Unplanned return visits to emergency in a regional hospital

2012 ◽  
Vol 36 (3) ◽  
pp. 336 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Upali W. Jayasinghe ◽  
Mark F. Harris
Keyword(s):  
Emergency Department ◽  
Patient Characteristics ◽  
Regional Hospital ◽  
Hospital Data ◽  
Service Usage ◽  
Return Visit ◽  
Visit Rate ◽  
Return Visits ◽  
Emergency Department Patients ◽  
Patient Service

Objective. The aim of this study was to determine the patient characteristics associated with unplanned return visits, using routinely collected hospital data, to assist in developing strategies to reduce their occurrence. Methods. Emergency department data from a regional hospital were analysed using univariate and multivariate methods to determine the influence of clinical, service usage and demographic patient characteristics on unplanned return visits. Results. Around 80% of the 16 000 patients attending emergency presented on only one occasion in a year. Five per cent of patients presented with an unplanned return visit. Older patients, those with minor and low urgency conditions and with non-psychotic mental health conditions, those presenting during winter and after hours were significantly more likely to present as unplanned return visits. Conclusion. Although patient characteristics associated with unplanned return visits have been identified, the reasons underpinning the unplanned return visit rate, such as patient service preference and attitudes, need to be more fully investigated. What is known about the topic? Patients who present as unplanned return visits are older and have a range of chronic and acute conditions. Some unplanned return visits occur because of limited access to other non-hospital service. What does this paper add? This paper adds to the field by providing information from a regional hospital in NSW Australia on the patient characteristics associated with unplanned return visits. It provides a basis for differentiating between other groups of frequent emergency department patients. However, the reasons behind the unplanned return visit rate need to be more fully investigated. What are the implications for practitioners? The implications of the findings of this study for policy makers, administrators and clinicians are that access to alternative services for the conditions associated with unplanned return visits need to be further investigated in the context of the role for emergency department services.

Frequent emergency attenders: is there a better way?

2011 ◽  
Vol 35 (4) ◽  
pp. 462 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Upali W. Jayasinghe ◽  
Mark F. Harris
Keyword(s):  
Emergency Department ◽  
Community Mental Health Services ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Hospital Data ◽  
Service Usage ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Repeat Prescriptions

Background. Understanding the reasons for frequent re-attendances will assist in developing solutions to hospital overcrowding. This study aimed to identify the factors associated with frequent re-attendances in a regional hospital thereby highlighting possible solutions to the problem. Methods. A retrospective analysis was performed on emergency department data from 2008. Frequent re-attenders were defined as those with four or more presentations in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on re-presentations using multivariate analysis. Results. A total of 8% of the total patients presenting to emergency re-attended four or more times in the year. Frequent re-attenders were older, presented with an unplanned returned visit and had a diagnosis of neurosis, chronic obstructive pulmonary disease (COPD), convulsions, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures and less likely to present in summer. Frequent re-attendances were unrelated to sex, time of presentation or country of birth. Conclusions. Diversion of patients with minor conditions to alternative services; referral of COPD patients to follow-up respiratory services and patients with neurosis to community mental health services would reduce emergency utilisation. Improving access to and resourcing of alternative non-hospital services should be investigated to reduce emergency overcrowding. What is known about the topic? Frequent re-attendances at emergency contribute to emergency overcrowding and are a problem worldwide. Generally, frequent re-attendances have been associated with disadvantage. Identifying patient factors that predict re-attendances will assist in developing strategies to prevent their occurrence. The reasons for re-attendances may vary depending on access to other services and the role of the hospital. What does this paper add? This paper adds to the field by demonstrating how routinely collected hospital data can be used to determine patient characteristics important in frequent re-attendances. The factors associated with frequently re-attending patients include older age, type of condition, unplanned return visit and season. What are the implications for practitioners? This paper has implications for both administrators and clinicians. The diversion of attending patients with neurosis, COPD, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures to alternative affordable and accessible services would reduce overcrowding in the emergency department.

