Frequency and patient attributes associated with emergency department visits after discharge: Retrospective cohort study

Abstract

Background The utilization of emergency department (ED) during the post-discharge period may provide relevant insights to reduce fragmentation of care, particularly in a context of general intense use. We aimed to describe frequency and patient attributes associated with emergency department (ED) visits within 30 days of inpatient discharge in a Portuguese health region–Algarve. Methods Secondary data on inpatient and emergency care, for adult patients discharged in 2016. To analyse the association between outcome–ED visit within 30 days of discharge–and selected variables (admission type and groups of or individual illnesses/conditions), we used age- and sex-adjusted odds ratios (aOR). We included all adult patients (aged ≥18 years) discharged during 2016 from the region’s public hospital inpatient departments. The period for ED visits also included January 2017. Results For 21,744 adults discharged in 2016 (mean age: 58 years; 60% female), 23 percent visited ED at least once within 30 days of discharge. Seventy-five percent of those visits were triaged with high clinical priority. Patients with more comorbidities or specific groups of illnesses/conditions had a significant increased risk of returning ED (aOR and 95% confidence intervals–endocrine: 1.566; 1.256–1.951; mental illness: 1.421; 1.180–1.713; respiratory: 1.308; 1.136–1.505). Conclusion Patients returned ED after inpatient discharge frequently and for severe reasons. Patients with more comorbidities or specific groups of illnesses/conditions (endocrine, mental illness or respiratory) had an increased risk of returning ED, so these groups may be prioritized in further research and health system initiatives to improve care before and after discharge.