scholarly journals P068: Predictors of admission in unscheduled return visits to the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S81-S81
Author(s):  
J. Hayward ◽  
R. Hagtvedt ◽  
W. Ma ◽  
M. Vester ◽  
A. Gauri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Performance Indicator ◽  
Multivariable Analysis ◽  
Distinct Subgroup ◽  
Return Visit ◽  
Index Visit ◽  
System Data ◽  
Return Visits ◽  
One Year ◽  
Ed Crowding

Introduction: The 72-hr unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in Emergency Medicine. Patients with unscheduled return visits and admission to hospital (URVA) may represent a distinct subgroup of URVs compared to unscheduled return visits with no admission (URVNA). Methods: A retrospective cohort study of all 72-hr URVs in adults across nine EDs in the Edmonton Zone (EZ) over a one-year period (Jan 1 2015 Dec 31 2015) was performed using ED information system data. URVA and URVNA populations were compared and a multivariable analysis identified predictors of URVA. Results: Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, OR 3.6), fewer annual ED visits (<4 visits, OR 2.0), higher disease acuity (CTAS 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a large referral hospital (OR 1.4), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit was also a risk factor (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion: We demonstrate that URVA patients comprise a distinct subgroup of 72-hr URVs across an entire health region. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.

Adherence to national paediatric bronchiolitis management guidelines and impact on emergency department resource utilization

2020 ◽  
Author(s):  
Kate Maki ◽  
Hawmid Azizi ◽  
Prabhjas Hans ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Prodromal Symptom ◽  
Retrospective Case ◽  
Management Guidelines ◽  
System Utilization ◽  
Index Visit ◽  
Return Visits ◽  
Physical Exam Finding ◽  
Study Participants ◽  
Control Study

Abstract Objective To evaluate the association between the use of nonrecommended pharmacology (salbutamol and corticosteroids) per national bronchiolitis guidelines, either during the index visit or at discharge, and system utilization measures (frequency of return visits [RTED] and on paediatric emergency department [PED] length of stay [LOS]). Study Design We conducted a retrospective case control study of 185 infants (≤12 months old) who presented to the PED between December 2014 and April 2017 and discharged home with a clinical diagnosis of bronchiolitis. Inclusion criteria included ≥ 1 viral prodromal symptom and ≥ 1 physical exam finding of respiratory distress. Cases were defined as infants who had ≥ 1 RTED within 7 days of their index visit and controls were matched for age and acuity but without RTED. Logistic regression analysis and multivariable linear regression were used to assess the odds of RTED and PED LOS associated with nonadherence to pharmaceutical recommendations per AAP and CPS bronchiolitis guidelines. Results Use of nonrecommended pharmacology per national bronchiolitis guidelines was documented among 39% of the 185 study participants. Adjusting for acuity of index visit, age, severe tachypnea, oxygen desaturation, and dehydration, use of nonrecommended pharmacology was not associated with RTED (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.47 to 2.03). Use of salbutamol and corticosteroids, however, were each independently associated with increased PED LOS (58.3 minutes [P=0.01] and 116.7 minutes [P&lt;0.001], respectively). Conclusion Nonadherence to the pharmaceutical recommendations of national bronchiolitis guidelines was not associated with RTED but salbutamol and corticosteroid use increased PED LOS.

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

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

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

CJEM ◽  
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.

scholarly journals Return visits to the pediatric emergency department: A multicentre retrospective cohort study

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 578-585 ◽  
Author(s):  
Colin B. Meyer-Macaulay ◽  
Mimi Truong ◽  
Garth D. Meckler ◽  
Quynh H. Doan
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Significant Proportion ◽  
Pediatric Emergency ◽  
Index Visit ◽  
Return Visits

AbstractObjectiveReturn visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED.MethodsWe conducted a retrospective cohort study of all visits to a referral centre PED between August 2012 and August 2013. We compared demographic variables between children with and without an RTED, measures of flow and disposition outcomes between the initial (index) visit and RTED, and between RTED to the original PED versus to other EDs in the community.ResultsAmong all PED visits, 7.6% had an RTED within 7 days, of which 13% were to a facility other than the original PED. Children with an RTED had higher acuity and longer length of stay on their index visit. They were also more likely to be admitted on a subsequent visit than the overall PED population. RTED to the original PED had a longer waiting time (WT), length of stay, and more frequently resulted in hospitalization than RTED to a general ED.ConclusionsA significant proportion of RTED occur at a site other than where the original ED visit occurred. Examining RTED to and from only PEDs underestimates its burden on emergency health services.

scholarly journals P041: Does the involvement of learners in emergency department patient assessments result in an increased rate of short-term return visits?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S77-S78
Author(s):  
C. Elliott ◽  
K. Chen ◽  
T. Fitzpatrick
Keyword(s):  
Medical Students ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Short Term ◽  
Return Visit ◽  
Patient Assessments ◽  
Ed Visits ◽  
Return Visits ◽  
Level Of Training ◽  
One Year

