Unscheduled return visits to a Dutch inner-city emergency department.

M Christien Van Der Linden,Robert Lindeboom,Ernie Rjt De Deckere,Naomi Van Der Linden,J Carel Goslings,Cees Lucas,Steven J Rhemrev,Rob De Haan

doi:10.1186/s12245-014-0023-6

Abstract

BackgroundUnscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems.MethodsAll unscheduled return visits occurring within 1 week and related to the initial ED visit were selected. Multivariable logistic regression was conducted to determine independent factors associated with unscheduled return, using patient information available at the initial visit. Reasons for returning unscheduled were categorized into illness-, patient- or physician-related. Post-ED disposition was compared between patients with unscheduled return visits and the patients who did not return.ResultsFive percent (n = 2,492) of total ED visits (n = 49,341) were unscheduled return visits. Patients with an urgent triage level, patients presenting during the night shift, with a wound or local infection, abdominal pain or urinary problems were more likely to return unscheduled. Reasons to revisit unscheduled were mostly illness-related (49%) or patient-related (41%). Admission rates for returning patients (16%) were the same as for the patients who did not return (17%).ConclusionsApart from abdominal complaints, risk factors for unscheduled return differ from previous studies. Short-term follow-up at the outpatient clinic or general practitioner for patients with urgent triage levels and suffering from wounds or local infections, abdominal pain or urinary problem might prevent unscheduled return.

Highlights

Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care
We examined factors that were associated with unscheduled return in previous research, including age [14,20], sex [17,20], lacking health insurance [11], lacking a general practitioner (GP) [10], triage level [11,14,16,20], arrival time [14,21], length of stay (LOS) [22] and medical complaints [11,15,18]
Return rate During the study year, a total of 49,341 ED visits were recorded, of which 4,653 visits were related to unscheduled return (Figure 1)

Summary

Introduction

In order to reduce unscheduled return visits, researchers have focused on risk factors that could help identify patients at risk for unscheduled return [11,14,15,16,17,18,19]. Most of these studies have been performed in Canada and the USA and reported acute triage category [14,16], arrival in the evening [14] and a respiratory diagnosis [19] as risk factors for paediatric unscheduled return. A low triage category and suffering from dermatologic van der Linden et al International Journal of Emergency Medicine 2014, 7:23 http://www.intjem.com/content/7/1/23 conditions [11] were risk factors for unscheduled return in a mixed (adults and children) population

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