title: Increased Identification of Emergency Department 72-hour Returns Using Multihospital Health Information Exchange.
abstract: Emergency departments (EDs) commonly analyze cases of patients returning within 72 hours of initial ED discharge as potential opportunities for quality improvement. In this study, we tested the use of a health information exchange (HIE) to improve identification of 72-hour return visits compared to individual hospitals' site-specific data.
  
  
  
  We collected deidentified patient data over a 5-year study period from Healthix, an HIE in the New York metropolitan area. We measured site-specific 72-hour ED returns and compared these data to those obtained from a regional 31-site HIE (Healthix) and to those from a smaller, antecedent 11-site HIE. Although only ED visits were counted as index visits, either ED or inpatient revisits within 72 hours of the index visit were considered as early returns.
  
  
  
  A total of 12,669,657 patient encounters were analyzed across the 31 HIE EDs, including 6,352,829 encounters from the antecedent 11-site HIE. Site-specific 72-hour return visit rates ranged from 1.1% to 15.2% (median = 5.8%) among the individual 31 sites. When the larger HIE was used to identify return visits to any site, individual EDs had a 72-hour return frequency of 1.8% to 15.5% (median = 6.8%). HIE increased the identification ability of 72-hour ED return analyses by a mean of 11.16% (95% confidence interval = 11.10% to 11.22%) compared with site-specific (no HIE) analyses.
  
  
  
  This analysis demonstrates incremental improvements in our ability to identify early ED returns using increasing levels of HIE data aggregation. Although intuitive, this has not been previously described using HIE. ED quality measurement and patient safety efforts may be aided by using HIE in 72-hour return analyses.
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Shy
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Eugene Y
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Genes
authors.affiliation: Healthix, Inc., New York, NY.
authors.forename: Tina
authors.initials: T
authors.lastname: Lowry
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: George T
authors.initials: GT
authors.lastname: Loo
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
authors.affiliation: Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006751:Hospital Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009519:New York City; D010351:Patient Discharge / Q000706:statistics & numerical data*; D061214:Patient Safety; D058996:Quality Improvement