Emergency rooms can affect hospital readmission rates, a massive EHR study shows

A study that analyzed the electronic health records of nearly 2 million Medicare benefit recipients found that some hospitals are better than others in preventing post-operative readmission from the emergency room.

The study, published in the Journal of Surgical Research, wanted to investigate whether hospitals with high readmission rates also have high rates of emergency admissions after discharge.

“Emergency departments are an important factor in preventing readmission,” said lead author Dr. Sharmistha Dev, researcher at the Regenstrief Institute. “The coordination of care should include the emergency department.”

WHY IT IS IMPORTANT

As the authors note, reducing readmission is a common priority for health care policy makers and leaders.

For example, the Centers for Medicare and Medicaid Services Hospital Admission Program reduces payments to hospitals for excess 30-day unplanned admissions after certain conditions, including coronary artery bypass surgery and knee arthroplasty.

For the JSR study, researchers from the Regenstrief Institute, the US Department of Veterans Affairs, Indiana University, and the University of Michigan performed an analysis of 1,947,621 patients who underwent one of five common surgical procedures in 2,894 hospitals between 2008 and 2011 subjected.

Procedures included percutaneous coronary intervention, colectomy, hip replacement, coronary artery bypass graft, and aortic valve repair or replacement.

The team then compared the emergency room rate after discharge, the proportion of patients re-admitted from the emergency room, and re-admissions within seven days of being discharged from the emergency room.

Although the risk-standardized readmission rates varied widely between hospitals 30 days after discharge, the post-operative emergency room rates were quite similar.

However, the proportion of patients readmitted from the emergency department was almost three times higher in hospitals with very high readmission rates than in those with low readmission rates.

At the same time, hospitals with a small percentage of re-admitted patients from the emergency room did not show an increased re-admission rate within seven days of discharge from the emergency room. This suggests that some emergency departments and their affiliated providers may offer treatment that prevents re-admission without an increased short-term risk of re-admission after discharge.

“Our immediate next steps are to delve deep into the practices of the best and worst performing hospitals and emergency rooms,” Dev said in a statement.

“Is there increased communication between the emergency room and the surgeons? Are there any outpatient care plans? ”She asked.

“Understanding these factors will help guide future interventions such as mobile health or telemedicine,” she added.

THE BIGGER TREND

Many health organizations have relied on digital tools to reduce short-term hospital admissions and improve outcomes.

For example, a 2017 study found that using health information exchanges shortened patient stays in both the emergency room and the inpatient department.

And in 2018, a case manager at Legacy Salmon Creek Medical Center in Vancouver, Washington, created a new program that reduced readmission rates from all causes by nearly 25%.

ON THE RECORD

“The reduction in 30-day readmission calls for greater attention to coordination of care in the emergency room,” observed researchers in the JSR study.

Kat Jercich is the Editor-in-Chief of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.