• Brian Suffoletto, Jennifer Hu, Maria Guyette, and Clifton Callaway.
• Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
• J Hosp Med. 2014 May 1;9(5):315-9.

BackgroundIdentifying needs in patients who utilize the emergency department (ED) soon after being discharged from inpatient care is essential for planning appropriate care-transition interventions.ObjectiveTo examine differences in stakeholder perspectives on reasons for ED care soon after hospital discharge and interventions that could be useful to prevent these ED visits.Design And MeasurementsA convenience sample of 135 patients who presented to an urban teaching hospital ED <30 days after last hospital discharge, their caregivers (when present), and emergency physicians were administered identical structured surveys. Concordance and agreement rates between patient-physician and patient-caregiver dyads were calculated.ResultsConcordances between stakeholders were poor, with weighted kappas ranging from 0.02 to 0.34 for patient-physician dyads and 0.03 to 0.68 for patient-caregiver dyads. Emergency physicians and caregivers identified factors between 1% and 42% of the time the patients did not. Less than half of any stakeholder could identify an intervention to potentially prevent the ED visit.ConclusionsOur findings suggest the difficulty in forming unified definitions for root cause of ED visits soon after hospital discharge and support the use of multiple stakeholders in identifying appropriate targets for care-transition interventions.© 2014 Society of Hospital Medicine.

40 keywords...

hide…