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Making the Case to Include EDs in Readmission Rates

Making the Case to Include EDs in Readmission Rates

In recent years, CMS has invested heavily in policies, incentives, and other interventions to encourage healthcare providers to improve transitions in care and reduce avoidable readmissions. Studies have shown that many patients return to the hospital via the ED within 30 days of discharge, but specifications for measuring rehospitalization vary. “Unless patients are readmitted to the hospital through the ED, they aren’t being counted in measurements of readmissions,” says Kristin L. Rising, MD. “By limiting the focus to inpatient-to-inpatient events and omitting ED visits, we’re missing a substantial source of healthcare utilization that is managed solely in the ED.” Patients may be effectively stabilized and discharged from the ED shortly after hospital discharge, but few data are available on the frequency and cost of ED visits after such discharges. Previous analyses have found that 40% of patients who sought acute medical care had multiple visits for inpatient or ED stays. About one-quarter of these patients had multiple inpatient stays, whereas one-third had multiple ED treat-and-release visits. Taking a Comprehensive Approach to Readmission Factors According to Dr. Rising, a comprehensive approach to understanding the factors that contribute to subsequent healthcare use in the post-hospital discharge period should include a closer look at ED use within 30 days of hospital discharge. In a retrospective study published in Annals of Emergency Medicine, Dr. Rising and colleagues examined 15,519 patient discharge records over a 5-month period. Nearly one-quarter (23.8%) of these discharges resulted in at least one ED visit within the subsequent 30 days, and more than half (54.0%) of these visits resulted in discharge back home. The median number of ED visits per patient...
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