Objective: Identification of variables prognosticating 30-day readmission among adult patients admitted for video-EEG (VEEG) monitoring at a major epilepsy center.Methods: A retrospective cohort study was conducted, examining 865 consecutive admissions to the epilepsy monitoring unit (EMU) from January 2010 to June 2013. Data extracted from chart review included demographics, length of stay (LOS), seizure type(s), number of 30-day readmissions or emergency department (ED) visits and reasons for these, and patient and system/provider factors potentially contributing to the readmission.Results: Of 865 elective admissions for VEEG monitoring, 49 patients accounted for 33 readmissions and 40 ED visits within 30 days of discharge for an overall 30-day encounter rate of 7.0% after excluding those lost to follow-up; 9 patients had more than one ED visit or readmission. Statistically significant risk factors for urgent 30-day encounters included a history of nonepileptic seizures (NES) (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.4), a dual diagnosis of both epilepsy and NES (OR 5.9, 95% CI 3.0-11.8), an urgent index admission to the EMU (OR 2.5, 95%CI 1.4-4.8), and a shorter LOS of index hospitalization (median 4.0 days vs 5.0 days, p , 0.01). The most common contributing patient factors included active psychiatric symptoms, medically refractory epilepsy, and living alone; the most common hospitalization-related factors included antiepileptic drug (AED) treatment adverse events or AED adjustment.Conclusions: In addition to the presence of intractable epilepsy and shorter LOS, mental health comorbidities and the presence of NES were important risk factors for 30-day readmissions and ED visits in the epilepsy population. Therefore, proactively addressing mental health comorbidities may decrease urgent health care utilization after VEEG monitoring. United States hospital readmission rates within 30 days of discharge are estimated to approach 20%, and many readmissions are preventable.1 The Centers for Medicare & Medicaid Services (CMS) initiated the Hospital Readmission Reduction Program in 2012, which financially penalizes hospitals with excessive hospital readmissions, dramatically heightening our awareness of care transitions.2 The majority of hospitals in the United States have undertaken readmission reduction collaboratives given the national priority to reduce hospital readmissions. Neurologyspecific readmission reduction programs are increasingly becoming commonplace, 3,4 and CMS has moved forward with using 30-day readmission rates for stroke starting in fiscal year 2016. Patients face numerous challenges after hospital discharge, some of which may be unrelated to their initial reason for hospitalization, which can predispose them to readmission. 5 Patients with epilepsy represent a particularly vulnerable population given the complexity of medication regimens and safety instructions, the toxicity of therapies, the potential for breakthrough seizures in refractory epilepsy, and the high prevale...

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Nonclinical discharge delays for guardianship patients are costly and potentially unavoidable. Further exploration into policy change is therefore recommended.