MedStar Authors catalog › Details for: The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.
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The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.

by Frohna, William J; Smith, Mark; Milzman, David.
Citation: Journal of Emergency Medicine. 45(2):281-8, 2013 Aug..Journal: The Journal of emergency medicine.ISSN: 0736-4679.Full author list: Abualenain J; Frohna WJ; Smith M; Pipkin M; Webb C; Milzman D; Pines JM.UI/PMID: 23352864.Subject(s): Adolescent | Adult | Aged | *Emergency Service, Hospital/st [Standards] | Emergency Service, Hospital/sn [Statistics & Numerical Data] | Female | Humans | Logistic Models | Male | Middle Aged | *Patient Readmission/sn [Statistics & Numerical Data] | *Quality Assurance, Health Care/st [Standards] | Retrospective Studies | Young AdultInstitution(s): MedStar Washington Hospital CenterDepartment(s): Emergency MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: J Emerg Med. 45(2):281-8, 2013 Aug.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues.Abstract: OBJECTIVES: We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.Abstract: METHODS: Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed. Any substandard quality on the first visit or change in outcome on the return admission was considered "low quality." Multivariate logistic regression was used to assess the relationship between cases judged as low quality vs. not low quality.Abstract: RESULTS: Of 741,132 ED visits across 5 years, 3682 (0.5%) were 72-h return admissions. Of those, 192 (5%) were low quality. In 158 (4%) and 8 (0.2%) there were moderate and severe deviations from care standards, respectively. Similarly, in 53 (1%) and 14 (0.4%) there were moderate and severe changes in outcome. In adjusted analysis, there were higher rates of low-quality 72-h return admissions in ambulance arrivals (odds ratio [OR] 1.5, 95% confidence interval (CI) 1.1-2.1); and lower rates in Medicaid patients (OR 0.3, 95% CI 0.2-0.7). There were higher rates in low-quality 72-h return admissions in hospital 1 (OR 3.6, 95% CI 2.2-6.1) and hospital 3 (OR 3.2, 95% CI 2.0-4.7) compared to hospital 2.Abstract: CONCLUSIONS: Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality. Copyright 2013 Elsevier Inc. All rights reserved.

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