Evaluation of a transitions clinic to bridge emergency department and primary care

Abstract

Background: Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. Objective: The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. Designs: Retrospective cross-sectional study. Settings and Participants: This study included adults 18 years and older discharged from the ED and reeferred to the CTC. Main Outcome and Measures: Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization.Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression.Results: Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2,7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.