Reducing “unnecessary” use of the hospital has become an important initiative nationwide, but little is known about the patients who repeatedly seek care in the ED within a short timeframe. Studies have shown that about one-third of all acute care visits in the United States and half of hospital admissions originate in the ED. However, it is unclear how repeat ED utilization fits into the overall conversation about hospital readmissions. “Using patients’ perspectives regarding their reasons for returning to the ED may help inform future initiatives that aim to reduce recurrent utilization,” says Kristin L. Rising, MD, MS.

A Look at Patient Perspectives

In a study published in the Annals of Emergency Medicine, Dr. Rising and colleagues sought to describe the personal experiences and challenges faced by patients transitioning home after an ED discharge. The study group conducted 60 in-person interviews with patients who returned to the ED within 9 days of discharge. “The primary reason patients returned to the ED was fear or uncertainty about their ongoing medical symptoms,” Dr. Rising says. “Patients who returned to the ED within a few days of discharge did so because they believed their symptoms were too severe to wait until they could schedule an appointment or because they were instructed to return to the ED by outpatient providers they contacted.”

ED-Return-Visits-Callout

Other prominent themes also emerged regarding patients’ limited use of outpatient care. Most patients had primary care physicians, but few visited them before returning to the ED. When study participants were asked about seeking follow-up care in an outpatient clinic instead of the ED, many reported that clinics lacked the resources to complete work-ups or treatments and to sufficiently address their symptoms. Patients cited convenience and more expedited evaluations as primary reasons for seeking care in the ED instead of the outpatient clinic.

Take a Patient-Centered Approach

To build an effective model of patient-centered care, Dr. Rising says it is important to include patients’ perspectives. “We must engage patients to determine how we should redesign the health system to deliver the types of care when and where they need it most,” she says. “In some cases, patients simply need reassurance, particularly when they are being discharged without a diagnosis or clear explanation for what’s causing their symptoms. Beyond focusing on preventing readmissions, we should develop and facilitate pathways for patients to ask questions and seek guidance after leaving the ED. In the future, we may be able to use technology to help connect patients

References

Rising KL, Padrez KA, O’Brien M, Hollander JE, Carr BG, Shea JA. Return visits to the emergency department: the patient perspective. Ann Emerg Med. 2014 Sep 2 [Epub ahead of print]. Available at: http://www.annemergmed.com/article/S0196-0644(14)00622-2/fulltext.

Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8:421-427.

Kangovi S, Grande D, Meehan P, et al. Perceptions of readmitted patients on the transition from hospital to home. J Hosp Med. 2012;7:709-712.

LaMantia MA, Platts-Mills TF, Biese K, et al. Predicting hospital admission and returns to the emergency department for elderly patients. Acad Emerg Med. 2010;17:252-259.

Engel KG, Buckley BA, Forth VE, et al. Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest? Acad Emerg Med. 2012;19:E1035-E1044.