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Thirty-day hospital readmissions among mechanically ventilated emergency department patients
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  • Published on: 19 July 2018
    Response to: Hospital readmissions among mechanically ventilated in the ED: Is it feasibly a preventative strategy?
    • David B Page, Emergency Physician & Intensivist University of Alabama at Birmingham
    • Other Contributors:
      • Brian M. Fuller, Emergency Physician & Intensivist

    Dr. Purro,

    First off, thank you for taking the time to read and respond to our article.  We are in agreement that invasive mechanical ventilation and hospital readmissions are important as they pertain to both patient-centered outcomes and resource utilization. 

    We also agree with your statement that Emergency Department (ED) length of stay is comparatively short when compared to the time spent in the hospital. However, in time-critical conditions such as sepsis, trauma, acute ischemic stroke, and myocardial infarction, this time period is highly influential on long-term patient outcomes. Regarding the management of mechanical ventilation, our group has previously demonstrated that the initial management of ventilator settings in the ED influences outcome (i.e. ventilator-associated lung injury and exposure to hyperoxia are also time-sensitive) (1-3). As it was previously unknown if hospital readmissions are influenced by initial ED management, and readmission is a patient-centered reflection of morbidity, we felt this topic merited further evaluation.

    We agree that the relationship between chronic illness and clinically significant outcomes is important (i.e. length of stay, duration of mechanical ventilation, etc.). Unfortunately, we felt that this data and subsequent analysis was beyond the scope of our paper.  Our aim was simply to evaluate whether or not processes of care in the ED influenced the rate of hospital readmissions in patients requir...

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    Conflict of Interest:
    None declared.
  • Published on: 19 June 2018
    Hospital readmissions among mechanically ventilated in ED. Is it feasibly a preventative strategy?
    • Andrea Purro, emergency and critical care medicine Humanitas Gradenigo Hospital, Turin, Italy
    • Other Contributors:
      • Davide Torti, emergency and critical care medicine
      • Alastair J Glossop, Department of Critical Care and Anaesthesia
      • Antonio Esquinas, Intensive Care Unit

    Dear Editor,

    It is widely recognised that the management of patients with acute respiratory failure in the Emergency Department (ED) is a pivotal point that may influence outcomes at later stages in patient care pathways. In particular, the decision to submit patients to invasive mechanical ventilation (IMV) and the mode of ventilator settings utilised are of relevance in determining patient outcomes. It is also acknowledged that early hospital readmission following an episode of acute critical illness is a major problem not only for patients’ quality of life but also healthcare systems in general. Thus we read with great interest the recent retrospective study by Page DB et al., in which the authors investigated the relationship between ED pathways of care and the risk factors for unplanned 30-day readmissions. We applaud the authors on their efforts, however we also feel that there are several confounding issues that warrant further discussion.

    Firstly, the length of the time for which patients were treated and mechanically ventilated in the ED was relatively short - at 5 hours and 30 mins - compared the total length of stay (LOS) in hospital. We feel that this short period is unlikely to have contributed any meaningful effect on overall patient outcomes. Moreover, it would have been of great interest to discuss any changes in ventilator parameters between ED and ICU, and if the initial choice of ventilator settings could have influenced patient outcomes, i...

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    Conflict of Interest:
    None declared.