Clinical question: What is the cost and frequency of ED revisits within three days and 30 days?
Background: ED revisits lead to a financial and resource utilization burden on the medical system. The costs and rates of these return visits are unknown and limited in characterization.
Study design: Observational study.
Setting: Six states, using Healthcare Cost and Utilization Project databases.
Synopsis: An observational study examined data from 2006-2010 across six states to determine cost and frequency of ED revisits within a 30-day period from initial ED treatment and discharge. The study examined revisit rates within the first three days of discharge, as well as the 30 days following discharge from the initial presentation.
Three-day revisit rates were 8.2%, with 29% resulting in admission; 32% of the revisits took place at a different institution.
The 30-day revisit rate was 19.9%, with 28% resulting in admission. The most common diagnoses were skin and soft tissue infections (23.9%) and abdominal pain (9.7%). The vast majority of revisits (89%) resulted in the same diagnosis as the first encounter.
Cost of the revisits was more difficult to assess, because only one of six states had full data (Florida); the cost data was extrapolated for the other states involved. In Florida, three-day revisit costs accounted for 30.3% of all primary visit costs. Thirty-day revisit costs were 118% of all primary ED visits costs within that time period.
There was not always an indication of whether the revisit was due to a planned revisit, worsening of symptoms, or inadequate initial treatment, however, leaving the evaluation of cost and revisit burden incomplete.
Bottom line: Initial evaluation of ED revisits shows that rates and cost are significant, though the nature of the revisits remains underevaluated. Preliminary data demonstrate that ED revisits are a significant cost to the healthcare system, though the number of preventable revisits remains unknown.
Citation: Duseja R, Bardach NS, Lin GA, et al. Revisit rates and associated costs after and emergency department encounter. Ann Intern Med. 2015;162(11):750-756.