Background:Rate of Unscheduled Return Visits (URVs) to the Emergency Department has been considered as a key indicator for evaluating the quality of the Emergency Department care for decades. A higher rate of URVs can have a negative impact on the quality of health care. Investigations of the reasons for these returns have indicated that many of these visits can be preventable.Objectives:Given that there are no clear findings about the frequency and reasons for 72 hours URVs to the Chest Pain Unit (CPU), in the present study, we investigated the causes of 72 hours URVs to our CPU in order to find out the inadequacies, and propose preventive strategies.Patients and Methods:This research was a single-center retrospective case control study in the setting of CPU of Tehran Heart Center (a 460-bed, tertiary-care teaching hospital), Tehran, Iran. The medical records of the patients who were presented to our CPU with the chief complaint of chest pain between December 28th, 2010 and February 28th, 2011 were reviewed. Of the 6247 eligible patients, forty-nine URVs that fulfilled our criteria were identified. The control group consisted of 196 patients who did not return to the Emergency Department during our study period.Results:Patient-related factors accounted for most 72 hours URVs (49%). Multivariable analysis revealed that in our CPU, leaving Against medical advice was the most important predictor for 72 hours URVs (P value < 0.001). Additionally, male sex, history of hypertension, first-visit disposition to observation unit and age were the other factors associated with URVs.Conclusions:Considering that the most frequent reason for our URVs was patient-related factors, where all cases had left the CPU Against Medical Advice (AMA) during their first attendance, we recommend that further appropriate strategies be devised to prevent leaving against medical advice.

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BackgroundThe quality of health services is determined on the basis of meeting customers’ needs and expectations. Due to the COVID-19 pandemic, health systems have faced high degrees of uncertainty as well as a variety of challenges. Thus, this study aimed to investigate the relationship between patient safety friendly hospital standards and customer orientation among Iranian nurses during the COVID-19 pandemic.MethodsThis cross-sectional, descriptive-analytical study was conducted on 266 nurses working in Imam Khomeini Hospital, Tehran, Iran selected via stratified sampling in 2020. The study data were collected using a questionnaire including demographic information, patient safety friendly hospital initiatives, and Kim’s customer orientation scale. Then, the data were entered into the SPSS V.16 software and were analysed using descriptive statistics, dispersion indices and correlation tests.ResultsThe mean age and mean duration of working as a nurse were 38.60+7.94 and 13.87+7.41 years, respectively. From the nurses’ perspective, the means of patient safety friendly hospital standards and customer orientation were 97.35±16.59 and 16.40±2.62, respectively, both of which were at the moderate level. In addition, patient safety friendly hospital standards and all its dimensions were positively correlated to customer orientation (p<0.001).ConclusionFrom the nurses’ viewpoint, the patient safety friendly hospital standards and customer orientation were both at the moderate level during the COVID-19 pandemic. In addition, patient safety friendly hospital standards and all its dimensions were significantly associated with customer orientation. In other words, increase in the patient safety friendly hospital standards was accompanied by an increase in the nurses’ customer orientation. These results can provide the organisations delivering health services with the opportunity for management on the basis of multicriteria decision making so as to adapt with the patient safety friendly hospital standards and to internalise customer orientation among nurses.