Postdischarge adverse events for 1-day hospital admissions in older adults admitted from the emergency department.
OBJECTIVE
We assess hospital readmission and death within 60 days in older adults admitted from the emergency department (ED) and discharged by an inpatient service within 24 hours.


METHODS
This was a retrospective review of ED patients aged 64 years or older, admitted from 2 hospitals (2004 to 2006), who were discharged home within 24 hours. Excluded were in-hospital deaths, observation admissions, transfers to other facilities, patients who left against medical advice, and hospice patients. Outcomes were 72-hour and 30-day readmissions and postdischarge deaths that occurred within 60 days of ED admission. Logistic regression was used to assess for predictors of readmission. A chart review of deaths after discharge was performed to assess for potential contributors to adverse outcomes.


RESULTS
A total of 1,470 admissions met inclusion criteria as 1-day admissions. Of those, 22 (1.5%) patients returned for hospital readmission within 72 hours and 156 (10.6%) within 30 days of discharge. In the multivariable analysis, previous admissions (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.1 to 1.4) and an admission diagnosis of heart failure (OR 2.2; 95% CI 1.0 to 5.0) were associated with 30-day readmission. In 841 individual patients with greater than or equal to one 1-day admission, there were 15 deaths (1.8%) within 60 days. Of those, 11 (73%) patients had abnormal ED ECG results, 6 (40%) were ruled out for acute myocardial infarction while hospitalized, and 3 (20%) had definitive follow-up arranged at discharge.


CONCLUSIONS
One-day admissions in hospitalized older adults through the ED do not represent a group at low risk for postdischarge adverse outcomes.
Pines
Jesse M
JM
School of Public Health and Health Services, Department of Emergency Medicine, George Washington University, 2121 K Street NW, Washington, DC 20037, USA. jesse.pines@gmail.com
Mongelluzzo
Jillian
J
Hilton
Joshua A
JA
Hollander
Judd E
JE
Shofer
Frances S
FS
Souder
Jeremy
J
Synnestvedt
Marie
M
Weiner
Mark G
MG
Datner
Elizabeth M
EM
D000368:Aged; D016001:Confidence Intervals; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors