Background: The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for excessive 30-day readmissions. As more patients visit the emergency department (ED) each year, the ED may play an increasingly important role in preventing readmissions. We define a sentinel ED visit as an ED visit and discharge that occurs between a hospital discharge and subsequent readmission. Our objective is to investigate trends in the incidence of sentinel ED visits among geriatric patients.
Methods: We conducted a retrospective cohort study of Medicare claims data for patients age ≥65 who had an ED visit at Mount Sinai Medical Center, Northwestern Memorial Hospital, or St. Joseph’s Regional Medical Center between 2013-2015. All hospital admission discharge dates, ED visit dates, and readmission dates from hospitals throughout the United States were obtained for these patients from 2006-2015. Thirty-day (30D) readmissions were defined as readmissions at any hospital within 30 days of a previous hospital admission discharge. We evaluated sentinel ED visits within the 30D or 180D readmission window. The ratio of total sentinel ED visits to total 30D readmissions was calculated for each year between 2006-2015, and annual changes were analyzed using a generalized linear model with a variance-stabilizing logit transformation.
Results: Over the 10-year period, there were a total of 1,915,631 hospital admissions for 414,137 Medicare patients, and 3,054,971 ED visits for 483,350 Medicare patients. Of these, there were 406,631 30D readmissions from 224,144 patients, and 63,277 30D sentinel ED visits from 28,874 patients. The ratio of sentinel ED visits to 30D readmissions has a positive linear association with time between 2006-2015 (R2=0.91, P<0.01). The ratio of sentinel ED visits to hospital readmissions ranged from 0.13-0.18 for 30D readmissions. Similar trends were seen in the ratio of patients with sentinel ED visits to patients with 30D readmissions (R2=0.89, P<0.01).
Conclusion: Patients discharged from the hospital increasingly have an ED visit and discharge prior to being readmitted to the hospital. These ED visits may be sentinel markers for patients at risk for readmission and an opportunity to direct additional resources and intervention to prevent hospital readmissions.