Introduction: Since the 1990s, the emergency department (ED) unscheduled return visit (URV), or "bounce-back," has been used as a quality of care measurement. During that time, resident training was also scrutinized and uncovered a need for closer resident supervision, especially of second-year residents. Over the years, bounce-backs have continued to be analyzed with vigor, but research on residency training and supervision has lagged with few studies concurrently investigating residency supervision and bounce-backs. Other literature on resident supervision suggests that with adequate attending supervision, resident performance is equivalent to attending performance. With that in mind, it was hypothesized that resident bounce-back rates will be equivalent to attending bounce-back rates, and there will be no change among residency years. The primary objective of this study was to determine the rate at which patients are seen as a bounce-back visit within 72 hours of their initial visit to a community hospital ED during the study time frame. The secondary aims were to evaluate if the ED bounce-back rate is impacted by training level (residents or attending) and to describe bounce-back patient characteristics, including primary complaint/disease, age, comorbidities and issues with compliance.

A 58-year-old male presented to the emergency department with a chief complaint of knee pain and swelling after performing hirudotherapy (leech therapy) approximately one week prior. Knee arthrocentesis demonstrated significant hemarthrosis. Hirudotherapy is being used for a broad array of reasons including treatment of osteoarthritis, to plastic and reconstructive surgery. Case reports and journal articles often discuss cutaneous reactions, bleeding, and infection as common adverse events. Intra-articular bleeding is not commonly mentioned. With hirudotherapy being utilized more as alternative therapy for osteoarthritis and joint pain, physicians should be aware of hemarthrosis as a possible adverse reaction.