“Remember that patient you had yesterday?” is infrequently a favorable start to a conversation. Emergency Department bouncebacks are frequently tracked metric, ostensibly for self-reflection, but also as a proxy for care quality and mismanagement.
This is a 6 state review of 2 to 5 years of data linked between State Emergency Department Databases and State Inpatient Databases, evaluating Emergency Department recidivism up to 30 days. The authors also linked this data to healthcare cost data, but highest quality cut of meat here is the detail on bouncebacks. Based on 53,530,443 Emergency Department visits, these authors found the overall 3-day revisit rate was 8.2%, and the 30-day revisit rate was 19.9%. Approximately 2/3rds of revisits were to the same Emergency Department, with the remainder choosing a different ED.
These numbers, I think, are much higher than most would expect – and provide at least a small amount of solace if you feel as though it seems there’s always a previous patient of yours checking back into the ED. The authors break down several interesting details regarding the types of revisits:
- Skin and soft-tissue infections resulted in 23.1% 3-day revisit rates, with 12.9% admission on revisit.
- Abdominal pain was the second-most frequent revisit, at 9.7%, associated with 29.9% admission on revisit.
- Patients aged 18-44 were more likely to visit a different ED for the second visit, while patients aged 65 and above were the most likely to be admitted on revisit.
- Patient with back pain had the highest revisit rate to a different ED within 3 days, 7.8%, with 41% of those visiting a different ED.
Simply at face value, these additional visits are expensive and resource-intensive – particularly if there’s not an effective local electronic information exchange preventing duplication of testing. There is also clearly ample opportunity to develop targeted interventions for certain groups of patients to potentially provide follow-up care in a lower-cost setting.
“Revisit Rates and Associated Costs After an Emergency Department Encounter”
http://www.ncbi.nlm.nih.gov/pubmed/26030633