Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.
OBJECTIVE
Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors.


METHODS
A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed. The study was performed over a one year period at a tertiary hospital ED. Data are reported as relative risk (RR) and 95% confidence interval (CI).


RESULTS
There were a total of 51.210 ED visits during the study period. The total number of ED return visits within 72 hours was 1.124 (2,19%; 95% CI 2,07 to 2,32). The total number of ED patients managed by the GIM service was 9.511. The percentage of patients treated by the GIM service who returned to the ED within 72 hours was 1,48% (95% CI 1,25 to 1,74) when calculated for the whole group and 2,9 % (95% CI 2,46-3,41) for those discharged home from the ED (n = 4.860). The majority (82,98%) of ED return visits by patients discharged from the GIM service were unscheduled and related to their index presenting complaint. Abdominal pain was the commonest initial presenting symptom in the patients who returned to the ED after discharge. Patients with diarrhoea as the initial initial presenting symptom had the highest relative risk of an ED return visit (RR = 4.07).


CONCLUSIONS
The percentage ED return visits by patients discharged from the ED by the GIM service is 1,48%. Patients presenting with diarrhoea as the initial presenting symptom have the highest relative risk of an early ED return visit. Our main practical conclusion is that patients with abdominal pain need to be re-examined carefully and instructed about potential evolution before discharge.
Vanbrabant
P
P
Emergency Department, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium. peter.vanbrabant@uz.kuleuven.ac.be
Knockaert
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D
D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000453:epidemiology; D010351:Patient Discharge; D019233:Retreatment / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult