ED visits common after surgery, especially for PCI, CABG

In a study of more than 2.3 million Medicare patients who underwent surgery, researchers found that 17.3 percent of these patients visited an emergency department (ED) within 30 days of discharge. Patients who underwent PCI and CABG had the highest rates of post-discharge ED visits compared with patients who had other procedures (17.9 percent and 22.4 percent respectively).

“Because readmissions signal an opportunity to improve care and reduce costs related to post-hospitalization transitions, they have become a hospital quality indicator and policy focus,” wrote the authors, led by Keith E. Kocher, MD, MPH, of the University of Michigan Health System in Ann Arbor, in the September issue of Health Affairs. “However, less attention has been paid to events that occur in the immediate postdischarge period that may be markers for poor care coordination.” They considered ED visits one of those markers.

They used Medicare data from 2005 through 2007 from 2,382,514 patients who underwent 2,456,021 procedures at 4,536 hospitals to analyze 30-day readmission and ED use rates for all procedures. They then broke the numbers down by procedure.

They found that 17.3 percent of patients visited an ED within the post-discharge period and almost half were readmitted. Of the 17.9 percent of patients who visited an ED post-PCI, 4.7 percent sought emergency care multiple times and 46.9 percent were ultimately readmitted. Of the 22.4 percent of post-CABG patients who used an ED, 6.1 percent visited an ED several times and 39 percent were readmitted.

PCI and CABG patients most often visited the ED because of cardiovascular or respiratory issues. They also often went to the ED because of infections, abdominal or gastrointestinal complaints and complications related to the procedures.

Their findings, the authors concluded, suggest the ED visits need to be integrated into the delivery of care.

“Given the frequency of ED use after an acute hospitalization, incorporating this venue of care into the strategic planning for evolving integrated delivery systems could reduce the need for readmissions and reduce costs,” the authors wrote.