Introduction: Learners, ether medical students or residents, often provide the initial assessment of patients visiting the Emergency Department (ED). Their involvement in ED patient care has been shown to increase length of stay, time to disposition decision, utilization of imaging and admission rates. It is unclear, however, if learners have an impact on the rate of short-term unscheduled return visits. The objective of this study was to determine if the involvement of learners in ED visits increases the rate of short-term unscheduled return visits. Methods: This study was a retrospective analysis of ED visit data at a single tertiary care center over a one-year period. Short-term unscheduled return visits (return visits) were defined as ED visits presenting within 72 hours of discharge from an initial non-admit ED visit and resulting in an admission to an inpatient unit on the second visit. The primary outcome was the rate of return visits for each staff physician, with and without learners involved during the initial visit. The secondary outcome assessed the interaction of level of training (medical student year 3, 4, resident year 1, 2, etc.) on return visit rates. For the primary outcome, statistical analysis was with a Wilcoxon Matched Pairs test; staff alone vs with learners. A Kruskal-Wallis test was used to compare learner level of training. Results: Return visits accounted for 1858 (1.09%) of all visits (N = 172494) to this tertiary care ED over the one-year study period. Return visits were statistically more likely when learners were involved in the initial ED visit (1.16%, CI 0.12), compared to initial visits seen by staff physicians alone (0.88%, CI 0.09) (p &lt; 0.0001). Return rates were statistically higher for PGY2 (1.67% CI 0.35) and PGY3 (1.66% CI 0.28) residents compared to staff physicians alone (p &lt; 0.0001). There was no difference in return visit rates between staff physicians and third year medical students (1.07% CI 0.27), fourth year medical students (1.21% CI 0.37), PGY1 (1.42% CI 0.22), PGY4 (1.23% CI 0.54) or PGY5 (1.33% CI 0.49) residents. Conclusion: This study demonstrated that the involvement of learners in ED patient assessments increased the rate of short-term unscheduled return visits. Moreover, return visit rates were highest for PGY2 and PGY3 residents. Further work is needed to understand the factors that contribute to this phenomenon.

scholarly journals P055: Quality assessment and improvement evaluation of return visits to the emergency department for ultrasound

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S83
Author(s):  
D. Giffin ◽  
K. Van Aarsen ◽  
M. Brine ◽  
K. Church ◽  
M. Fotheringham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Surgical Treatment ◽  
Ultrasound Examination ◽  
Hospital Setting ◽  
Medical Intervention ◽  
Initial Presentation ◽  
Return Visit ◽  
Retrospective Audit ◽  
Return Visits

Introduction: Depending on the time and day of initial Emergency Department (ED) presentation, some patients may require a return to the ED the following day for ultrasound examination. Return visits for ultrasound may be time and resource intensive for both patients and the ED. Qualitative experience suggests that a percentage of return ultrasounds could be performed at a non-ED facility. Our objective was to undertake a retrospective audit of return for ultrasound usage, patterns and outcomes at 2 academic EDs. Methods: A retrospective review of all adult patients returning to the ED for ultrasound at both LHSC ED sites in 2016 was undertaken. Each chart was independently reviewed by two emergency medicine consultants. Charts were assessed for day and time of initial presentation and return, type of ultrasound ordered, and length of ED stay on initial presentation and return visit. Opinion based questions were considered by reviewers, including urgency of diagnosis clarification required, if symptoms were still present on return, and if any medical or surgical treatment or follow up was arranged based on ultrasound results. Agreement between reviewers was assessed. Results: After eliminating charts for which the return visit was not for a scheduled ultrasound examination, 328 patient charts were reviewed. 63% of patients were female and median [IQR] age was 40 years [27-56]. Abdomen/pelvis represented 50% of the ultrasounds; renal 24%; venous Doppler 15.9%. Symptoms were still present and documented in 79% of cases. 22% of cases required a medical intervention and 9% an immediate surgical intervention. 11% of patients were admitted to hospital on their return visit. Outpatient follow-up based on US results was initiated in 29% of cases. Median [IQR] combined LOS was 479.5 minutes [358.5-621.75]. Agreement between reviewers for opinion based questions was poor (63%-96%). Conclusion: Ideally, formal ultrasound should be available on a 24 hour basis for ED patients in order to avoid return visits. A percentage of return for ultrasound examinations do not result in any significant change in treatment. Emergency departments should consider the development of pathways to avoid return visits for follow up ultrasound when possible. The low incidence of surgical treatment in those returning for US suggests that this population could be served in a non-hospital setting. Further research is required to support this conclusion.

scholarly journals P120: Characteristics and outcomes of patients with neurologic complaints who have an unscheduled return visit to the emergency department within 72 hours

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S107
Author(s):  
A. Schouten ◽  
A. Gauri ◽  
M. Bullard
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Admission Rate ◽  
Quality And Safety ◽  
University Of Alberta ◽  
Return Visit ◽  
Ed Visits ◽  
Return Visits ◽  
Ischemic Attack ◽  
The University

