Emergency Department Pediatric Unscheduled Return Visits: Why do patients return and does it matter?
Abstract
Introduction: Unscheduled return visits are an important quality indicator in the emergency department. We aim to compare clinical characteristics and ED resource usage of pediatric high risk unscheduled return visits (HRURVs) between the index and return visit and explore root cause of HRURVs.
Methods: A retrospective chart-review study conducted between November 1, 2014 and October 31, 2015. All patients who returned to the ED within 72 hours of discharge and were admitted or died on re-presentation were considered.
Results: The incidence rate of HRURV in our study was 0.96% (95%, CI:0.81-1.13%). We found that significantly more patients were febrile on index visit than on the return visit. In contrast, HRURV patients had significantly more imaging, labs, IV fluids, ED consults and procedures on return visit. Also, the return visit length of stay (LOS) was significantly higher than on index visit (2.76±1.82 Vs. 5.88±0.44). Upon revisit, 2.2% of patients required ICU admission and 7.9% required surgery. The most common discharge diagnosis were digestive system disorders (29.5%) and infectious/parasitic diseases (27.3%). Only infectious/parasitic disease showed a high number of changes in diagnosis from first to second visit. The majority (73.4%) of HRURVs were classified as being “illness-related”. Digestive disorders accounted for the largest portion of “physician related” reasons for revisit (41%).
Conclusion: HRURV patients require more resources on return visits and have longer ED stays than the index visit. While the majority of re-visits do not lead to a change in diagnosis and are primarily related to progression of disease, specific attention should be paid to digestive disorders where physician related causes were high and which account for 18% of surgeries on return visit.