Geriatrics
Abstracts
Lauren Southerland, MD
The Ohio State University
Background: Hospitals with excessive 30-day (30D) readmissions face financial penalties. Patients who present to the emergency department (ED) within 30D of hospital discharge may present an opportunity to reduce this risk. We define a sentinel ED visit as an ED visit and discharge that occurs between hospital discharge and readmission. Our goal is to identify risk factors for sentinel ED visits associated with subsequent 30D readmission in geriatric patients.
Methods: We conducted a retrospective cohort study using Medicare claims data from patients age ≥65 who visited the ED at Mount Sinai Medical Center (MSMC) between 2013-2015. Hospital discharge dates, readmission dates, and inpatient data from hospitals throughout the United States were obtained from Medicare claims data from 2010-2015. ED visit dates, ED discharge disposition, and clinical administrative data at MSMC were obtained from the Mount Sinai Data Warehouse. Risk factors for sentinel ED visits that precede 30D readmission were compared with risk factors for sentinel ED visits without subsequent readmission using chi-square goodness of fit test.
Results: There were 4,405 sentinel ED visits at MSMC within 30-days of hospital discharge between 2010-2015. 36.52% of ED visits within 30D of hospital discharge were sentinel ED visits. 20.68% of sentinel ED visits had subsequent 30D readmission. Risk factors for subsequent readmission after sentinel ED visit included cirrhosis (RR 95% CI 1.09-1.39, P<0.01), Charlson Comorbidity Index >2 (RR 95% CI 1.03-1.10, P<0.01), and ED arrival by ambulance (RR 95% CI 1.03-1.09, P<0.01). Factors associated with decreased risk for readmission include age ≥75 (RR 95% CI 0.93-0.99, P<0.01), patient seen during dayshift (9a-9p) (RR 95% CI 0.92-0.99, P=0.01), prior inpatient stay at the same hospital as the ED visit (RR 95% CI 0.94-0.99, P=0.02), and principal diagnosis of pneumonia during the previous hospitalization (RR 95% CI 0.83-0.97, P=0.03).
Conclusion: Approximately a fifth of ED visits at MSMC with discharge occurring within 30D of a previous hospitalization result in a 30D readmission. Risk factors for 30-day readmission following a sentinel ED visit include liver disease and mode of transport to the ED. Identifying risk factors for geriatric patients in the ED who are more likely to be rehospitalized may be an opportunity to provide additional resources and prevent readmission.