Research Activities, March 2014
"Bounceback" admissions not linked to emergency department crowding
Emergency department (ED) crowding, a growing problem in the United States, has been associated with poor quality of care and worse outcomes. Another potential adverse effect of ED crowding is subsequent hospital admission after initial ED discharge, sometimes referred to as "bounceback" admissions. However, a new study found that ED crowding was not significantly associated with increased bounceback admissions during the subsequent 7 days. Instead, bounceback admissions were associated, even after controlling for crowding and other factors, with increased age, male gender, minority ethnicity, and public insurance.
ED crowding was measured by "ambulance diversion," which occurs when ED staff can no longer safely care for new patients and ambulances are diverted to other facilities. Ambulance diversion is one of the few consistent measures of crowding available and is commonly used by prehospital and regulatory agencies to monitor crowding. The researchers used public data files on all outpatient and inpatient ED visits in California during 2007.
They concluded that while it may be useful to track bounceback admissions for other purposes, its application as a quality indicator and linking it to incentives such as pay for performance warrants careful evaluation before widespread implementation. The study was supported in part by AHRQ (HS18098).
See "Is emergency department crowding associated with increased "bounceback" admissions?" by Renee Y. Hsia, M.D., Steven M. Asch, M.D., Robert E. Weiss, Ph.D., and others in the November 2013 Medical Care 51(11), pp. 1008-1014.