ER patients who return may have better outcomes, costs

Emergency room patients who return at a later time for more care have significantly lower costs and mortality rates than those who are admitted as inpatients during the initial episode of care.

That's the conclusion of researchers at the University of Washington, University of Michigan at Ann Arbor and University of California San Francisco. Their conclusions were published in a recent edition of the Journal of the American Medical Association (JAMA). 

The study questions the basic concept that not pinpointing the exact trouble during the first ER visit would lead to worse outcomes. Instead, the individual acuity of each patient seems to play a bigger factor in costs and likelihood of death.

Emergency departments and patient flow have become big issues for hospitals, with some working hard to try and increase the number of patients they treat while also increasing the quality of care they deliver.

The researchers studied 9 million patients who visited a hospital ER. About 20 percent were admitted to the hospital during the first ER visit. Of those, 42.4 percent had a return visit to the ER within 30 days. Among the other 80 percent of patients who visited the ER but were not initially admitted as inpatients, 36.3 percent returned to the ER within 30 days, and 43.3 percent of those were admitted to the hospital.

The latter group who were admitted to the hospital within a week of an ER visit had a mortality rate of 1.85 percent. By contrast, those who were admitted as inpatients during their first ER visit had a mortality rate of 2.5 percent. They also were less likely to be admitted to the ICU, and their overall costs were about 6 percent less than those who were admitted during their first ER visit.

It is unknown if the study may have been skewed by the rising use of observation status for ER patients, which some critics say distort the quality of care that hospitals deliver. 

"These findings suggest that hospital admissions associated with return visits to the ED may not adequately capture deficits in the quality of care delivered during an ED visit," the researchers concluded.

To learn more:
- read the JAMA study abstract