SHM Converge Scientific Abstract ePoster Gallery-Burden of Observation Stays and Emergency Department Visits on 30-Day Hospital Revisit Rates: A 9-Year Retrospective Study From a Tertiary Care Center

Burden of Observation Stays and Emergency Department Visits on 30-Day Hospital Revisit Rates: A 9-Year Retrospective Study From a Tertiary Care Center

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This 9-year retrospective study examined whether the usual 30-day readmission metric misses important returns to the hospital by excluding emergency department (ED) visits and observation stays. Using electronic medical record data from Medical College of Wisconsin/Froedtert Hospital, the authors analyzed 76,936 Medicare hospitalizations from 2015–2023 for six HRRP-targeted conditions: acute myocardial infarction (AMI), COPD, heart failure (HF), pneumonia, CABG, and elective THA/TKA.<br /><br />Overall, 15% of index hospitalizations were followed by a 30-day hospital revisit. Of these revisits, 73% were inpatient readmissions, 20% were ED visits, and 8% were observation stays. Thus, about 28% of 30-day revisits would be missed if only inpatient readmissions were counted.<br /><br />Pneumonia had the highest burden of 30-day revisits (44% of all revisits), followed by heart failure (29%) and COPD (19%). Together, these three diagnoses accounted for more than 90% of all revisits. The average patient age at index admission was about 78 years; 52% were female, 79% were Non-Hispanic White, and 18% were Non-Hispanic Black.<br /><br />The study highlights a key limitation of current HRRP-style metrics: excluding ED and observation-unit returns may underestimate true hospital reutilization and distort policy assessments. The authors suggest that observation stays and ED revisits should be incorporated into future readmission evaluations, especially for high-burden conditions such as pneumonia, HF, and COPD.<br /><br />Main limitations include the single-center design and possible influence of the COVID-19 pandemic, which may have increased pneumonia-related admissions and affected mortality patterns. Further research is needed to confirm these findings and assess outcomes over time.

Asset Subtitle

Bimatshu Pyakuryal

Meta Tag

Author List Barbara Slawski, Bimatshu Pyakuryal, Pinky Jha, Prasun Pudasainee, Sanjay Bhandari

Category Research

Concept Hospital Return Encounter

Concept Hospital Readmission

Concept Emergency Department Visits

Concept Hospital Readmission Reduction Program

Concept Observation Stay

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Bimatshu Pyakuryal

Track Value in Hospital Medicine

Keywords

30-day readmission

hospital revisits

emergency department visits

observation stays

Medicare hospitalizations

HRRP metrics

pneumonia

heart failure

COPD

electronic medical records

Hospital Return Encounter

Hospital Readmission

Emergency Department Visits

Hospital Readmission Reduction Program

Observation Stay