Return visits to a pediatric emergency department.
OBJECTIVE
To determine the incidence of return visits (RVs), types of RVs, and factors associated with RVs to a pediatric emergency department (ED).


METHODS
: Retrospective cohort study of patients seen in an urban, tertiary care pediatric ED.


RESULTS
RV within 48 hours, identified from a computerized log.


RESULTS
The total RV rate was 3.5% (95% confidence interval, 3.3-3.6), similar to rates (2.4% to 3.4%) reported in general EDs. Most (78.5%) RVs were unscheduled, 17% were scheduled, and 4% were called back to the ED. Infectious disease (45%), respiratory (16%), and trauma (16%) accounted for most RV diagnoses. When compared with the overall ED population, RV patients were more likely to be younger than 2 years [relative risk, 1.3 (1.2-1.4)], to be admitted to the hospital [relative risk, 1.3 (1.2-1.5)], and to be triaged as acute [relative risk, 1.1 (1.0-1.2)]. Patients called back to the ED were younger, more likely to be triaged as acute, and more likely to be admitted than other RV patients. Significant diagnoses were made at RV in 7 (0.4%; 95% confidence interval, 0.1-0.7) patients, half of whom were called back to the ED or had a scheduled RV.


CONCLUSIONS
Similarities between our pediatric ED RV rate and other published research implies that benchmarking and quality improvement tools for RV can be used and compared in both pediatric and general EDs. Focusing on systems to call patients back to the ED when necessary may be an efficient way to reduce medical error and adverse patient outcomes.
Alessandrini
Evaline A
EA
Division of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA.
Lavelle
Jane M
JM
Grenfell
Stephanie M
SM
Jacobstein
Cynthia R
CR
Shaw
Kathy N
KN
D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006693:Holidays / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015143:Philadelphia; D012189:Retrospective Studies; D012621:Seasons; D014505:Urban Population