Recently Discharged Inpatients as a Source of Emergency Department Overcrowding

• Published in: Academic emergency medicine 2001-11, Vol.8 (11), p.1091-1094
• Main Authors: Baer, Ryan B., Pasternack, Joel S., Zwemer, Frank L.
• Format: Article
• Language: English
• Subjects: Crowding; emergency department; Emergency Service, Hospital - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; New York; Observation; overcrowding; Patient Admission - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; readmission; Retrospective Studies
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.2001.tb01121.x

Objective: To assess the impact on the emergency department (ED) of recently discharged inpatients and how they contribute to and worsen the current situation of ED overcrowding. Methods: Retrospective, observational study of medical records and billing data of all patients presenting to the ED within seven days of inpatient discharge from the hospital (“returns”) in September 2000. The data were collected from electronic logs. Billing charges were used to estimate ED resources. Medical records were reviewed to classify visits: 1) new problem, 2) related problem, likely preventable, 3) related problem, not likely preventable, 4) unable to classify, or 5) incomplete chart. Results: One‐hundred seventy‐four returns occurred among 6,290 total ED visits (3%). Significant differences between returns and total ED patients were noted for length of stay (LOS) (6.58 vs 5.22 hours, p ? 0.000), percent admitted (47% vs 19%, p ? 0.000), and ED billing ($1,415.67 vs $391.00, p ? 0.000). The highest rate of admission was for patients presenting 48‐72 hours after inpatient discharge (65.4%). Admission rate was higher for patients presenting >48 hours than