There is significant variation in the rate of emergency department visits within 30 days of hospital discharge for six common inpatient surgeries, according to a study in Health Affairs.
Researchers examined CMS' Outpatient and Carrier Standard Analytical Files and Medicare Provider Analysis and Review Files for 2005 to 2007, which included data on more than 2.3 million patients at 4,536 hospitals. The study focused on Medicare patients undergoing one of six major inpatient procedures: percutaneous coronary intervention, coronary artery bypass grafting, elective abdominal aortic aneurysm repair, back surgery, hip fracture repair and colectomy.
Overall, 17.3 percent of these patients had at least one ED visit 30 days after discharge, and 4.4 percent had multiple ED visits. Of the 14.4 percent of patients who were readmitted, 56.5 percent were readmitted from the ED.
The overall ED visit rate nearly doubled across hospitals, ranging from 13.7 percent in the best-performing quintile of hospitals to 21.1 percent in the worst-performing quintile, according to the study. ED visits after colectomy had the most variability, ranging from 7.1 percent in the top quintile to 24.1 percent in the bottom quintile.
The authors suggested that the ED visit rate after hospitalization could reflect "a failure in upstream coordination of care and therefore represent a novel hospital quality indicator."
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