Longitudinal Trends in Pediatric Return Visits to US Emergency Departments

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.

Download Full-text

Qualitative evaluation of a mandatory provincial programme auditing emergency department return visits

BMJ Open ◽

10.1136/bmjopen-2020-044218 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044218

Author(s):

Lucas B Chartier ◽

Hanna Jalali ◽

M. Bianca Seaton ◽

Howard Ovens ◽

Bjug Borgundvaag ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Emergency Departments ◽

Large Scale ◽

Qualitative Evaluation ◽

Snowball Sampling ◽

Continuous Quality ◽

Return Visits ◽

Perceived Impact ◽

Key Aspects

ObjectiveThe objective of this qualitative study was to evaluate the perceived impact and value of the Return Visit Quality Programme (RVQP), a mandatory province-wide emergency department audit programme.DesignWe employed an interpretive descriptive qualitative approach with maximum variation sampling to ensure diverse representation across several geographical and institutional factors. RVQP programme leads were invited to participate in semistructured interviews and snowball sampling was used to reach non-lead physicians to capture the perspectives of those working within the programme.SettingIn Ontario’s RVQP, participating emergency departments must audit their return visits resulting in admission to identify issues that can be addressed through quality improvement initiatives.ParticipantsBetween June and August 2018, we interviewed 32 participants (local programme leads and non-lead physicians) from 23 out of the 86 participating centres.ResultsParticipants’ perceived impact and value of the programme was associated with the existence (or absence) and nature of the local quality improvement culture, the implementation approach of the programme within their emergency departments, and key aspects of the programme pertaining to medicolegal concerns and resource availability.ConclusionsThis study of an innovative, large-scale programme aimed at promoting continuous quality improvement in emergency departments showed that while its perceived impact has been meaningful, there are key structural and operational elements that support and hinder this aim. Healthcare leaders should consider these findings when looking to implement large-scale audit or quality improvement programmes.

Download Full-text

P072: Comparing met vs. unmet palliative care needs in patients with end-stage conditions presenting to two Canadian emergency departments

CJEM ◽

10.1017/cem.2019.263 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S89 ◽

Cited By ~ 1

Author(s):

M. Garrido Clua ◽

M. Kruhlak ◽

S. Kirkland ◽

C. Villa-Roel ◽

A. Elwi ◽

...

Keyword(s):

Palliative Care ◽

Emergency Departments ◽

Screening Tool ◽

Care Utilization ◽

Care Needs ◽

Significant Difference ◽

Return Visits ◽

Met Needs ◽

End Stage ◽

The Impact

Introduction: Patients with end-stage conditions require integrated physical, spiritual, psychological and social care. Despite efforts to provide comprehensive community care, those with severe symptoms often present to emergency departments (EDs) with palliative care (PC) needs. The objective of this study was to identify patients with end-stage diagnoses presenting to EDs, and to document and compare their PC needs. Methods: A four-month prospective cohort study was conducted in two Canadian EDs. Using a modified PC screening tool, volunteer emergency physicians identified adult patients with end-stage illnesses and documented their PC needs. This tool has the ability to classify patients as having met vs. unmet PC needs based on the documentation of risk factors. Research assistants documented demographic information, severity at presentation (Canadian Triage and Acuity Scale {CTAS}), disposition and revisits from an electronic repository. Bivariate comparisons between patients with met vs. unmet PC needs were completed. Results: Overall, 663 patients were enrolled, of which 78% (n = 518/663) were identified as having unmet PC needs according to the screening tool. Cancer was the most prevalent condition in each group (43% unmet needs, 37% met needs). There was no significant difference between the two groups in terms of age, sex or CTAS score. The unmet PC needs group was more likely to be admitted (68% vs. 50%; p = 0.0001) when compared to patients with PC needs assessed as being met. No significant difference was noted in terms of time to physician assessment or ED length of stay. The two groups did not significantly differ in the proportion of return visits within 30 days (34% vs. 32%) or the average number of return visits (3 vs. 2 visits). A higher proportion of patients with unmet PC needs made at least one visit to the ED in the 6 months prior to their index visit compared to patients with met PC needs (74% vs. 51%, p < 0.001); yet, the average number of ED visits was similar between the groups (3 visits). Conclusion: This study revealed that patients with end-stage diagnoses, especially cancer, commonly have unmet PC needs. They are also more likely to present to the ED and to require hospitalization than patients in whom PC needs have been met. Further investigations into their clinical profile and health care utilization may clarify the impact of their unmet PC needs on the healthcare system.

Download Full-text

Prevalence and predictors of return visits to pediatric emergency departments

Journal of Hospital Medicine ◽

10.1002/jhm.2273 ◽

2014 ◽

Vol 9 (12) ◽

pp. 779-787 ◽

Cited By ~ 31

Author(s):

Ayobami T. Akenroye ◽

Cary W. Thurm ◽

Mark I. Neuman ◽

Elizabeth R. Alpern ◽

Geetanjali Srivastava ◽

...

Keyword(s):

Emergency Departments ◽

Pediatric Emergency ◽

Return Visits

Download Full-text

Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000001 ◽

2010 ◽

Vol 31 (1) ◽

pp. 1-6 ◽

Cited By ~ 62

Author(s):

Gregory Luke Larkin ◽

Annette L. Beautrais

Keyword(s):

Suicide Prevention ◽

Emergency Departments

Download Full-text

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽

10.1027/0227-5910/a000499 ◽

2018 ◽

Vol 39 (5) ◽

pp. 318-325 ◽

Cited By ~ 8

Author(s):

Barbara Stanley ◽

Glenn W. Currier ◽

Megan Chesin ◽

Sadia Chaudhury ◽

Shari Jager-Hyman ◽

...

Keyword(s):

Emergency Departments ◽

Suicide Attempts ◽

The United States ◽

Administrative Claims ◽

Suicide Attempters ◽

Self Injury ◽

Axis I ◽

Ed Visits ◽

External Causes ◽

Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

Download Full-text