Emergency department visits following discharge: Implications for healthcare management

ABSTRACT

Objective: This study aimed to reveal the frequency of emergency department (ED) visits within 7 and 30 days after discharge and to identify the factors affecting these ED visits.

Methods: A total of 1570 patients discharged from the internal medicine wards of a university hospital in Turkey within 1 year were included in this prospective cohort study. Multiple logistic regression analyses were used to identify the factors affecting ED visits.

Results: Of the patients, 1.3% visited the ED within the first 7 days after discharge and 5.2% within 30 days. Multivariable analyses showed that the probability of an ED visit within 30 days was 1.83 (95% CI 1.09–3.08; p = 0.023) times higher for male patients and 2.15 (95% CI 1.00–4.60; p = 0.049) times higher for patients with intensive care unit (ICU) stay before discharge. The probability of an ED visit increased by 1.25 (95% CI 1.11–1.42, p < 0.001) times for every 1-point increase in the comorbidity score. The costs of ED visits within 0–7 days were lower than the costs within 8–30 days (p = 0.001).

Conclusion: Innovative approaches targeting discharge planning and postdischarge care for patients with high comorbidity scores and ICU use during index hospitalization could reduce ED visits within 30 days after discharge.

KEYWORDS:

• Emergency department
• return visit
• risk factors
• post-discharge
• internal medicine

Acknowledgements

The data (except ED visits data) used in this study were obtained from the research project no. 114K404 supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK). The authors thank TÜBİTAK for providing financial support. The authors also thank Ahmet Yıldız, Cahit Korku, İpek Bilgin Demir, Duygu Ürek, Gülsüm Şeyma Koca, Nazan Kartal and Sabri Karahan for collecting data as scholarship students under this TÜBİTAK project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributors: Conception and design: Kaya S; Acquisition of data: Sain Guven G, Teleş M, Aydan S, Kar A, Bahcecioglu AB, Firat Sentürk E; Analysis and interpretation of data: Kaya S, Sain Guven G, Teleş M, Aydan S, Kar A.; Drafting of the manuscript: Kaya S, Sain Guven G, Teleş M, Aydan S, Kar A, Bahcecioglu AB, Firat Sentürk E; Critical revision of the manuscript for important intellectual content: Kaya S; Statistical analysis: Teleş M; Obtaining funding: Kaya S; Administrative, technical, or material support: Sain Guven G; Supervision: Kaya S.

Ethical issues: The study was approved by the Hacettepe University Ethics Commission.

Additional information

Funding

The data (except ED visits data) used in this study were obtained from research project no. 114K404 supported by the Scientific and Technological Research Council of Turkey (Türkiye Bilimsel ve Teknolojik Araştırma Kurumu [TÜBİTAK]). The authors thank TÜBİTAK for providing financial support.

Notes on contributors

Sıdıka Kaya

Sıdıka Kaya, Ph.D. is a professor in the Department of Healthcare Management at Hacettepe University, Ankara, Turkey. She holds an MSc and a PhD in healthcare management. She was a Fulbright Visiting Scholar at Boston University and a research and advanced training fellow at Harvard University. Her research focuses on quality in health care, patient safety, hospital performance, utilization, readmission, workforce issues, and medical tourism.

Gulay Sain Guven

Gulay Sain Guven is a professor at Hacettepe University, Faculty of Medicine. She is a professor in Internal Medicine Department. She holds an MSc. in Epidemiology. She was an observer at Northwestern University, Chicago and visiting professor in a Cleveland Clinic, Cleveland, USA. Her interests are principles of preventive medicine, internal medicine wards utilization, quality in health services.

Mesut Teleş

Mesut Teleş, PhD, is an assistant professor in the Niğde Zübeyde Hanım School of Health, Department of Health Management at Niğde Ömer Halisdemir University, Turkey. He holds a MSc and a PhD in healthcare management. His research focuses on quality in healthcare, patient safety culture, readiness for hospital discharge and statistical analysis.

Seda Aydan

Seda Aydan, Ph.D. is a research assistant in the Department of Healthcare Management at Hacettepe University, Ankara, Turkey. She holds an MSc and a PhD in healthcare management. Her research focuses on health care management, quality in health care, human resources management.

Ahmet Kar

Ahmet Kar, PhD. is an assistant professor in the healthcare management department at Kırıkkale University, Kırıkkale, Turkey. His research interests include health technology assessment and multi-criteria decision-making models of health organizations.

A. Begum Bahcecioglu

A. Begum Bahcecioglu, M.D. is a fellow of Endocrine and Metabolism Disorders at Ankara University Medical School, since 2017. She had the degree of M.D. at Hacettepe University Medical School, between 2006-2012, graduated at the honor list, as the top of the class. After graduation,she did her internal medicine residency at Hacettepe University Medical School, during 2012-2017, and had the specialist degree at internal medicine since 2017. Her main areas of research are the sonographic evaluation of thyroid disorders and the hypopheseal disorders.

Esra Firat Senturk

Esra Firat Senturk, MD, is a research assistant III at CAGE (Center for Autoimmune Genomics and Etiology) in Cincinnati Children Hospital. She had the degree of MD at Hacettepe University Medical School between 2006 and 2012, graduated at the honor list, as the second of the class. After graduation, she did her internal medicine residency at Hacettepe University Medical school, during 2012–2017 and had the specialist degree at internal medicine since 2017. Her main areas of research are rheumatologic diseases.