Key result
Increasing emergency medicine resident floor coverage did not significantly reduce the rate of hospital admissions during 48-hour emergency department revisits (41.1% vs 44.5%; OR 0.87).
Why the study?
Early unexpected hospital admission after ED discharge is an important target for preventive measures, but the impact of increasing physician numbers and 24-h emergency physician coverage on 48-h revisits and admissions was unclear.
Does increasing emergency medicine resident floor coverage reduce 48-h emergency department revisits with subsequent hospital admission in adult patients?
Observational (n=523)
No
Does increasing emergency medicine resident floor coverage reduce 48-h emergency department revisits with subsequent hospital admission in adult patients?
Odds Ratio: 0.87 (95% CI 0.61–1.23)
Absolute Event Rate: 41.1% vs 44.5%
Increasing emergency medicine resident coverage alone did not significantly reduce the incidence of hospital admissions during 48-hour ED revisits.
Does not support expanding resident coverage to cut admissions on 48-h ED revisits; leaves open effects of alternative staffing models.
BACKGROUND: Early unexpected hospital admission after emergency department (ED) discharge is an important topic regarding effective preventive measures. Reducing avoidable return visits can improve ED effectiveness and emergency care. This study evaluated the effects of an increase in the number of physicians and the 24-h coverage of emergency physicians on 48-h ED revisits with subsequent hospital admission. The characteristics and risk factors of the patients were also investigated. RESULTS: This was a retrospective analysis performed 2 years before and 2 years after the implementation of an intervention in a tertiary care hospital in Thailand. The medical records of adult patients who revisited the ED within 48 h for related complaints were reviewed. The effect of the intervention was analyzed, and a prediction model was developed based on logistic regression. After implementing the intervention, the hospital admission rate at the second ED visit decreased from 44.5 to 41.1%; no significant difference was found (95% confidence interval (CI) - 5.05 to 11.78). Patients who required hospital admission had a significantly higher comorbidity score, more ED visits, and more hospitalizations within the past 12 months. A significantly higher hospital admission rate was also observed among patients older than 60 years, those who had an initial infectious diagnosis, and those who had a higher triage severity level (ESI II) at their first visit. The odds ratio (OR) showed lower odds of hospital admission at the second visit in the postintervention period; this difference was not significant (OR 0.87; 95% CI 0.61 to 1.23). CONCLUSION: Our intervention did not significantly decrease the incidence of admission at an ED revisit. However, some factors identified in this study seem to have some benefits and might be helpful for preventing errors and constructing a standard discharge care plan for patients with these risk factors.
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Palungwachira et al. (2022) conducted an observational in Emergency department revisits (n=523). Increased emergency medicine resident floor coverage vs. Standard resident coverage (pre-intervention period) was evaluated on Hospital admission rate at the second ED visit (OR 0.87, 95% CI 0.61 to 1.23). Increasing emergency medicine resident floor coverage did not significantly reduce the rate of hospital admissions during 48-hour emergency department revisits (41.1% vs 44.5%; OR 0.87).
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