Extending emergency care beyond discharge: Piloting a virtual after care clinic.

ABSTRACT

Objective: Many unscheduled return visits to the emergency department (ED) stem from insufficient access to outpatient follow-up. We piloted an emergency medicine-staffed, on-demand, virtual after care clinic (VACC) as an alternative for discharged ED patients. Methods: Prospective cohort study of discharged ED patients who scheduled VACC appointments within 72 hours of index ED visit. We performed descriptive analyses and compared risks of ED return at 72 hours and 30 days between patients who did/did not attend their appointment. Results: From March to December 2022, 309 patients scheduled VACC appointments and 210 (68%) attended them. Patients who scheduled appointments were young (median 37 years), non-Hispanic white (80%), females (75%) with a primary care physicians (PCP) (90%), and commercial insurance (72%).  Most VACC visits reinforced ED testing and/or treatment (64%) or adjusted medications (26%). VACC attendees were less likely to return to the ED within 72 h (3.3% vs. 13.1%; risk difference 9.3% [95% confidence interval, CI 2.7%‒19.8%]) and 30 days (16.2% vs. 30.3%; risk difference 14.1% [95% CI 3.8%‒24.4%]) compared to those who scheduled but did not attend a VACC appointment. VACC attendance was associated with lower odds of 72-h (adjusted odds ratio [aOR] 0.0; 95% CI 0.0‒0.4) and 30-day (aOR 0.4; 95% CI 0.2‒0.7) return ED visits. Conclusions: In this pilot study, younger, white, female, commercially insured patients with a PCP preferentially scheduled VACC appointments. Among patients who scheduled VACC appointments, those who attended their appointments were less likely to return to the ED within 72 hours and 30 days than those who did not.