ER revisits costly, occur more frequently than thought

Even as the healthcare industry strives to curb emergency department visits and hospital readmissions, a new study suggests that ED revisit rates are twice as high as previously reported and often more costly than an initial ED visit.

The study, led by researchers from the University of California, San Francisco and published in the Annals of Internal Medicine, analyzed data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project database. The data concerned patients who were discharged from EDs from 2006 to 2010 in six states that provided data on linked visits to EDs and hospital admissions.  

Nearly 1 in 12 patients who visited an ED returned after three days, the study found, while previous research indicated that about 3 percent of patients return to the ED within the same amount of time, according to Forbes. This may be because, as the new study found, 32 percent of the patients who revisited the ED within three days visited a different institution than their initial one.

In Florida, which the study says is the only state with complete cost data, the total cost of a return ED visit within 30 days--which occurred for 1 in 5 patients--was 118 percent of the initial cost.

Overall, 9 out of 10 ED revisits within three days occurred due to the same condition that led the patient to the ED in the first place, constrasting data that say most hospital readmissions occur for a difference condition, according to an accompanying opinion piece.

In all aspects of hospital care, reducing readmissions has become a top priority, as the federal government now ties readmission rates to reimbursements. Providers also have worked to lessen the number of unnecessary ED visits, an effort that has seen some success through the use of specialized first-responder programs and house calls.

The study authors conclude that since more ED revisits than previously thought occur at different institutions, providers should consider improving their inter-institution care coordination as well as develop and keep national benchmarks for revisit rates.   

"To improve outcomes for patients, we must think broadly about their experiences in multiple healthcare settings. The ED, with respect to revisits, represents a new venue for such inquiry," states the opinion piece. "Whether factors associated with risk for readmission change over time and whether this information has implications for interventions designed to reduce adverse events remains worthy of further investigation."

To learn more:
- check out the study
- here's the opinion piece
- here's the Forbes post