90-Day return visit to the Emergency Department after an initial neurosurgical evaluation

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

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In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department

JAMA ◽

10.1001/jama.2016.0649 ◽

2016 ◽

Vol 315 (7) ◽

pp. 663 ◽

Cited By ~ 47

Author(s):

Amber K. Sabbatini ◽

Keith E. Kocher ◽

Anirban Basu ◽

Renee Y. Hsia

Keyword(s):

Emergency Department ◽

Hospital Outcomes ◽

Return Visit

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270 Hospital Outcomes in Geriatric Patients Who Had a 72-Hour Return Visit to the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.300 ◽

2011 ◽

Vol 58 (4) ◽

pp. S268

Author(s):

A.R. Kanthala ◽

B.R. Allen ◽

J.A. Lee ◽

A.N. Bodhit ◽

S.K. Nayfield ◽

...

Keyword(s):

Emergency Department ◽

Geriatric Patients ◽

Hospital Outcomes ◽

Return Visit

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Inpatient Outcomes Following a Return Visit to the Emergency Department: A Nationwide Cohort Study

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.6.52212 ◽

2021 ◽

Vol 22 (5) ◽

pp. 1124-1130

Author(s):

Chu-Lin Tsai ◽

Dean-An Ling ◽

Tsung-Chien Lu ◽

Jasper Lin ◽

Chien-Hua Huang ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Resource Use ◽

Admission Rate ◽

National Database ◽

Return Visit ◽

Icu Admission ◽

Inpatient Outcomes ◽

Ed Visits ◽

Admission Group

Introduction: Emergency department (ED) revisits are traditionally used to measure potential lapses in emergency care. However, recent studies on in-hospital outcomes following ED revisits have begun to challenge this notion. We aimed to examine inpatient outcomes and resource use among patients who were hospitalized following a return visit to the ED using a national database. Methods: This was a retrospective cohort study using the National Health Insurance Research Database in Taiwan. One-third of ED visits from 2012–2013 were randomly selected and their subsequent hospitalizations included. We analyzed the inpatient outcomes (mortality and intensive care unit [ICU] admission) and resource use (length of stay [LOS] and costs). Comparisons were made between patients who were hospitalized after a return visit to the ED and those who were hospitalized during the index ED visit. Results: Of the 3,019,416 index ED visits, 477,326 patients (16%) were directly admitted to the hospital. Among the 2,504,972 patients who were discharged during the index ED visit, 229,059 (9.1%) returned to the ED within three days. Of them, 37,118 (16%) were hospitalized. In multivariable analyses, the inpatient mortality rates and hospital LOS were similar between the two groups. Compared with the direct-admission group, the return-admission group had a lower ICU admission rate (adjusted odds ratio, 0.78; 95% confidence interval [CI], 0.72-0.84), and lower costs (adjusted difference, -5,198 New Taiwan dollars, 95% CI, -6,224 to -4,172). Conclusion: Patients who were hospitalized after a return visit to the ED had a lower ICU admission rate and lower costs, compared to those who were directly admitted. Our findings suggest that ED revisits do not necessarily translate to poor initial care and that subsequent inpatient outcomes should also be considered for better assessment.

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Evaluation of Unscheduled Return Visits to the Pediatric Emergency Department and Risk Factors for Admission After Return Visit

Pediatric Emergency Care ◽

10.1097/pec.0000000000002504 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Funda Kurt ◽

Damla Hanalioğlu ◽

Fatmanur Can ◽

Fatma Eren Kurtipek ◽

Halil İbrahim Yakut ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Return Visit ◽

Return Visits

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Hospitalization After a Return Visit to the Emergency Department

JAMA ◽

10.1001/jama.2016.5247 ◽

2016 ◽

Vol 316 (2) ◽

pp. 223

Author(s):

Piyush Kalakoti ◽

Christina Notarianni ◽

Anil Nanda

Keyword(s):

Emergency Department ◽

Return Visit

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Hospitalization After a Return Visit to the Emergency Department—Reply

JAMA ◽

10.1001/jama.2016.5253 ◽

2016 ◽

Vol 316 (2) ◽

pp. 223 ◽

Cited By ~ 1

Author(s):

Amber K. Sabbatini ◽

Anirban Basu ◽

Renee Y. Hsia

Keyword(s):

Emergency Department ◽

Return Visit

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P050: Unplanned return visits to the paediatric emergency department: Caregiver and physician perspectives

CJEM ◽

10.1017/cem.2019.241 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S81

Author(s):

K. Gardner ◽

B. Taylor

Keyword(s):

Emergency Department ◽

Family Physician ◽

Health Centre ◽

Final Analysis ◽

Primary Outcome Measure ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Return Visit ◽

Return Visits

Introduction: Unplanned return visits to the pediatric emergency department contribute to overcrowding and are used as a quality measure. They have not been well characterized in the literature making it difficult to design interventions to reduce unnecessary return visits. The aim of this study was to understand the reasons for return from the caregiver and physician perspective. Methods: This was a cross sectional survey performed on a convenience sample of unplanned return visits within 72 hours at the IWK Health Centre ED between February and October 2016. Exclusion criteria were: planned return visit, admission during the index visit, or triaged as Canadian Triage and Acuity Score (CTAS) 1 on return visit. Caregiver and physician surveys were developed based on themes identified in published literature. The caregiver was approached to complete a survey after triage and the most responsible physician from the return visit was asked to complete a survey immediately after discharge of the patient from their care. Demographic and clinical data were collected from the ED record from the index and return visits. The primary outcome measure was most important reason for return from the caregiver perspective. Results: There were 461 return visits during the study period and 67 caregivers (14.5%) were included in the final analysis. The response rate for the physician survey was 71%. Caregivers and physicians reported that the most important reason for return was a perceived progression of illness requiring reassessment (79.1% and 66.7% respectively). The majority of caregivers had a family physician on record (95%) but a minority attempted to access their family physician (19.4%) or a walk-in clinic (11.9%). Of those who contacted their family physician only 3 (23%) were offered an appointment within 48 hours and of those who did not contact their family physician 21 (38.2%) stated they would not be able to get an appointment in a reasonable amount of time. Despite this 97% would have trusted their family physician to manage their child's illness. Physicians surveyed stated that the return visit was necessary in 64.6% of cases. Conclusion: Caregivers returned to the ED due to a perceived progression of disease. While some cases may have been appropriate for management in a primary care setting, perceived difficulty with timely access was a barrier. Improved caregiver education about the natural history of disease and the urgency of follow up may reduce return ED visits.

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