• Emerg Med J · Apr 2018

    Observational Study

    Thirty-day hospital readmissions among mechanically ventilated emergency department patients.

    • David B Page, Anne M Drewry, Enyo Ablordeppey, Nicholas M Mohr, Marin H Kollef, and Brian M Fuller.
    • Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
    • Emerg Med J. 2018 Apr 1; 35 (4): 252-256.

    BackgroundUnplanned 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.DesignRetrospective cohort study.SettingTertiary-care, academic medical centre.PatientsAdult ED patients receiving mechanical ventilation.MeasurementsBaseline 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.ResultsA 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)).ConclusionsAlmost 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.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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