December 1, 2022Open Access

Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Emergency department revisits (n=523). Intervention: Increased emergency medicine resident floor coverage vs. Standard resident coverage (pre-intervention period). Primary outcome: Hospital admission rate at the second ED visit (OR 0.87, 95% CI 0.61 to 1.23).

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).

Study Design

Type

Observational (n=523)

Multicenter

Structured PICO

Does increasing emergency medicine resident floor coverage reduce 48-h emergency department revisits with subsequent hospital admission in adult patients?

Population

523 adult patients who had an unscheduled emergency department revisit within 48 hours of initial discharge at a tertiary care hospital in Thailand.

Intervention

Increased emergency medicine resident coverage (3 residents during morning/evening shifts, 2 residents during night shift for full 24-hour coverage).

Comparator

Preintervention period with standard emergency medicine resident coverage (2 residents during morning/evening shifts, 1 resident with partial coverage during night shift).

Outcome

Incidence of 48-hour unscheduled ED revisits with subsequent hospital admission.

Increasing emergency medicine resident coverage alone did not significantly reduce the incidence of hospital admissions during 48-hour ED revisits.

Main Result

Odds Ratio: 0.87 (95% CI 0.61–1.23)

Absolute Event Rate: 41.1% vs 44.5%

Limitations

Retrospective study carried out in a single tertiary hospital, limiting generalizability
Did not enroll patients who may have revisited other hospitals, were admitted more than 2 days after ED discharge, or died before the return visit
Potential for insufficient data due to retrospective chart review

Abstract

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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Cite This Study

Palungwachira et al. (Thu,) conducted a 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).

synapsesocial.com/papers/6a202d430a65adb0c2d8d2f0 https://doi.org/https://doi.org/10.1186/s12245-022-00471-z

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