Keith Kocher, M.D., found that postsurgical ED visits are too frequent.

From the OR to the ED

Study highlights need for better care coordination

issue 20 | winter 2014

Nearly one in five geriatric patients who undergo frequently performed surgical procedures will visit the emergency department within a month of their hospital stay, a new U-M study finds — a surprisingly high number found in the first national look at the issue. The rate varied widely between hospitals.

The findings, published in Health Affairs, show the need for better coordination of post-surgical care, says lead author and U-M emergency physician Keith Kocher, M.D. He and others suggest that post-surgical emergency department use could be added to quality measures used to evaluate hospital performance. The findings come from an analysis of Medicare data from nearly 2.4 million adults who had percutaneous coronary intervention, coronary artery bypass, hip fracture repair, back surgery, elective abdominal aortic aneurysm repair or colectomy in a three-year period.

Just over 17 percent had one emergency department visit, and more than 4 percent had two or more visits within 30 days of leaving the hospital. More than half of the patients who sought emergency care ended up being readmitted to the hospital directly from the ED. The most common issues were cardiovascular and respiratory conditions, infections, complications with the site of their surgery or procedure incision, and abdominal or gastrointestinal problems.

"This research is a high-altitude look at this problem and suggests that we should really be doing more investigation into what is driving the frequency with which patients need to come into the emergency department," says Kocher. "We should be looking for things we can do as a health system to head off the need for an ED visit in the first place, or to deliver care in the ED that can prevent a hospital readmission if we can."

The findings highlight the need for surgical and inpatient teams to do a better job at educating patients and linking with the patient's primary care site in the first days after discharge. If nothing else, emergency visits by post-surgical patients should be treated as an opportunity to re-establish coordination of care.

At U-M, adult emergency department patients have access to a care manager to coordinate patients' care across UMHS sites, and a free phone-based service that assists them in getting outpatient appointments to follow up on their health needs.

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