Clin Psychopharmacol Neurosci.  2018 Nov;16(4):398-406. 10.9758/cpn.2018.16.4.398.

Increased Readmission Risk and Healthcare Cost for Delirium Patients without Immediate Hospitalization in the Emergency Department

• Ma IC
• Chen KC
• Chen WT
• Tsai HC
• Su CC
• Lu RB
• Chen PS
• Chang WH
• Yang YK

• KMID: 2428969
• DOI: http://doi.org/10.9758/cpn.2018.16.4.398

Abstract

OBJECTIVE
Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit.
METHODS
Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson's comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed.
RESULTS
Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities (CCI≥3) or older patients (≥65 years). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period.
CONCLUSION
Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

Keyword

Delirium; Hospital emergency service; Health care costs; Re-hospitalization; Risk factors

MeSH Terms

Comorbidity
Delirium*
Delivery of Health Care*
Diagnosis
Emergencies*
Emergency Service, Hospital*
Follow-Up Studies
Health Care Costs*
Hospitalization*
Humans
National Health Programs
Risk Factors