Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children

Abstract

Objective

To test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index ED visit.

Methods

Retrospective analysis of ED visits by children age 0-17 to hospitals in Florida and New York in 2013. Children hospitalized during an ED return visit within 7 days were classified as “ED return admissions” (discharged at ED index visit and admitted at return visit) or “readmissions” (admission at both ED index and return visits). In-hospital outcomes for ED return admissions and readmissions were compared to “index admissions without return admission” (admitted at ED index visit without 7-day return visit admission).

Results

Among 1,886,053 index ED visits to 321 hospitals, 75,437 were index admissions without return admission, 7,561 were ED return admissions and 1,333 were readmissions. ED return admissions had lower intensive care unit (ICU) admission rates (11.0% versus 13.6%; adjusted odds ratio (AOR) 0.78, 95% confidence interval (CI) 0.71-0.85), longer length of stay (LOS, 3.51 vs. 3.38 days; difference 0.13 days; incidence rate ratio (IRR) 1.04; 95% CI 1.02-1.07), but no difference in mean hospital costs (($7138 vs. $7331; difference -$193; 95% CI -$479 to 93) compared to index admissions without return admission.

Conclusions

Compared with children who experienced index admissions without return admission, children who are initially discharged from the ED who then have a return visit admission had lower severity and similar cost, suggesting that ED return visit admissions do not involve worse outcomes than do index admissions.

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