In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department

In this article, researchers explored what types of outcomes patients experience as well as what resources are utilized when patients are hospitalized during a unscheduled return visit to the ED.  The study looked at parameters including in-hospital mortality, ICU admission, length of stay, and inpatient costs.

Unexpectedly, patients who returned to the ED after initially being discharged had a lower in-hospital mortality rate. They also had lower ICU admission rates, lower hospital costs, and longer lengths of stay.  They article attempts to suggest that the idea of readmission as a negative might not tell the whole story.  It may not be as telling about deficits in the quality of care as we previously thought.

The problem that I have with these findings is that the data seems to suggest that patients who are initially admitted to the ED are not receiving a high quality of care.  In both cases, being discharged or returning, something is not going right.  If a patient is leaving the ED, they should be able to rest assure that they were taken care of properly.  They should not worry about having to return when their condition worsens.

One way I believe we could fix this problem is with the use of pharmacists.  In POP we learned about the many mistakes patients make with their medication upon discharge.  Having a pharmacist on staff to explain medications to the patients might help to reduce the number of readmissions.

Sabbatini AK, Kocher KE, Basu A, et al. In-hospital outcomes and costs among patients hospitalized during a return visit to the emergency department. JAMA. 2016;315(7):663-671.