Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children |
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| Authors: | Marion R Sills MD MPH Michelle L Macy MD MS Keith E Kocher MD MPH Amber K Sabbatini MD MPH |
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| Affiliation: | 1. Departments of Pediatrics and Emergency Medicine and the Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, and Children's Hospital Colorado (MRS), Aurora, CO;2. Department of Pediatrics, University of Michigan, Ann Arbor, MI;3. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI;4. Child Health Evaluation and Research, University of Michigan, Ann Arbor, MI;5. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI;6. Division of Emergency Medicine, University of Washington, Harborview Medical Center, Seattle, WA |
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| Abstract: | Objective The objective was to test the hypothesis that in‐hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index ED visit. Methods This was a retrospective analysis of ED visits by children age 0 to 17 to hospitals in Florida and New York in 2013. Children hospitalized during an ED return visit within 7 days were classified as “ED return admissions” (discharged at ED index visit and admitted at return visit) or “readmissions” (admission at both ED index and return visits). In‐hospital outcomes for ED return admissions and readmissions were compared to “index admissions without return admission” (admitted at ED index visit without 7‐day return visit admission). Results Among 1,886,053 index ED visits to 321 hospitals, 75,437 were index admissions without return admission, 7,561 were ED return admissions, and 1,333 were readmissions. ED return admissions had lower intensive care unit admission rates (11.0% vs. 13.6%; adjusted odds ratio = 0.78; 95% confidence interval CI] = 0.71 to 0.85), longer length of stay (3.51 days vs. 3.38 days; difference = 0.13 days; incidence rate ratio = 1.04; 95% CI = 1.02 to 1.07), but no difference in mean hospital costs (($7,138 vs. $7,331; difference = –$193; 95% CI = –$479 to $93) compared to index admissions without return admission. Conclusions Compared with children who experienced index admissions without return admission, children who are initially discharged from the ED who then have a return visit admission had lower severity and similar cost, suggesting that ED return visit admissions do not involve worse outcomes than do index admissions. |
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