Department of Emergency Medicine, Indiana University, Indianapolis, Indiana; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana; Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
Department of Surgery, Indiana University, Indianapolis, Indiana; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana; Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana.
J Surg Res. 2021 Sep;265:187-194. doi: 10.1016/j.jss.2021.02.052. Epub 2021 May 1.
Reliable strategies for reducing postoperative readmissions remain elusive. As the emergency department (ED) is a frequent source of post-operative admissions, we investigated whether hospitals with high readmission rates also have high rates of post-discharge ED visits and high rates of readmission once an ED visit occurs.
We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing 1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. We stratified hospitals into quintiles based on risk-standardized, 30-day post-discharge readmission rates (RSRR) and then compared rates of post-discharge ED visits, proportion readmitted from the ED, and readmissions within 7 days of ED discharge across these quintiles.
RSRR varied widely across extremes of hospital quintiles (3.9% to 17.5%). Hospitals with either very low or very high RSRR had modest differences in rates of ED visits (12.4% versus 14.6%). In contrast, the proportion readmitted from the ED was nearly 3 times greater in Hospitals with very high RSRR compared with those with very low RSRR (12% versus 32.2%). These findings were consistent across all procedures. Importantly, hospitals with a low proportion readmitted from the ED did not exhibit an increased rate of readmission within 7 days of ED discharge.
Although hospitals experience similar rates of ED visits following major surgery, some EDs and their affiliated surgeons and health system may deliver care preventing readmissions without an increased short-term risk of readmission following ED discharge. Reducing 30-day readmissions requires greater attention to the coordination of care delivered in the ED.
可靠的降低术后再入院率的策略仍难以捉摸。由于急诊科（ED）是术后入院的常见来源，我们调查了高再入院率的医院是否也有高出院后 ED 就诊率和 ED 就诊后再次入院率。
我们对 2008 年至 2011 年间在 2894 家医院接受 5 种常见手术之一的 1947621 名 Medicare 受益人的回顾性分析。我们根据风险标准化的 30 天出院后再入院率（RSRR）将医院分为五组，然后比较这些组出院后 ED 就诊率、从 ED 再入院的比例和 ED 出院后 7 天内的再入院率。
医院五组的 RSRR 差异很大（3.9%至 17.5%）。RSRR 非常低或非常高的医院在 ED 就诊率方面差异不大（12.4%与 14.6%）。相比之下，RSRR 非常高的医院从 ED 再入院的比例几乎是 RSRR 非常低的医院的 3 倍（12%与 32.2%）。这些发现适用于所有手术。重要的是，从 ED 出院后再入院比例低的医院并没有表现出 ED 出院后 7 天内再入院率增加。
尽管医院在大手术后经历了类似的 ED 就诊率，但一些 ED 及其附属医生和医疗系统可能在提供护理方面做得更好，从而降低了 ED 出院后的短期再入院风险，而无需增加再入院率。降低 30 天再入院率需要更加关注 ED 提供的护理的协调。
