It is well known that the post discharge period is full of challenges and is often dangerous for patients. While recent initiatives to improve the transition from hospital to home are encouraging, these efforts often rely on hospital readmission rates as a marker of success, and may miss the point. Emergency department (ED) visits are another important outcome following hospital discharge – even when they do not result in hospital admission. Of course, some ED visits result in hospital readmission due to acute, unforeseen complications. On the other hand, many return visits reflect break-downs in social supports and difficulties accessing and communicating with providers. Regardless of the reason, these patients return to the ED and wait to be seen because of some unmet need or gap in care. In turn, these ED visits contribute to fragmented patient care, overcrowding of EDs, and increased health care costs.
We conducted a study to determine the degree to which ED visits (treat-and-release encounters) contribute to overall use of acute care services following hospital discharge. In a study of over 5 million hospitalizations in 3 states (CA, NE, and FL) during 2008-2009, we found that for every 1,000 discharges, there were 97.5 ED treat-and-release visits and 147.6 hospital readmissions in the 30 days following discharge. Visits to the ED comprised nearly 40% percent of all post-discharge acute care encounters. Moreover, patients commonly returned to the ED for reasons related to their initial hospitalization.
Our study raises concerns that many more patients require acute medical care after hospital discharge than previously recognized. The use of hospital readmissions as a lone metric for post discharge health care quality may be incomplete without considering the role of the ED.