Unplanned Reattendance Research Articles

PB11 The impact of frequent attenders to the emergency department on “unplanned reattendance rate” & “left without being seen rate” clinical quality indicators

Objectives and BackgroundThe eight new clinical quality indicators of performance for Emergency Departments (EDs) focus on patient satisfaction, patient safety and effectiveness of care. This audit aims to identify the...

031 Delivering safety net advice and the Emergency Department Clinical Quality Indicator of unplanned re-attendance in children

Objectives and BackgroundA Department of Health study has shown parents of children presenting with fever who did not receive safety net advice were more likely to unnecessarily re-attend. This work...

Can an Emergency Department-based Clinical Decision Unit successfully utilize alternatives to emergency hospitalization?

To evaluate a Clinical Decision Unit (CDU) designed to utilize alternatives to emergency hospitalization. CDUs are one model of care designed to strengthen the gatekeeper role of Emergency Departments (EDs). This retrospective cohort study was carried out in a UK NHS acute hospital. All 854 patients in the CDU cohort were compared with three age-stratified, historical cohorts from the same clinical centre. The median age was 62 years (range 16-94).The main outcome measures were discharge to general practitioner, outpatient services or hospitalization, the 30-day unplanned reattendance rate for those not hospitalized, and monthly medical admission figures. Approximately 511 [59.8%, 95% confidence interval (CI): 56.5-63.1%] to 560 (65.6%, 95% CI: 62.3-68.7%) patients were admitted in the comparison cohorts, compared with only 186 (21.8%, 95% CI: 19.1-24.7%) in the CDU cohort (P≤0.05). Approximately 243 (28.5%, 95% CI: 25.5-31.6%) to 289 (33.8%, 95% CI: 30.7-37.1%) patients were discharged to general practitioner services in the comparison groups, compared with 562 (65.8%, 95% CI: 62.6-68.9%) in the CDU group (P≤0.05). Approximately eight (0.9, 95% CI: 0.5-1.8%) to 17 (2%, 95% CI: 1.2-3.2%) patients in the comparison groups were discharged to outpatient clinics, compared with 82 (9.6%, 95% CI: 7.8-11.8%) in the CDU group (P≤0.05). There was no consistent trend towards statistically significant rises in unplanned reattendance (P>0.05). Monthly medical admissions fell substantially during CDU operation. This CDU model was associated with statistically and clinically significant reductions in hospital admissions. The judicious application of this CDU model to other ED environments can be expected to yield similar benefits.

Unplanned Re-Attendance in the Accident and Emergency Department

The notes of patients who re-attended the Accident and Emergency Department with a problem for which they had already been seen and treated were reviewed over a five-week period. Such patients comprised 2.5% of total attendances. The commonest reason for re-attendance was persistent pain following an injury and of such patients, about a half required a significant change in management. It was estimated that two-thirds of re-attendances were unavoidable. Twenty patients were admitted following re-attendance, and of these, two had serious medical conditions which were missed on initial presentation. The role of senior Accident and Emergency doctors is discussed in the light of these findings.