Conference Coverage

Return ED Visits by Sickle Cell Patients Common



SAN DIEGO – More than 40% of patients with sickle cell disease return for acute care within 14 days following an emergency department treat-and-release visit, with young adults and those with public insurance having the highest rates of return.

Those are key findings from a large analysis of data from the 2005 and 2006 State Emergency Department Databases and State Inpatient Databases managed by the Healthcare Cost and Utilization Project, a federal, state, and industry partnership sponsored by the Agency for Healthcare Research and Quality.

Dr. David C. Brousseau

"Patients with sickle cell disease who are discharged from the hospital have higher rates of rehospitalization than [patients with] almost any other chronic disease," lead study author Dr. David C. Brousseau said at the annual meeting of the American Society of Hematology. "Because of the high rate of rehospitalizations, many hospitals have been developing programs to decrease rehospitalization rates for sickle cell disease. This effort is primarily driven by two factors: the recent federal emphasis on rehospitalizations, and a desire to improve care, with the belief that rehospitalizations represent a deficiency in care quality, or at least an opportunity to improve care."

Previous studies have shown that about half of ED visits made by patients with sickle cell disease result in inpatient hospitalization, he continued, "yet little emphasis has been placed on what happens after an ED treat-and-release visit."

Dr. Brousseau and his associates conducted a retrospective cohort study of all sickle cell disease–related ED visits and hospitalizations during 2005 and 2006 in the states of Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee. "One-third of patients with sickle cell disease in the United States reside in these eight states," said Dr. Brousseau, of the pediatrics department at the Medical College of Wisconsin and an emergency medicine specialist at Children’s Hospital of Wisconsin, Milwaukee.

The researchers hypothesized that patients with sickle cell disease who were treated and released from an ED would have high rates of 14-day return visits to both the ED and an inpatient unit. A 14-day window was chosen "to more accurately reflect a time period ... where a revisit would not be due to a new crisis," he said.

During the 2-year study period, 12,109 people with sickle cell disease made 39,775 index ED visits. The 14-day return visit rate was 42.1%, "meaning that 42.1% of all ED treat-and-release visits were followed within 14 days by a return visit to either the ED or the inpatient unit," Dr. Brousseau said. A higher proportion of the return visits were to the ED than to the inpatient unit (25.4% vs. 16.7%, respectively).

Analysis of data by patient age and insurance provider revealed that the highest proportion of return visits within 14 days was made by patients aged 18-30 years (49%) and by those who carried public insurance (46.5%).

The 7-day return rate was 31.6%. Of these, 18.6% were to the ED and 13% were to the inpatient unit.

The 14-day revisit rate to the same hospital was 31.2%. Children were more likely than adults to make return visits to the same hospital (84.3% vs. 72.7%, respectively).

"We conclude that an ED treat-and-release visit should serve as a trigger to focus enhanced outpatient care to prevent subsequent inpatient visits and to improve patient care," Dr. Brousseau said.

Dr. Brousseau said he had no relevant financial disclosures.

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