The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.
BACKGROUND
Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues.


OBJECTIVE
We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.


METHODS
Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed. Any substandard quality on the first visit or change in outcome on the return admission was considered "low quality." Multivariate logistic regression was used to assess the relationship between cases judged as low quality vs. not low quality.


RESULTS
Of 741,132 ED visits across 5 years, 3682 (0.5%) were 72-h return admissions. Of those, 192 (5%) were low quality. In 158 (4%) and 8 (0.2%) there were moderate and severe deviations from care standards, respectively. Similarly, in 53 (1%) and 14 (0.4%) there were moderate and severe changes in outcome. In adjusted analysis, there were higher rates of low-quality 72-h return admissions in ambulance arrivals (odds ratio [OR] 1.5, 95% confidence interval (CI) 1.1-2.1); and lower rates in Medicaid patients (OR 0.3, 95% CI 0.2-0.7). There were higher rates in low-quality 72-h return admissions in hospital 1 (OR 3.6, 95% CI 2.2-6.1) and hospital 3 (OR 3.2, 95% CI 2.0-4.7) compared to hospital 2.


CONCLUSIONS
Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality.
Department of Emergency Medicine, The George Washington University, Washington, DC 20037, USA.
Jameel
J
Abualenain
William J
WJ
Frohna
Mark
M
Smith
Michael
M
Pipkin
Cynthia
C
Webb
David
D
Milzman
Jesse M
JM
Pines
D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult
Emergency Department; quality assurance; return admissions; return visits