1. Emergency Department Admission Refusals Requiring Readmission at an Academic Medical Center David R. Kumar MD, Adam E. Nevel MD/MBA, John P. Riordan MD University of Virginia Medical Center Background Retrospective analysis of patients seen in the University of Virginia ED between 4/5/2015 and 9/4/2015. Patients included in the study were those evaluated by the General Medicine or Hospitalist inpatient teams upon request of the ED providers, and were subsequently discharged. Information was gathered using electronic medical record (EMR). Methods Objectives Outlining the admission process at a large university hospital ED and providing a detailed analysis in the form of a case series of patients that were discharged after evaluation by the inpatient team and subsequently returned to the ED within 24 hours. We hypothesize that a select group of patients will end up returning to the ED, resulting in admission. Admission process policies vary at Academic Emergency Departments (ED). This can have significant impacts on the following: Patient flow Resource utilization Patient safety Patient satisfaction Overall efficiency A lack of literature exists examining admission refusals requiring readmission.

2. Emergency Department Admission Refusals Requiring Readmission at an Academic Medical Center David R. Kumar MD, Adam E. Nevel MD/MBA, John P. Riordan MD University of Virginia Medical Center Results Percentage ED Admissions by Admitting ServicesPercentage of Pre-Admits Who Get Admitted Results

3. Emergency Department Admission Refusals Requiring Readmission at an Academic Medical Center David R. Kumar MD, Adam E. Nevel MD/MBA, John P. Riordan MD University of Virginia Medical Center Results 84 patients were requested for admission by ED providers and discharged by the General Medicine or Hospitalist services. Four (4.8 %) of these patients returned to the ED within 24 hours, all requiring admission. The average length of stay (LOS) for these patients was 10 days, and all arrived by emergency medical service (EMS) upon return.

4. Emergency Department Admission Refusals Requiring Readmission at an Academic Medical Center David R. Kumar MD, Adam E. Nevel MD/MBA, John P. Riordan MD University of Virginia Medical Center Conclusions This study focused on the admission process at a large university hospital ED where admission requests are made by attendings and residents in the ED, however final dispositions are made by attendings and residents of the inpatient services. In this setting during the study period, 4.8% of patients that were felt to warrant admission by ED providers were discharged by the inpatient team and returned to the ED within 24 hours. The average length of stay was 10 days. Supports initial hypothesis that a select group of patients will be re-admitted after being discharged by inpatient team Small sample size Selection bias Also, patients may have been reevaluated at outside facilities and not captured in our review. This case series may lend to a reevaluation of the admission process policies at our facility and future need for change. Additionally, analyze data from other admitting services in the hospital in similar fashion (see below). This could result in optimization of patient flow, improvements in patient outcomes, and reduction in health care costs. Limitations/Future Directions