Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan

Chiu-Lung Wu, Fa-Tsai Wang, Yao-Chiu Chiang, Yuan-Fa Chiu, Teong-Giap Lin, Lian-Fong Fu, Tsung-Lung Tsai
Journal of Emergency Medicine 2010, 38 (4): 512-7

BACKGROUND: When patients return to the emergency department (ED) shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate.

OBJECTIVES: The purpose of this study was to determine the rates and causes of revisits to the ED of a 710-bed secondary teaching referral hospital (Kuang Tien General Hospital), to identify areas for improvement, and to define the initial ED presentations that are associated with such revisits.

METHODS: The study period was from January 1, 2006 to December 31, 2006. There were 34,714 patients seen and discharged in the ED; 1899 patients returned within 72 h. Monthly revisit rates were calculated. The patients who revisited the ED within 72 h were retrospectively identified by the authors, and their charts were examined to determine the causes of the revisits.

RESULTS: There were 1899 patients (5.47% of total) found to have revisited the ED within 72 h after their initial visit. The monthly revisit rates ranged from 2.85% to 6.25% (average, 5.47%). The rates of revisits that were related to factors of illness, patients, and doctors were 80.9%, 10.9%, and 8.2%, respectively. Among the factors related to doctors, 3.7% (70 cases) were misdiagnosis, and abdominal pain was the most common presentation (55.7%, 39/70). The most common initial ED presentations were for abdominal pain (12.9%), fever (12.6%), vertigo (4.5%), headache (2.1), and upper respiratory infection (2.1%).

CONCLUSIONS: Unplanned ED revisits are associated with medical errors in prognosis, treatment, follow-up care, and information. Differentiation between the natural course of a disease, suboptimal therapy, over-anxious reaction of the patient, and medical errors is difficult. Although this study indicates that most revisits are illness-related, further prospective studies are needed to evaluate the most common and the most serious causes of revisits to see if improvements can be made.

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