Introduction: Patients with neurologic presenting complaints comprised 12.5% of total University of Alberta Emergency Department (ED) visits in 2017. This group of patients has high rates of EMS utilization, admission, and ED resources including diagnostic imaging and consult services. We sought to analyze the characteristics and outcomes of the patients with neurologic complaints who have an unscheduled return visit (URV) to the ED within 72 hours to identify opportunities for improvement in quality and safety of patient care. Methods: Data was extracted from the Emergency Department Information System (EDIS) and National Ambulatory Care System databases to select adult patients presenting to the University of Alberta hospital in 2017 with neurologic complaints as defined by the Canadian Triage and Acuity Scale (CTAS). We additionally selected for return visits to Edmonton Zone EDs within 72 hours. Using standard descriptive statistics, we examined demographic and clinical characteristics of patients with 72-hour URV. Results: Of 8,770 total visits, 674 (7.69%) had a 72-hour URV to an Edmonton zone ED. The URV rate was 9.0% in patients seen by a physician and discharged with approval and 23.4-33.3% in patients who left against medical advice (LAMA), prior to completion of treatment (LPCT), or without being seen by a physician (LWBS). The mean age of URV patients was 45.6 years, 56.5% were male, with a mean ED length of stay of 7.37 hours. The top 5 diagnoses for URV patients were headache, migraine, alcohol related disorders, concussion, and transient ischemic attack. 14.7% of URV patients were admitted, 13.5% LWBS, 1.6% LAMA, 1.6% LPCT, and 66.1% were discharged. Conclusion: The majority of neurologic complaint patients with URV within 72 hours are those who LAMA, LPTC, or LWBS at index visit. The admission rate for URV patients (14.7%) is lower than for the index ED visit (55%), however these patients have high LWBS rates. Identifying strategies to limit the LWBS rate for these patients would reduce return visits and improve the quality and safety of patient care.

scholarly journals Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2748-2756
Author(s):  
Sophia Sheikh ◽  
Ashley Booth-Norse ◽  
Carmen Smotherman ◽  
Colleen Kalynych ◽  
Katryne Lukens-Bull ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Literacy ◽  
Adult Literacy ◽  
Middle Aged ◽  
Index Visit ◽  
Predictive Variables ◽  
Pain Scores ◽  
Academic Center ◽  
Return Visits

Abstract Objective The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients &gt; 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. Methods Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. Results The majority of the 130 enrolled patients &gt; 55 years of age returned for pain (57%), were African American (78%), were younger (55–64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8–0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3–7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0–1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. Conclusions The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.

scholarly journals Frequent users of the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 401-408 ◽  
Author(s):  
Jade Seguin ◽  
Esli Osmanlliu ◽  
Xun Zhang ◽  
Virginie Clavel ◽  
Harley Eisman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Social Deprivation ◽  
Pediatric Emergency ◽  
Primary Objective ◽  
Deprivation Index ◽  
Pediatric Emergency Department ◽  
Frequent User ◽  
Index Visit ◽  
Ed Crowding

AbstractObjectivesEmergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use.MethodsWe conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children’s Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient’s characteristics and the number of PED visits over a 1-year period following the index visit.ResultsPatients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit.ConclusionOur study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.

scholarly journals Current Disease pattern and Out-come of patients in a Medical Unit of a Pediatric Hospital

2020 ◽  
Vol 10 (2) ◽  
pp. 386-388
Author(s):  
M Mizanur Rahman ◽  
Mirza Md Ziaul Islam ◽  
M Atiqul Islam ◽  
AKM Tajuddin Bhuiyan ◽  
AFM Ashik Imran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Rural Areas ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
Pediatric Hospital ◽  
Female Ratio ◽  
Medical College ◽  
Disease Pattern ◽  
System Data ◽  
One Year

Background: Epidemiological trends of diseases and causes of mortality is not constant, it is always changing. Analysis of admitted patients gives us information on the burden of diseases in the community as well as cause of mortality. Objectives: To determine current pattern of admissions and their outcomes in a tertiary care Pediatric hospital. Material and Methods: A descriptive study was carried out at Dhaka Shishu (Children) Hospital over a period of one year from 1st January to 31st December, 2015. All the admitted patients during the study period were included and data were collected from medical records for analysis of age, residence, mode of admission, referral source, disease profile and outcome. Final diagnosis and mortality were grouped according to involved organ system. Data were analyzed by using SPSS version 17.0. Results: Total 1424children with a male and female ratio of 1.5:1 were admitted in one year. Patients younger than 5 years were 73%and 27% were less than one year. Respiratory infection, neurologic, hematology, oncologic conditions were the main diseases. Mortality was 2.6% and it was highest in nonspecific infection group followed by respiratory, hematologic, neurologic, and oncologic diseases. Mean duration of hospital stay was 11.5 days. Most patients 59.1% were admitted through Emergency Department(ED) and came directly to the hospital. Fifty percent of admissions were from Dhaka and neighboring areas and rest were from other cities and rural areas of Bangladesh. Conclusion: Non-specific infection, respiratory or neurologic diseases are main diseases found in admitted patients and these diseases were the main contributor to death as well. Most of the patients approach directly to this hospital and also through emergency department. Northern International Medical College Journal Vol.10 (2) Jan 2019: 386-388

Sign in / Sign up

Export Citation Format

Share Document