to use in identifying patients at highest risk of unexpected ED revisits before we develop targeted strategies to predict and prevent these occurrences,” she says. To address this issue, Dr. Rising and colleagues conducted a study—published in Academic Emergency Medicine—to characterize the timing of return ED revisits after prior ED discharges. According to the findings, over 7% of ED discharges assessed in the study had ED revisits within 3 days, and over 22% of ED discharges had revisits within 30 days. When statistical models were applied to the data, the most reasonable cutpoint for...
POLST & Emergency Medicine: Considering the Issues

POLST & Emergency Medicine: Considering the Issues

Emergency physicians frequently care for dying patients and are forced to make time-sensitive decisions without adequate medical history and knowledge of end-of-life care preferences. “Complicating these decisions is the fact that patients may be unable to communicate with their physicians,” says Arvind Venkat, MD. “In addition, accompanying documents—such as advance directives or do-not-resuscitate (DNR)/do-not-intubate (DNI) documents—are often inadequate to guide physicians in making decisions about critical interventions. These factors can lead to gaps in knowledge regarding patient preferences.” Several factors can compound the problems related to end-of-life care in the ED, including the complexity of medical conditions among the aging population and technologic advances that offer an increasing number of options for intervention. The Physician Orders for Life-Sustaining Treatment (POLST) was developed to provide a way for patients to clearly inform caregivers about their specific treatment preferences if they develop a serious or end-stage illness. In 1991, the Center for Ethics in Health Care at Oregon Health Sciences University convened a task force to address standardized portable medical orders for patients with progressive, chronic illnesses with regard to life-sustaining medical treatments. In 1993, the university adopted the acronym POLST. Throughout the United States, POLST documents have also been referred to as physician orders for scope of treatment, medical orders for scope of treatment, and medical orders for life-sustaining treatment, but these all share the same core elements and have similar form design. Research Supports POLST Early studies have shown that POLST effectively increases care that is delivered in accordance with patient wishes, according to Dr. Venkat. This was recently described in an article published in the Annals of Emergency...
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