Why Do Patients Return to the Emergency Department?

Abstract

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Return Visits to the Emergency Department: The Patient Perspective." This qualitative inquiry performed 60 semistructured interviews of patients who returned to the emergency department within 9 days of their primary visit for the same complaint. Patients most often returned because of concerns that their initial visit did not adequately address their complaint, and they needed assurance from providers that their clinical condition was not a serious health concern. Patients also expressed a lack of contact with a provider between the 2 visits either to answer questions or to address ongoing concerns. This study highlights the important role of the APN in providing quality care, reassurance, and communication related to follow-up care.

Patients' experiences and reasons for unplanned return visits to the emergency department: A qualitative study

“…In this study, heightened concerns around symptoms worsening or not improving as expected, coupled with not being able to manage these changes at home, were key contributing factors to participants' decisions to return to ED. This finding is consistent with existing studies from the USA that report on returning patient perspectives (Augustine et al, 2016; Chin‐Yen et al, 2017; Proud & Howard, 2016; Rising et al, 2015). A lack of understanding about symptom duration/trajectory contributed to increasing participants' fears when their experiences did not align with expectations (Augustine et al, 2016; Rising et al, 2015).…”

“…At the time, this approach was probably unfamiliar to many people living in large Australian cities like Sydney and may have contributed to the perceived inability to access suitable healthcare, prompting an ED visit. A lack of inperson healthcare consultation being associated with increased return visits to ED is consistent with other reports (Proud & Howard, 2016).…”

“…In this study, several factors appeared to influence how the patient experienced their initial visit, including communication, particularly at discharge, the physical environment and ED processes. This finding is consistent with other return visit literature and the wider pre-COVID-19 pandemic ED literature, which identifies dissatisfaction with communication and information, prolonged wait times and uncomfortable physical environment as impacting the experience of ED (Blackburn et al, 2019;Proud & Howard, 2016;Rising et al, 2015;Sonis et al, 2018).…”

“…The convenience of the ED and difficulty accessing primary health care have been reported as reasons for patients returning to the ED (Proud & Howard, 2016), with some patients rarely attempting to make follow‐up GP appointments (Augustine et al, 2016). A point of difference in our study was that participants did not automatically view the ED as a service to return to.…”

“…Few studies report directly on the perspectives of returning patients about their return visit to ED, and these studies are predominantly from the United States of America (USA) (Hutchinson et al, 2019). Reasons for return, from a patient perspective, include concern around ongoing symptoms (Augustine et al, 2016), dissatisfaction at the initial visit, lack of follow‐up care and need for reassurance that their condition was not serious (Proud & Howard, 2016). However, existing qualitative studies are limited in number and generalized to all return visits regardless of the patients' disposition at return.…”