Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Outcomes Research
• Hospital Readmission Analysis

Background:

• Understanding in-hospital outcomes for pediatric patients experiencing return emergency department (ED) visits is crucial for healthcare quality.
• Previous studies have not clearly defined outcomes for children admitted after an initial ED visit discharge and subsequent return visit.

Purpose of the Study:

• To test the hypothesis that in-hospital outcomes are worse for children admitted during a return ED visit compared to those admitted during an index ED visit.
• To compare outcomes of ED return admissions and readmissions with index admissions without a return visit.

Main Methods:

• Retrospective analysis of 1,886,053 pediatric ED visits (ages 0-17) in Florida and New York during 2013.
• Classification of hospitalizations into 'index admissions without return admission', 'ED return admissions', and 'readmissions' based on 7-day return visit criteria.
• Comparison of in-hospital outcomes including intensive care unit (ICU) admission rates, length of stay, and hospital costs.

Main Results:

• ED return admissions (7,561) had lower ICU admission rates (11.0% vs. 13.6%) compared to index admissions without return (75,437).
• ED return admissions experienced a longer length of stay (3.51 vs. 3.38 days) but similar mean hospital costs compared to index admissions without return.
• Readmissions (1,333) data was also analyzed, though specific outcome comparisons were detailed for ED return admissions.

Conclusions:

• Pediatric ED return visit admissions are associated with lower severity of illness compared to index admissions without a return visit.
• The findings suggest that ED return visit admissions do not result in worse in-hospital outcomes or increased costs.
• This study indicates that children discharged from the ED who are subsequently admitted do not face poorer outcomes.