Revisits After Emergency Department Discharge for Conditions with High Disposition-Decision Variability at Hospitals...

Area of Science:

• Health Services Research
• Emergency Medicine
• Health Economics

Background:

• Alternative payment models for emergency care aim to reduce avoidable emergency department (ED) admissions.
• These models may inadvertently increase the risk of adverse events post-discharge.
• Understanding ED discharge rate variations is crucial for patient safety and care efficiency.

Purpose of the Study:

• To describe variations in hospital-level ED discharge rates for specific conditions.
• To determine if higher ED discharge rates are associated with increased rates of ED revisits.

Main Methods:

• Retrospective cohort study using California administrative data (2017).
• Analyzed ED discharge and revisit rates for conditions with known discharge variability (e.g., abdominal pain, altered mental status, chest pain).
• Hospitals categorized into quartiles by adjusted discharge rates; revisits compared between highest and lowest quartiles.

Main Results:

• Significant differences (>10%) in adjusted discharge rates observed across quartiles for most conditions, except abdominal pain.
• No statistically significant association found between adjusted discharge rates and ED revisits.
• Altered mental status and syncope showed high revisit rates regardless of discharge quartile.

Conclusions:

• Opportunities exist to increase ED discharges for select conditions without elevating ED revisit rates.
• ED revisits may not be a direct surrogate for adverse events post-discharge in all cases.
• Findings support potential adjustments to emergency care payment models to improve efficiency.