Ratio of Postdischarge Emergency Department Visits to Readmissions by Diagnosis

BACKGROUND Pediatric readmissions and postdischarge emergency department (ED) visits are common measures of postdischarge use and vary across pediatric conditions. Although often studied separately, these outcomes represent a continuum of hospital reuse. We introduce the ED/READ ratio (the ratio of postdischarge ED visits to readmissions) to characterize diagnosis-specific patterns of hospital reuse across common pediatric conditions. METHODS In this single-center retrospective cohort study, we included children aged 0 to 17 years discharged from an urban tertiary children’s hospital between July 2016 and December 2019. We included primary All-Patient Refined Diagnosis-Related Groups comprising 1% or more of admissions. The primary outcome was the 30-day ED/READ ratio, calculated as the number of all-cause postdischarge ED visits divided by the number of all-cause readmissions within 30 days of discharge, computed for each diagnosis with 95% CIs. RESULTS Among 16 518 hospitalizations from 11 728 patients, the overall 30-day postdischarge ED visit rate was 8.1% and the readmission rate was 9.2%. The 30-day ED/READ ratio ranged from 0.08 (95% CI, 0.05–0.12) for chemotherapy to 2.41 (95% CI, 1.50–3.33) for tonsil and adenoid procedures. Diagnoses with ratios significantly more than 1 included asthma, bronchiolitis and respiratory syncytial virus pneumonia, and gastroenteritis; ratios less than 1 included chemotherapy, sickle cell anemia crisis, and seizures. CONCLUSION The ED/READ ratio is a descriptive metric that complements traditional measures by characterizing diagnosis-specific patterns of postdischarge reuse across care settings. Used alongside existing metrics, the ratio may help generate hypotheses about diagnosis-specific targets for improvement. Further research is needed to evaluate its reproducibility and applications across diverse settings.