Unravelling the drivers of repeat hospital visits: Insights from internal medicine emergency department discharges and short-stay admissions

Introduction: Hospital readmissions are an important indicator of health care quality, but the rate and causes of hospital revisits among short-stay internal medicine (IM) patients has been understudied. In this study, we aimed to identify predictors of hospital revisits in two cohorts of patients: those seen by IM and discharged home without admission (DHWA) and those with IM admissions of less than 24 hours. Methods: We conducted a two-phase retrospective study of patients DHWA and with short IM admissions between 2017 and 2022. The outcomes of interest were the rate and predictors of a hospital revisit within 14 days of discharge. The associations of revisits with demographics, comorbidity, and other health care-related variables were analyzed and rational subgrouping was used to identify drivers of revisits among a purposely sampled subgroup of patients with a 14-day revisit. Results: A total of 2,874 hospitalizations were analyzed and 135 chart reviews conducted. The hospital revisit rate was lower in the short-admission group (18.2% versus 26.4%, P <.001). Applying rational subgrouping, we grouped patients by symptom progression, along with frailty and residence status. Patients living with dementia re-presented with stable symptoms, and patients with inadequate follow-up often had frailty indicators and/or heart failure and respiratory diseases. Discussion: This study demonstrates how a classical approach to risk factor analysis failed to lead to actionable root causes of hospital revisits in medically complex IM patients. Applying rational subgrouping helped understand deeper drivers of revisits, findings which can empower internists to make more informed discharge decisions and support the design of future quality improvement strategies.