Frequency, Causes, and Outcomes of Return Visits to the Emergency Department Within 72 Hours: A Retrospective Observational Study

Abstract

Background

Emergency departments (EDs) serve as an accessible gateway to healthcare system wherein numerous patients consider it a prime choice for medical complaints. Frequency of ED revisits, causes, and its burden are necessary to assess quality of care provided to patients and identify factors that leads to revisit.

Patients and Methods

Electronic and printed medical records of all patients who revisited ED from January to May 2016 within 72 hours of initial visit were reviewed. Patients’ cause of revisit were classified to three categories: patient-, physician- and system-related factors. Common complaints that require revisits were also collected. Descriptive analysis was performed and categorical variables were represented by the frequency; percentages and continuous variables were presented as median, and range if data did not follow normal distribution.

Results

Of the 79,279 patients who visited ED during the study period, 1.3% (1000) patients revisited within 72 hours; 51.3% (n=513) were males, with a mean age of 31.5 years (SD=17.7 years) where majority (57.1%) had no comorbidity recorded. The most attributed factors for revisit were as follows: patient-related causes 635 patients (63.5%), physician-related factors 167 patients (16.7%), and system-related factors 42 patients (4.2%); 15.6% were found not related to the initial visit. Recurrence of the same complaint was the highest among patient-related factors (80.5%), inadequate management and no improvement of symptoms in 71.3% among the physician-related factors. The most common ED revisit complaint was fever 29.1% (n=291). Outcomes of the revisit were mainly patient discharge 96.7% (n=967), admission 1.2% (n=12) and death in 0.2% (n=2).

Conclusion

Recurrence of the same complaint with no symptoms improvement and suboptimal management of physicians contributed to most of the ED revisits within 72 hours. Encouraging physicians to provide clear instructions in educating patients on discharge regarding disease progression and its red flags as to when a return to ED, might help in reducing revisit rate.

Keywords:

• emergency department
• revisit
• factors

Abbreviation

ED, emergency department; CTAS, Canadian Triage Acuity Scale.

Data Sharing Statement

All data produced and analyzed in this study are included in this manuscript as presented in Tables 1–3 and Figures 1–4.

All data requests should be addressed to the corresponding author for consideration. Access to anonymised data may be granted following review. All source records including electronic data are stored in secured systems in accordance with institutional policies and regulations. Data including any electronic transmission of data are only identified by the study coded number.

The study results will be released to the participating physicians, patients and the general medical community on publication.

Ethics Approval and Consent to Participate

No patients were involved either in the design, recruitment and conduct of this study nor in the development of outcome measures. We will publish the results of the study in lay language for patient interest groups. This study, including data acquisition was approved by the Ethics Committee of Imam Abdulrahman Bin Faisal University Ethics Board approval no. IRB-2015-01-136. All patient data was de-identified and patient consent acquisition was waived by our ethics board due to the retrospective nature of this study.

The manuscript does not contain any individual person’s data and is compliant based on Declaration of Helsinki. Standing Committee for Research Ethics on Living Creatures (SCRELC) of the Imam Abdulrahman bin Faisal University and the authors have no objection in granting and assigning the Journal of Multidisciplinary Healthcare unrestricted right to reproduce, publish, and distribute this manuscript in all forms.

Acknowledgments

We wish to acknowledge the King Fahad Hospital of the University administrators and staff for providing much needed assistance throughout the course of this research. We thank our colleagues from the ED who provided insight and expertise that greatly assisted the research and for their comments on an earlier version of the manuscript.

This article is accessible in the book of abstracts which was presented in Research Forum ACEP17 in October 29–31, 2017; Walter E. Washington Convention Center, Washington DC.

Author Contributions

The corresponding author had full access to all data presented in this study and the final responsibility of deciding to submit the study for publication. All authors made significant contributions to conceptualization, design, acquisition, analysis and interpretation of data. Likewise, all authors took part in drafting and critically revising the article for essential intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

Authors declare that they receive no financial support from any commercial organization or company.