Abstract
Background: Emergency department (ED) visits following inpatient discharge can indicate patient instability and inadequate follow-up, increasing costs, crowding, and adverse outcomes. This study aimed to identify the individual characteristics of patients associated with repeated returns to the emergency department within 30 days of inpatient discharge.
Approach: We conducted a retrospective study (2018-2021) at three Portuguese hospitals to identify factors predicting repeated ED visits within 30 days post-discharge. The study included adult individuals (≥18 years) that returned to the ED at least once in that period. Using inpatient and ED records, we analysed patient demographics, clinical characteristics, hospital utilization, and year through logistic regression (one or multiple visits). Analysis was conducted overall and per type of treatment (surgical or medical).
Results: Our study included 36,836 hospitalisations, of which 21,303 with medical treatment. We observed that, for 25.1% of hospitalisations, patients returned more than once to the ED. This percentage was higher in the medical group (27.0%; surgical: 22.0%). The median time until the first return was 9 days (medical: 10, surgical: 8). Younger and older age, hospitalisations in 2018-2019, and comorbidities like congestive heart failure and dementia showed higher odds of repeated ED visits. The probability of multiple returns decreased over the years, with 2021 having the lowest rates. Femur fracture and cholelithiasis were associated with fewer repeated returns. Gender, diabetes, and prior hospitalisation variables were not significant.
Implications: Our results emphasize the influence of age, the year of hospitalisation, and specific comorbidities on the probability of multiple ED visits. Our findings may reflect the changes experienced during the COVID-19 pandemic. They highlight the need for personalised discharge planning and follow-up, especially for patients with higher risk comorbidities, to reduce preventable ED revisits. These changes may contribute to a better management of patients’ needs, leading to improved outcomes.
Keywords: Emergency room visits, Transitional care, Patient readmission