Patient Returns to the Emergency Department: The Time‐to‐return Curve

• Published in: Academic emergency medicine 2014-08, Vol.21 (8), p.864-871
• Main Authors: Rising, Kristin L., Victor, Timothy W., Hollander, Judd E., Carr, Brendan G., Griffey, Richard T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Discharge; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Florida; Health services utilization; Hospitals; Humans; Male; Middle Aged; Models, Statistical; Nebraska; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patients; Quality of care; Retrospective Studies; Time Factors; Young Adult
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.12442

Objectives Although 72‐hour emergency department (ED) revisits are increasingly used as a hospital metric, there is no known empirical basis for this 72‐hour threshold. The objective of this study was to determine the timing of ED revisits for adult patients within 30 days of ED discharge. Methods This was a retrospective cohort study of all nonfederal ED discharges in Florida and Nebraska from April 1, 2010, to March 31, 2011, using data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP). ED discharges were followed forward to identify ED revisits occurring at any hospital within the same state within 30 days. The cumulative hazard of an ED revisit was plotted. Parametric and nonparametric modeling was performed to characterize the rate of ED revisits. Results There were 4,782,045 ED discharges, with 7.5% (95% confidence interval [CI] = 7.4% to 7.5%) associated with 3‐day revisits, and 22.4% (95% CI = 22.3% to 22.4%) associated with 30‐day revisits, inclusive of the 3‐day revisits. A double‐exponential model fit the data best (p