Characteristics of an Unscheduled Emergency Department Revisit Within 72 hours of Discharge

Abstract

Background An unscheduled emergency department (ED) revisit is defined as a patient presenting to the ED with the same problem within 72 hours of discharge. The revisits result in overcrowding and compromise the care provided by the ED. We assume that the poor quality of care provided by the ED is the reason for revisiting. However, the circumstances surrounding these revisits are not well-understood. We conducted this study to understand the characteristics associated with the revisits. Objectives We aimed to identify the common causes of ED revisits within 72 hours of discharge and determine the outcome of these patients during the revisit. Methods We conducted a prospective observational study at a tertiary care center from July 2015 to June 2017, including patients presenting at the ED within 72 hours after their first visit. Our study selected 50 patients using a simple random sampling method and identified the leading causes of revisit as doctor-related, patient-related, and illness-related. Results We found that 56% (28/50) of patients returned to the ED for illness-related reasons, 26% (13/50) for doctor-related reasons, and 18% (9/50) for patient-related reasons. In addition, we found that 62% (31/50) of patients who returned to the ED within 72 hours required in-patient admission. Conclusion The most common cause of ED revisit was illness-related causes, and more than half of the patients during a revisit required in-patient admission. The modifiable causes of the ED revisit, such as doctor-related and patient-related factors, were discovered in this study. These findings may aid in reducing ED revisits and improving the ED quality.

Improving the emergency services using quality improvement project and Donabedian model in a quaternary teaching hospital in South India

“…During the postimplementation phase, the rate of patients revisiting the ED with similar problems within 72 hours of discharge was reduced to <1%, which is considered an acceptable rate by some studies. Several factors influence whether a patient will revisit the ED, including age, sex, time and day of presentation, type of complaint, triage acuity level, physician expertise, investigations, treatment provided and hospital accessibility 27. By addressing these factors and implementing improvement strategies, the rate of revisits was successfully reduced in this study.…”

“…Several factors influence whether a patient will revisit the ED, including age, sex, time and day of presentation, type of complaint, triage acuity level, physician expertise, investigations, treatment provided and hospital accessibility. 27 By addressing these factors and implementing improvement strategies, the rate of revisits was successfully reduced in this study. Overcrowding in the ED is another concern, as it may lead to patients leaving the ED without being seen, which negatively affects patient satisfaction and compromises patient outcomes.…”

Elements affecting emergency department rate of return within 72 hours: a retrospective cross-sectional study

“…11 However, some studies have suggested that illness-related factors are more common than patient-or healthcarerelated factors in causing return visits to the ED within 72 hours. 2,13 Physician-related return visits, which constitute one of the three categories of ED return visits within 72 hours alongside patient-related and illness-related returns, exhibit variable percentages based on available search results. 5 A study focused on a subset of return visits resulting in admission found that illness-related admissions accounted for nearly all admissions within 72 hours, while physician-related admissions accounted for only 3.5%.…”

“…19 Abdominal pain is the most common chief complaint in the first return visit, followed by cough and upper respiratory tract infection, with illness-related complaints being the most common reasons for revisits. 2,13 To minimize the need for patients to revisit the emergency department, healthcare providers need to ensure that patients are adequately prepared to manage their recovery at home and adhere to discharge instructions and prescription regimens. A study on general pediatric patients found that having access to a pediatrician reduced the likelihood of a return visit to the ED by nearly 30 percent.…”

“…An unplanned return visit is defined as a patient presenting to the ED with the same problem within 72 hours of their initial visit. 2 The purpose of this study is to identify the elements that are associated with the rate of return to the emergency department within 72 hours among patients who have been discharged from the emergency department. Also, to identify the rate of a return visit to ED within 72 hours from the initial visit to determine the underlying factors associated with unplanned ED return visits.…”