Factors Affecting Return Visits to the Emergency Department within 30 Days
1Institute of Health Sciences, Medical Faculty, Vilnius University, Lithuania
2Centre of Emergency Medicine, Vilnius University, Lithuania
3Centre of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University, Lithuania
4Centre of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
DOI: 10.22514/sv.2020.16.0080 Vol.17,Issue 1,January 2021 pp.32-38
Published: 08 January 2021
Background and Objectives: The goal of this study is to determine the factors associated with the admission to hospital on a return visit to the ED. The reasons of return visits to the ED are complex and involve such causes as disease progression, medical errors, delayed diagnosis, or misdiagnosis. Materials and methods: A retrospective study was conducted in Vilnius University Hospital Santaros Klinikos. All the emergency visits from 1 January 2018 through 20 May 2019 were included. The patients were divided into two groups: the patients who visited the ED only once within a month were attributed to group 1, while those who paid two or more visits to the ED within 30 days belonged to group 2. The demographic data, the triage category, the number of laboratory and radiology tests, specialist consultations, diagnoses and the time spent in the ED were evaluated. The statistical analysis was performed using R statistical software package, non-parametric statistical methods were used. Results: 32,215 patients were included in the analysis, 3,243 patients (10.05%of all the initial visits) returned to the ED within 30 days. The number of laboratory tests had a statistically significant impact on admission to the ward both the first and the return visits. The triage category was associated with the admission on the return visit to the ED. Age, gender, number of consultations and radiology tests had no medium or large impact. Among the diagnoses, cardiovascular, gastrointestinal and renal diseases were related to the admission on return visit. Conclusions: Patients with cardiovascular, gastrointestinal and renal system diseases in all age groups, patients with medical conditions and advanced investigation (the increased number of laboratory testing and the time spent in the ED) have an increased risk for a return visit over a 30-day time frame and an increased rate of hospital admissions.
Return visits, Hospital admission, Emergency department
Aušra Bilotienė Motiejūnienė,Andrius Klimašauskas,Eglė Kontrimavičiūtė,Eugenijus Jasiūnas,Rūta Janulevičienė,Dovilė Majauskytė,Rimantas Stukas. Factors Affecting Return Visits to the Emergency Department within 30 Days. Signa Vitae. 2021. 17(1);32-38.
 Jelle de Gelder, Jacinta A Lucke, Bas de Groot, et al. Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department. Journal of the American Geriatrics Society. 2018;66:735-741.
 Trivedy CR, Cooke MW. Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Emerg Med J. 2015;32:324-329.
 Hutchinson CL, McCloughen A, Curtis K. Incidence, characteristics and outcomes of patients that return to Emergency Departments. An integrative review. Australas Emerg Care. 2019;22:47-68.
 Sheikh S, Booth-Norse A, Henson M, et al. Clinical Predictors for Older Adult Emergency Department Revisits for Pain. Annals of Emergency Medicine. 2018;72:S94-S95.
 Wu C-L, Wang F-T, Chiang Y-C, et al. Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan. J Emerg Med. 2010;38:512-517.
 Biese K, Massing M, Platts-Mills TF, et al. Predictors of 30-Day Return Following an Emergency Department Visit for Older Adults. N C Med J. 2019;80:12-18.
 Soh CHW, Lin Z, Pan DST, et al. Risk Factors for Emergency Department Unscheduled Return Visits. Medicina (Kaunas). 2019;55:457.
 Hayward J, Hagtvedt R, Ma W, et al. Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department. West J Emerg Med. 2018;19:912-918.
 Potezny TM, Horwood CM, Hakendorf P, et al. Predicting re-presentation following discharge from the emergency department with non-specific chest pain. Emerg Med Australas. 2018;30:193-199.
 Hiti EA, Tamim H, Makki M, et al. Characteristics and determinants of high-risk unscheduled return visits to the emergency department. Emerg Med J. 2020;37:79-84.
 Boendermaker AE, Coolsma CW, Emous M, et al. Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain. Emerg Med J. 2018;35:499-506.
 Li L, Georgiou A, Vecellio E, et al. The effect of laboratory testing on emergency department length of stay: a multihospital longitudinal study applying a cross-classified random-effect modeling approach. Acad Emerg Med. 2015;22:38-46.
 Hendin A, Eagles D, Myers V, et al. Characteristics and outcomes of older emergency department patients assigned a low acuity triage score. CJEM. 2018;20:762-769.
 Pereira L, Choquet C, Perozziello A, et al. Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study. PLoS ONE. 2015;10:e0123803.
 Sauvin G, Freund Y, Saïdi K, et al. Unscheduled return visits to the emergency department: consequences for triage. Acad Emerg Med. 2013;20:33-39.
 National Emergency Departments Advisory Group. A Quality Frame-work and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand. Wellington: Ministry of Health; 2014.
 TCoE Medicine. Emergency department clinical quality indicators: a guide to CEM implementation. TCoE Medicine, London; 2008.
 CfDCaPNCfH Statistics. Survey content for the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, USA; 2012.
 Obiagwu C, Rabice S, Ambesh P, et al. Developing a Targeted Approach to 30-Day Chf Readmissions. J Am Coll Cardiol. 2018;71:A721.
 Goldman MP, Monuteaux MC, Perron C, et al. Identifying discordance between senior physicians and trainees on the root cause of ED revisits. Emerg Med J. 2017;34:825-830.
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