The Metrics of Acute Care Reentry and Emergency Department Visits by Recently Discharged Inpatients

• Published in: Advanced emergency nursing journal Vol. 42; no. 2; pp. 150 - 160
• Main Authors: Hodgins, Marilyn J., Fraser, Jacqueline M., Filiatreault, Sarah
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc. All rights reserved 01-04-2020
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Infant; Infant, Newborn; Length of Stay - statistics & numerical data; Male; Middle Aged; New Brunswick; Nursing; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Sex Factors; Time Factors; New Brunswick
• ISSN: 1931-4485; 1931-4493
• DOI: 10.1097/TME.0000000000000293

Research on acute care reentry by recently discharged inpatients has generally focused on hospital readmissions, with less attention given to presentations to the emergency department (ED). This omission results in underestimation of the extent of reentry and its impact on ED patient volumes and flow. This project involved an analysis of administrative data to examine the rate of ED presentations by recently discharged inpatients using 3 time metrics—within 0–3 days, 0–7 days, and 0–30 days of discharge. Descriptive-correlational analyses were conducted to examine the rates of reentry and ability to predict ED presentations using patient demographic (age and sex) and clinical profile (length of hospital stay and day of presentation). Approximately 12% of hospital discharges to home involved patients who presented to the ED within 30 days, and almost half occurred within the first week. Results of multivariable analyses suggest that the influences of ED presentations differ depending on the time metric examined. Emergency department presentations within 3 and 7 days of discharge compared with 30 days were not predicted by patient age or sex but were more likely to involve those with shorter hospital stays. A weekend presentation was also more likely among case patients presenting within 3 days of discharge. Only about one third of ED presentations resulted in readmission. Emergency department presentations are an important component of acute care reentry. Establishment of a common reentry metric for ED presentations would facilitate efforts to determine the impact of these events. Emergency nurses working in advanced practice roles are ideally positioned to assume a leadership role in addressing the needs of recently discharged inpatients who present to the ED. By reviewing these cases and collaborating with the inpatient unit staff, it may be possible to identify strategies for augmenting discharge planning and the provision of transitional care.