Return Visits to the Emergency Department: What Can We Learn From Older Adults’ Experiences?

BACKGROUND Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. OBJECTIVE This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. METHODS We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. RESULTS The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. CONCLUSIONS Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

Download Full-text

Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2017-019318 ◽

2017 ◽

Vol 7 (12) ◽

pp. e019318 ◽

Cited By ~ 4

Author(s):

Joyce J H Wachelder ◽

Isabelle van Drunen ◽

Patricia M Stassen ◽

Steffie H A Brouns ◽

Suze L E Lambooij ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Socioeconomic Status ◽

Older Adult ◽

Community Dwelling ◽

Low Ses ◽

Inhospital Mortality ◽

Average Household Income ◽

Return Visits ◽

Triage Level

ObjectivesOlder adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.DesignA retrospective study.ParticipantsOlder adults (≥65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low (<€1800/month), intermediate (€1800–€2300/month) and high (>€2300/month).Primary outcomesHospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.ResultsIn total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).ConclusionIn older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.

Download Full-text

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

Pain Medicine ◽

10.1093/pm/pnaa213 ◽

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 > 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 > 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.

Download Full-text

Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study

JMIR Medical Informatics ◽

10.2196/22491 ◽

2021 ◽

Vol 9 (7) ◽

pp. e22491

Author(s):

Rai-Fu Chen ◽

Kuei-Chen Cheng ◽

Yu-Yin Lin ◽

I-Chiu Chang ◽

Cheng-Han Tsai

Keyword(s):

Older Adults ◽

Emergency Department ◽

Health Insurance ◽

Chronic Illness ◽

Length Of Stay ◽

Prediction Model ◽

Older Adult ◽

National Health Insurance ◽

Research Database ◽

Return Visits

Background Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. Objective This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. Methods We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. Results The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. Conclusions Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

Download Full-text

Predictors of return visits to the emergency department among different age groups of older adults

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.07.042 ◽

2020 ◽

Author(s):

Lucas Oliveira J. e Silva ◽

Molly M. Jeffery ◽

Ronna L. Campbell ◽

Aidan F. Mullan ◽

Paul Y. Takahashi ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Age Groups ◽

Return Visits

Download Full-text

Development of a Risk Prediction Screening Tool for Opioid-Prescription Injury (STOP Injury) in Older Adults Initiated on Opioids From the Emergency Department

Case Medical Research ◽

10.31525/ct1-nct03836235 ◽

2000 ◽

Author(s):

Keyword(s):

Older Adults ◽

Emergency Department ◽

Risk Prediction ◽

Screening Tool ◽

Opioid Prescription

Download Full-text

Injuries and frequent use of emergency department services: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-040272 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040272

Author(s):

Catherine Laferté ◽

Andréa Dépelteau ◽

Catherine Hudon

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Cohort Studies ◽

Eligibility Criteria ◽

Geriatric Population ◽

Physical Injuries ◽

Frequent Use ◽

Different Types ◽

Ed Visits ◽

Return Visits

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.

Download Full-text