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

Questions to the article: Predicting Unscheduled Emergency Department Return Visits Among Older Adults (Preprint)

2021 ◽  
Author(s):  
Shu-Chun Kuo ◽  
Tsair-wei Chien ◽  
Willy Chou
Keyword(s):  
Emergency Department ◽  
Decision Tree ◽  
Class Imbalance ◽  
Patient Characteristics ◽  
Small Sample ◽  
Clinical Settings ◽  
Data Set ◽  
Online Module ◽  
Study Results ◽  
Return Visits

UNSTRUCTURED The article published on 28 July 2021 is well-written and of interest, but remains several questions that are required for clarifications, such as (1) the Figure 1 is too complex to release the decision criteria for predicting unscheduled emergency department return visits (EDRVs); (2) the Table 1 with 11 rules is not succinct for readers to capture the core features of the influencing factors on the unscheduled EDRVs, and (3) the decision tree technique using Weka software did not demonstrate an online module that can be implemented in clinical settings. We suggested three ways to improve the study in methods and illustrated examples presented in previous studies using the decision tree technique. In addition, to solve the problem of class imbalance in data should be combined with an MP4 video(or a Multimedia Appendix) to make readers easily replicate similar research in the future. The patient characteristics and variables deposited in Multimedia Appendix 1 are insufficient. A small sample of data (e.g., one-tenth from the 10-fold cross-validation method to randomly partition the data set into ten subsets in the study) should be provided for readers to verify the decision tree that can yield appropriately 76.65% and 76.95% in sensitivity and specificity, respectively, as did in predicting the unscheduled EDRVs. Otherwise, the study results are doubtable.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

scholarly journals Factors Affecting 72-Hour Unplanned Return Visits after Emergency Department Index Discharge of a Tertiary Private Hospital in the Philippines

2020 ◽  
Vol 54 (5) ◽  
Author(s):  
Ma. Lourdes Concepcion D. Jimenez ◽  
Rafael L. Manzanera ◽  
Ronne D. Abeleda ◽  
Diego A. Moya ◽  
Jose V. Segura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Strong Association ◽  
Tertiary Hospital ◽  
The Philippines ◽  
Third Party ◽  
Factors Affecting ◽  
Premature Discharge ◽  
Return Visits ◽  
Emergency Department Patients

Objectives. This study aimed to analyze if the indicator 72-hours Unplanned Return Visits after EmergencyDepartment (ED) index discharge was influenced by the patient’s age, triage severity, month, payment methods,and length of stay. Likewise, it aimed to determine if the 72-hour Unplanned Return Visits was a robust indicator inassessing the quality of Emergency Department services. Methods. This was a retrospective single-center study from January to December 2017. Data were retrievedfrom a tertiary hospital in the Philippines. All Emergency Department patients discharged on their index visitwere monitored for Unplanned Return Visits within 72 hours in the hospital. A univariate and multivariate logisticregression model was used to assess the variables associated with the 72-hour Unplanned Return Visits. Results. The 72-hour Unplanned Return Visits rate was measured at 2.67%, with the highest occurrence on thefirst 24 hours, and with predominance on third-party payer (p.<.0001), pediatrics (p.<0001), January (p<.0001),February (p<.0001), November (p<.0001), December (p<0001), and shorter length of stay (p<.0001) dischargedafter ED index visit. Conclusions. Strong association of Unplanned Return Visits during the first 72 hours after Emergency Departmentindex discharge was found for patients financed through third party-payers, with seasonal variations andinclination to the younger population with shorter length of stay. These findings warrant exploratory studies todetermine the reasons for the 72-hour Unplanned Return Visits after Emergency Department index discharge andinvestigation on the association of premature discharge, socio-economic, health structure, and illness progression.

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 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.

Sign in / Sign up

Export Citation Format

Share Document