Evaluating Costs of Emergency Department Visits for Tracheotomy Patients from Long Term Acute Care Facilities

BACKGROUND: Transfers of adult patients to the Emergency Department (ED) from long-term acute care hospitals (LTACH) and skilled nursing facilities (SNF) for tracheotomy-related problems are common. The goal of this study is to determine the frequency, cost, and avoidability of these visits. METHODS: After obtaining IRB approval, researchers performed a retrospective chart review to identify patients who presented to the ED from LTACHs or SNFs with tracheotomy-related complaints between August 2015 and August 2022. The reason for transfer, laboratory tests, imaging, consultations obtained, procedures performed, and length of stay were all recorded. Costs were obtained from the hospital's posted charge sheet to determine the overall cost of each visit. Avoidability of the ED visit was then determined using the validated NYU Wagner avoidable visit algorithm. RESULTS: Of 396 visits reviewed for eligibility, 93 met inclusion criteria. The most common reasons for ED visits were tracheotomy tube dislodgement (37.6%), bloody tracheal secretions (23.6%), increased respiratory distress/requirement (9.6%), inability to pass suction (8.6%), crusting, lack of supplies, or routine exchange (5.4%), and increased tracheotomy secretions (1%). Sixty-one (65.5%) patients were transferred from a SNF, whereas 32 (34.4%) were referred from an LTACH. Thirty-six patient visits (38.7%) were deemed avoidable, with one-third of these patients arriving from a single skilled nursing facility. The mean total cost for an avoidable patient visit was $3128 (range $1541-$5485). DISCUSSION: Transfers to the ED from LTACH and SNF facilities are common and costly. Many of these visits may be avoidable by promoting focused educational partnerships.