title: Reasons for readmissions: what are the reasons for 90-day readmissions of psychiatric patients from the ED?
abstract: BACKGROUND
  Frequent users of the emergency department (ED) contribute to the problem of overcrowding and are more likely to have psychiatric problems and a higher than average 90-day readmission rate. In addition, ED visits due to mental health problems have increased in recent years, thus driving up 90-day readmission rates.
  
  
  OBJECTIVE
  The objective of the study is to determine the reasons for readmissions of psychiatric patients who have previously presented to the ED.
  
  
  METHODS
  This is a retrospective chart review of a random sample of 350 psychiatric patients who presented to the ED and had a return visit within 90 days. This study was conducted at a 432-bed, urban, level I adult and pediatric trauma center with 50000 ED visits per year. The inclusion criterion was all psychiatric patients who presented to the ED since August 2011 and had a least 1 return visit within 90 days. The exclusion criterion was patients who presented with nonpsychiatric complaints. SPSS version 14 was used, and the study was institutional review board approved.
  
  
  RESULTS
  There was a significant difference (P=.01) between the reasons for psychiatric patients to be readmitted to the hospital between their first, second, and third ED visits. The most common reasons for admission on the first visit were depression, schizophrenia, schizoaffective disorder, bipolar disorder, and psychosis. The most common reasons for the second and third visits, however, were psychiatric (61.9%), musculoskeletal (9.2%), cardiovascular (5.7%), neurologic (4.3%), and dermatological (3.2%).
  
  
  CONCLUSIONS
  Psychiatric patients are not returning to the ED repeatedly for the same complaints or for only psychiatric complaints. A total of 30% of patients who presented for a second and third time within 90 days were admitted for medical illness, as opposed to their initial psychiatric presentation. This indicates that a 2-pronged approach toward treatment might have to be developed-one that focuses on specific types of mental illness and one that focuses on a separate set of physical illnesses-to reduce 90-day readmission rates within this patient population.
authors.affiliation: Health Services/Public Administration, Roosevelt University, Chicago, IL 60605. Electronic address: LDowney@roosevelt.edu.
authors.forename: La Vonne A
authors.initials: LV
authors.lastname: Downey
authors.affiliation: Department of Emergency Medicine, Finch University/Chicago Medical School, 15th and California Mount Sinai Hospital, Chicago, IL 60063. Electronic address: zunl@sinai.org.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Zun
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States