Revisits and Readmissions in Emergency Department Patients After Presenting for Placement

Patients presenting to the Emergency Department (ED) with no acute medical needs but requiring placement in a skilled nursing facility (SNF) are frequently boarded in the ED or observation unit. Demographics of these patients are underreported, and they may be at risk for recurrent healthcare utilization. The purpose of this study is to identify factors in ED placement patients associated with ED revisits and readmissions.

We conducted a retrospective chart review of adult patients (>18 years) presenting to an urban ED (10/1/24-3/31/25) who were placed in observation. Patients admitted to the hospital or transferred during the index ED visit were excluded. The outcomes were 1) 30-day ED revisit and 2) 30-day hospital admission. Patient demographics, length of stay, prior healthcare encounters, past medical history, and ED vital signs were collected from the electronic medical record. Multivariate logistic regression (SPSS v29) with odds ratios (OR) was determined with significance of p<0.05, and 95% confidence intervals (CI) were reported.

A total of 100 patients were held in observation for placement. Mean age was 69±13 years. Mean disposition to discharge time was 66±57 hours (range, 0-337). During the observation stay, 47 patients were deemed appropriate for discharge home. In total, 26 patients returned to the ED within 30 days, and 13 patients were admitted to the hospital during their subsequent visit, with no difference seen between patient previous discharge destination. Patients with heart failure (OR 4.3, CI 1.4-13.6), younger age (OR 0.95, CI 0.906-0.988), or prior admissions (OR 1.7, CI 1.1-2.6) were independently associated with a 30-day ED revisit. Patients with heart failure (OR 12.6, CI 2.0-77.8), hemiplegia (OR 13.4, CI 1.6-110), and prior hospital admissions (OR 2.0, CI 1.2-3.3) were independently associated with subsequent 30-day hospital admission. No significant associations between ED revisits or admissions were observed based on sex, race, ethnicity, insurance status, length of stay, or ED discharge vital signs.

Patients presenting to the ED requiring placement experience prolonged observation and have a high revisit and admission rate. Patients with heart failure and a history of recent admissions should be considered carefully during placement. ED placement patients are a high-risk group that warrants further study with a larger sample size.