Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital

Abstract

INTRODUCTION 72-hour emergency department (ED) reattendance is a widely-used quality indicator for quality of care and patient safety. It is generally assumed that patients who return within 72 hours of ED discharge (72-hour re-attendees) received inadequate treatment or evaluation. The current literature also suggests considerable variation in probable causes of 72-hour ED reattendances internationally. This study aimed to understand the characteristics of these patients at the ED of a Singapore tertiary hospital. METHODSWe conducted a retrospective cohort study on all ED visits between 1 January 2013 and 31 December 2013.72-hour re-attendees were compared against non-re-attendees based on patient demographics, mode of arrival, patient acuity category status (i.e. P1/P2/P3/P4), seniority ranking of doctor-in-charge and medical diagnoses. Multivariate analysis using the generalised linear model was conducted on variables associated with 72-hour ED re-attendance.RESULTS Among 104,751 unique patients, 3,065 (2.93%) were in the 72-hour re-attendees group. Multivariate analysis showed that the following risk factors were associated with higher risk of returning within 72 hours: male gender, older age, arrival by ambulance, triaged as P2, diagnoses of heart problems, abdominal pain or viral infection (all p < 0.001), and Chinese ethnicity (p = 0.006). There was no significant difference in the seniority ranking of the doctor-in-charge between both groups (p = 0.419).CONCLUSION Several patient and event factors were associated with higher risk of being a 72-hour re-attendee. This study forms the basis for hypothesis generation and further studies to explore reasons behind reattendances so that interventions can be developed to target high-risk groups.

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

“…A previous study forms the basis for this classification because ED revisit was found to be common in the population aged ≥60+ years. 10 A new patient was defined as the first presentation of an individual to receive ED services.…”

“…The ED revisit within 72 hours has been widely reported in earlier studies, and its rate depends on the chronic disease status and the cultural background. 6 – 12 The rates of 72-hour ED revisits may depend on age, 10 , 11 gender, 10 , 13 disease categories, 6 – 8 , 12 medical errors, 7 , 8 patients, 7 and doctors. 7 Although data regarding ED revisits within 72 hours can be used to implement changes and modifications to improve the electronic medical record database, the rate of revisits to the ED within 72 hours has not been documented among adults with chronic diseases in Saudi Arabia, particularly in our center.…”

A prospective study of hospital episodes of adults with intellectual disability

“…This finding may reflect certain risk factors for our participant group, in particular being male and arriving by ambulance, previously associated with ED re‐presentation within a short period (Chan et al . 2016). Using another indicator of possible hospital care failings was that for 46% of participants and 59% of the re‐presentations, subsequent presentations occurred within 30 days, which was higher than for male ID patients reported by Kelly et al .…”

“…Results of a Singapore study, however, indicated the following risk factors for a 72h ED return: arriving by ambulance, male gender, older age, nonambulant with a major emergency triage, and diagnosis of cardiac problems, abdominal pain or viral infection, and Chinese ethnicity (Chan et al . 2016). A return within 30 days has been an indicator of preventable hospital presentation (Kelly et al .…”

Programa educativo sobre registro da pressão arterial em serviço hospitalar de emergência: um estudo de intervenção

“…Readmissões dentro de 72 horas na unidade de emergência são amplamente utilizadas como indicador de qualidade da assistência e segurança do paciente, uma vez que estão associadas aos erros de avaliação médica e ao estabelecimento de tratamentos inadequados (BENBASSAT;TARAGIN, 2000). Estudos avaliaram as características clínicas de pacientes readmitidos e constataram que idosos, portadores de doenças cardíacas, abdominais e virais, bem como pacientes classificados como graves no momento da triagem inicial estavam mais propensos a retornar à unidade emergência após três dias da alta hospitalar (CHAN et al, 2016;MAGDELIJNS et al, 2016). As estatísticas mostraram que 42% dos pacientes relataram novas queixas e 24% foram readmitidos devido a exacerbação ou piora dos sintomas relatados na visita anterior (HEITMANN et al, 2016).…”