1 in 5 Medicare patients return to hospital after an observation stay

A large number of patients who are admitted to observation status return to the hospital within 30 days of discharge, according to a new study.

In fact, as many as 1 in 5 older Medicare patients will return to the hospital after being in observation or a short-term outpatient stay, according to a Yale-led study published in the BMJ.  The high rate is reason for concern and suggests changes in care might be needed, researchers say.

Observation stays are for patients who are too sick to be sent home but not sick enough for hospital admissions. These stays, which typically follow an emergency department visit and often last less than 24 hours, affect 1.5 million patients and often are less expensive than a hospital admission.

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But little research has been done to assess observation stays and patient outcomes, lead author author Kumar Dharmarajan, M.D., assistant professor of medicine at Yale University School of Medicine, said in an announcement about the study findings.

So the research team conducted a national retrospective analysis of Medicare patients aged 65 or older from 2006 to 2011. They calculated hospital revisit rates and mortality rates in the 30 days following discharge from an observation stay and then compared that data with the same outcomes for Medicare recipients who had an initial inpatient stay or received care in the emergency department.

“We found that in the 30 days after discharge, one in five patients had a revisit, such as an ED stay, another observation stay, or inpatient stay,” said Dharmarajan. “Half of those revisits were for inpatient care and these revisits increased over time.”

The outcomes following observation stays were similar to outcomes after ED visits, the researchers said.