Sickle Cell Patients at Higher Risk for ER Readmission, Hospitalization, Study Finds

Patients with sickle cell disease show the highest rates of readmission and hospitalization within 30 days of being discharged from an emergency department, a single-center study found.

The study, “Patients Discharged From the Emergency Department After Referral for Hospitalist Admission,” was published in The American Journal of Managed Care.

Unnecessary hospitalizations are very costly and can also expose patients to unnecessary risks, but the characteristics and outcomes of patients discharged from the emergency department after being referred for hospital admission have been poorly explored.

To study this, researchers performed a retrospective analysis of emergency room consults at an academic medical center in North Carolina during a three-year period, from April 2011 to April 2014. They analyzed the demographics, diagnoses, and healthcare outcomes of patients who were referred for hospital admission but were eventually discharged from the emergency department without hospitalization.

During the three-year period, they identified 710 emergency department discharges for 670 patients. The mean age of admitted patients was 52.1 years. Of the patients, 61 percent were white and 30 percent were black. About 75 percent of the patients had some form of insurance.

The most common diagnoses in emergency room admissions were unspecified chest pain (34.1%), followed by unspecified abdominal pain (9%).

Of the patients in the analysis, 21.7% of them returned to the emergency department within 30 days of the initial consultation and discharge. Patients who returned most frequently had sickle cell disease (82.4%), alcohol-related diagnoses (43.5%), and abdominal pain (35.7%).

The probability of returning to the emergency room within 30 days was highest for those with abdominal pain or alcohol-related diagnoses, compared with the rest of the group in the analysis.

Similarly, the rate of hospitalization within 30 days after an initial emergency room visit was highest among patients with sickle cell disease (58.8%), followed by alcohol-related diagnoses (19.6%), and abdominal pain (14.3%).

“Among insurance types, patients with Medicaid had the highest likelihood of returning to the ED [emergency department] within 30 days,” the authors wrote. Those with private insurance or other forms of healthcare coverage were less likely to revisit the emergency room.

Overall results showed that most patients discharged from the emergency department didn’t return within a 30-day period and the 30-day hospitalization rate remained low.

“Our data suggest that hospitalists can safely aid patients by reducing the costs and adverse outcomes associated with unnecessary hospitalization,” the study concluded.