Why do so many patients come back three days later?

Nearly one-third of revisits take place at an alternate facility

Twenty percent of hospital discharges come back to a hospital ED within 30 days, and many of those patients are readmitted at a different facility, a new study in the Annals of Internal Medicine finds.

For the study, researchers from the University of California-San Francisco culled data from six states—Arizona, California, Florida, Hawaii, Nebraska, and Utah—between 2006 and 2010. The data came from the Healthcare Cost and Utilization Project, a database maintained by the Agency for Healthcare Research and Quality (AHRQ), which included records from the State Emergency Department Databases, State Inpatient Databases, and additional files between the two.

AHRQ: The conditions that cause the most readmissions

In all, researchers examined nearly 54 million independent three-day windows of time to analyze revisits, Sarah Wickline Wallan writes at MedPage Today.

One-fifth of all patients return to EDs days after discharge

The researchers concluded that:

  • About 20% of patients returned to an ED within 30 days of being discharged, and 28% of those return visits were at an alternate facility.
  • Nearly 8.3% of patients revisited a hospital within three days. Twenty-nine percent of those individuals were readmitted, and 32% of those visits took place at a different location than the initial visit.
  • Patients between ages 18 and 44 were more likely to revisit an ED—with a revisit rate of 8.2%—than patients 65 and older (7.8%), but patients in the oldest age group were more likely to be admitted after a revisit. In addition, patients between ages 18 and 44 were also more likely to revisit an ED at a different institution than their older counterparts.

A patient's insurance status also affected the rate at which he or she revisited the hospital, the study found. For instance, Medicaid patients had an about 10% revisit rate, compared to a 6.3% rate for patients with private insurance.

The researchers found skin infections and abdominal pain to be the most common revisit diagnoses and 89% of revisits had the same primary diagnosis as the initial ED visit, according to the study.

Study limitations could play a role in results

In an editorial accompanying the study, researchers Kuman Dharmarajan and Harlan Krumholz of the Yale School of Medicine suggest the reason patients seek follow-up care at a new hospital is that they are "dissatisfied with their initial encounter or are exercising greater discretion in their choice of facility."

Should hospitals keep patients longer? It may reduce readmissions, study finds

Surprisingly, they also noted that typical illness indications, such as being in the ICU during a hospital stay, disjointed nursing care, and clinical instability at the time of discharge were not associated with readmission rates.

However, the two acknowledge that a limited scope of data may have had an impact on the study results—as three states were unable to provide data for one to three years of the study period. The study authors also note study limitations, including the inability to track revisits across state lines and some discrepancies in linking files (Wallan, MedPage Today, 6/1).

We can help you reduce readmissions

Check out two key resources to help your hospital cut readmissions:

Reducing Preventable Readmissions. This popular study outlines best practices for elevating transitions and disease management to prefect care across the continuum.

Nurse-Led Strategies for Preventing Avoidable Readmissions. Get 14 best practices for preventing avoidable readmissions by leveraging the inpatient stay to equip patients for long-term self-management and facilitating seamless transfers to post-acute care settings.

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