title: Emergency department visits after surgery are common for Medicare patients, suggesting opportunities to improve care.
abstract: Considerable attention is being paid to hospital readmission as a marker of poor postdischarge care coordination. However, little is known about another potential marker: emergency department (ED) use. We examined ED visits for Medicare patients within thirty days of discharge for six common inpatient surgeries. We found that these visits were widespread and showed extensive variation across facilities. For example, 17.3 percent of these patients experienced at least one ED visit within the postdischarge period, and 4.4 percent of patients had multiple ED visits. Among those patients who were readmitted, 56.5 percent were readmitted from the ED. There was substantial variation-as much as fourfold-in hospital-level ED use for these patients across all six procedures. The variation might signify a failure in upstream coordination of care and therefore might represent a novel hospital quality indicator. In addition, the postdischarge ED visit is an opportunity to ensure that care is properly coordinated and is the last best chance to avoid preventable readmissions.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Kocher
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000145:classification; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014481:United States
keywords: Cost Of Health Care; Health Reform; Medicare; Organization And Delivery Of Care; Quality Of Care