title: Recently discharged inpatients as a source of emergency department overcrowding.
abstract: OBJECTIVE
  To assess the impact on the emergency department (ED) of recently discharged inpatients and how they contribute to and worsen the current situation of ED overcrowding.
  
  
  METHODS
  Retrospective, observational study of medical records and billing data of all patients presenting to the ED within seven days of inpatient discharge from the hospital ("returns") in September 2000. The data were collected from electronic logs. Billing charges were used to estimate ED resources. Medical records were reviewed to classify visits: 1) new problem, 2) related problem, likely preventable, 3) related problem, not likely preventable, 4) unable to classify, or 5) incomplete chart.
  
  
  RESULTS
  One-hundred seventy-four returns occurred among 6,290 total ED visits (3%). Significant differences between returns and total ED patients were noted for length of stay (LOS) (6.58 vs 5.22 hours, p = 0.000), percent admitted (47% vs 19%, p = 0.000), and ED billing (1,415.67 dollars vs 391.00 dollars, p = 0.000). The highest rate of admission was for patients presenting 48-72 hours after inpatient discharge (65.4%). Admission rate was higher for patients presenting >48 hours than <48 hours (54% vs 33%, p = 0.01). A review of the medical records (117/174) revealed: 15 new problems (13%); 16 related, likely preventable (14%); 72 related, not likely preventable (62%); 4 unable to assess (2%); and 10 incomplete charts (9%).
  
  
  CONCLUSIONS
  The ED is appropriately utilized as a safety net for discharged inpatients. Though "returns" are a small percentage of ED patients, they have longer LOSs, have higher ED charges, and are more frequently admitted. Returns increase the strain on an already overcrowded ED.
authors.affiliation: Department of Emergency Medicine, University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Baer
authors.forename: J S
authors.initials: JS
authors.lastname: Pasternack
authors.forename: F L
authors.initials: FL
authors.lastname: Zwemer
mesh_terms: D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009518:New York; D019370:Observation; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies