Normal view MARC view ISBD view

The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.

MedStar author(s):

Citation: Journal of Emergency Medicine. 45(2):281-8, 2013 Aug.PMID: 23352864Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Emergency Service, Hospital/st [Standards] | *Patient Readmission/sn [Statistics & Numerical Data] | *Quality Assurance, Health Care/st [Standards] | Adolescent | Adult | Aged | Emergency Service, Hospital/sn [Statistics & Numerical Data] | Female | Humans | Logistic Models | Male | Middle Aged | Retrospective Studies | Young AdultLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0736-4679

Name of journal: The Journal of emergency medicineAbstract: 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.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.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.OBJECTIVES: We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.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.All authors: Abualenain J, Frohna WJ, Milzman D, Pines JM, Pipkin M, Smith M, Webb CDigital Object Identifier:

http://dx.doi.org/10.1016/j.jemermed.2012.11.012

Date added to catalog: 2014-04-03

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		23352864

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

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.

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.

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.

OBJECTIVES: We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.

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.

English