A simple 5-question checklist that predicts which patients are most likely to return to the ER within a week. Toggle the factors below to calculate.
Background
The Discharge Severity Index is a quick bedside checklist for emergency rooms. Right now, when patients leave the ER, everyone gets roughly the same instructions. The DSI helps doctors and nurses figure out who needs extra follow-up and who is safe with standard care.
About 1 in 7 patients who leave the ER end up coming back within a month. Many of those return visits could be prevented with a follow-up call or check-in—but until now, there was no simple way to decide who needs that extra attention.
At discharge, you check 5 simple things: the patient's age, heart rate, oxygen level, how long they were in the ER, and how many medications they take. Add up the points (0–7) and the score tells you their risk level (1–5).
Based on the score, each patient gets a follow-up plan that matches their risk: a phone call, a video visit, a home nurse visit, or simply a reminder to see their regular doctor. Higher risk = more follow-up.
Scoring
These 5 factors were identified by analyzing nearly 230,000 ER visits. Each factor is weighted by how strongly it predicts a return visit—the stronger the link, the more points it gets. Maximum score: 7.
1.3× more likely to return (OR 1.29)
1.7× more likely to return (OR 1.67)
1.4× more likely to return (OR 1.36)
2.9× more likely to return (OR 2.87)
2.7× more likely to return (OR 2.65)
Risk Stratification
The score maps to 5 levels, from highest risk (Level 1) to lowest (Level 5). Each level comes with a suggested follow-up plan. Validated on a separate group of ~57,000 patients.
| DSI Level | Score Range | Risk Multiplier | 7-day Return Rate | Prevalence | Suggested Follow-up |
|---|---|---|---|---|---|
| 1 Highest risk | 6–7 | 14.6× | ~1 in 20 | ~1.4% | Video/phone check-in within 24h, home nurse visit, remote monitoring |
| 2 High risk | 5 | 11.7× | ~1 in 25 | ~10.4% | Nurse calls within 48h, medication review, video visit |
| 3 Moderate risk | 3–4 | 8.4× | ~1 in 33 | ~25.3% | Follow-up plan before leaving, see your doctor within 1 week |
| 4 Low risk | 1–2 | 3.5× | ~1 in 100 | ~46.5% | Standard go-home instructions, schedule a doctor visit if needed |
| 5 Lowest risk | 0 | 1.0× (baseline) | <1 in 200 | ~16.3% | Routine care, no special follow-up needed |
Context
Several scoring tools exist in medicine, but the DSI is the first designed specifically for the moment a patient leaves the ER. Here's how it compares.
Evidence
The DSI was published in a peer-reviewed emergency medicine journal and featured on ALiEM, a leading medical education site.