Clin Psychopharmacol Neurosci 2018; 16(4): 398-406  
Increased Readmission Risk and Healthcare Cost for Delirium Patients without Immediate Hospitalization in the Emergency Department
I Chun Ma1, Kao Chin Chen2, Wei Tseng Chen2, Hsin Chun Tsai2,3, Chien-Chou Su2, Ru-Band Lu2,4, Po See Chen2,4, Wei Hung Chang2,5,*, Yen Kuang Yang2,3,4
Departments of 1Emergency Medicine and 2Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 3Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, 4Institute of Behavioral Medicine and 5Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Correspondence to: Wei Hung Chang, MD
Department of Psychiatry, National Cheng Kung University Hospital, 138 Sheng Li Road, North Dist., Tainan 70403, Taiwan
Tel: +886-6-2353535 ext. 5189, Fax: +886-6-2084767
E-mail: weihung2364009@gmail.com
ORCID: https://orcid.org/0000-0002-5964-106X
Received: November 29, 2017; Revised: January 26, 2018; Accepted: March 5, 2018; Published online: November 30, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Delirium; Hospital emergency service; Health care costs; Re-hospitalization; Risk factors.


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  • National Cheng Kung University Hospital(NCKU Hospital)
      10.13039/501100004844
      NCKUH-10403020, NCKUH-10503011

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