Repeat Emergency Department Visits: A Flawed Quality Metric

The proportion of emergency department (ED) patients who return to the ED within 30 days is touted as a measure of the quality of emergency care. Investigators reviewed data from the Healthcare Cost and Utilization Project database, covering roughly 9 million ED visits to 424 hospitals in New York and Florida during 2013. They compared outcomes between patients who were hospitalized during an initial ED visit and those who were discharged at the initial visit and hospitalized during a repeat visit.

Overall, 36% of patients discharged from the initial visit had a return visit, and of these, 14.4% were admitted. Patients admitted on a return visit within 7 days, compared with those admitted on the initial visit, had lower rates of in-hospital …