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Thirty-day hospital readmissions among mechanically ventilated emergency department patients
  1. David B Page1,
  2. Anne M Drewry2,
  3. Enyo Ablordeppey3,
  4. Nicholas M Mohr4,
  5. Marin H Kollef1,
  6. Brian M Fuller3
  1. 1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2 Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri, USA
  3. 3 Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri, USA
  4. 4 Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr David B Page, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO 63110, USA; davidbrianpage{at}gmail.com

Abstract

Background Unplanned 30-day readmissions have a negative impact on patients and healthcare systems. Mechanically ventilated ED patients are at high risk for complications, but factors associated with readmission are unknown.

Objective (1) Determine the rate of 30-day hospital readmission for ED patients receiving mechanical ventilation. (2) Identify associations between ED-based risk factors and readmission.

Design Retrospective cohort study.

Setting Tertiary-care, academic medical centre.

Patients Adult ED patients receiving mechanical ventilation.

Measurements Baseline demographics, comorbid conditions, illness severity and treatment variables were collected, as were clinical outcomes occurring during the index hospitalisation. The primary outcome was 30-day hospital readmission rate. Multivariable logistic regression was used to evaluate factors associated with the primary outcome.

Results A total of 1262 patients were studied. The primary outcome occurred in 287 (22.7%) patients. There was no association between care in the ED and readmission. During the index hospitalisation, readmitted patients had shorter ventilator, hospital and intensive care unit duration (P<0.05 for all). The primary outcome was associated with African-American race (adjusted OR 1.34 (95% CI 1.02 to 1.78)), chronic obstructive pulmonary disease (adjusted OR 1.52 (95% CI 1.12 to 2.06)), diabetes mellitus (adjusted OR 1.34 (95% CI 1.02 to 1.78)) and higher illness severity (adjusted OR 1.03 (95% CI 1.01 to 1.05)).

Conclusions Almost one in four mechanically ventilated ED patients are readmitted within 30 days, and readmission is associated with patient-level and institutional-level factors. Strategies must be developed to identify, treat and coordinate care for the most at-risk patients.

  • Readmission
  • Mechanical Ventilation
  • Emergency Department

https://doi.org/10.1136/emermed-2017-206651

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    Footnotes

    • Contributors DBP, BMF: conception and study design, acquisition of data, analysis and interpretation of data, drafting and revising the manuscript. MHK: conception and study design, interpretation of data, revising the manuscript. AMD, EA, NMM: acquisition of data, analysis and interpretation of data, revising the manuscript. All authors approved the final version of the manuscript.

    • Funding BMF and AMD were funded by the KL2 Career Development Award, and this research was supported by the Washington University Institute of Clinical and Translational Sciences (Grants UL1 TR000448 and KL2 TR000450) from the National Center for Advancing Translational Sciences (NCATS). BMF was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant No 8041-88). AMD was also funded by the Foundation for Anesthesia Education and Research. EA was supported by the Washington University School of Medicine Faculty Scholars grant and the Foundation for Barnes-Jewish Hospital. NMM was supported by grant funds from the Health Resources and Services Administration. MHK was supported by the Barnes-Jewish Hospital Foundation. Funders played no role in the design and conduct of the study, nor the collection, management, analysis and interpretation of the data, nor the preparation, review or approval of the manuscript.

    • Competing interests None declared.

    • Ethics approval Washington University in St Louis IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.