title: Repeat emergency room visits for hand and wrist injuries.
abstract: OBJECTIVE
  To characterize patients with hand or wrist injuries presenting to our university-based emergency department (ED) after a previous evaluation by an outside ED. We hypothesized that a majority of these patients did not require emergent care, most arrived during working hours, and a disproportionate number were uninsured.
  
  
  METHODS
  We retrospectively reviewed 3,047 orthopedic hand consults from 2002 to 2010. Patients were included if our ED was the patient's second ED evaluation within 30 days for the same complaint. Demographics, diagnosis, referral instructions from the initial institution, date and time of ED visit, treatment received, and insurance status were recorded. Clinical urgency was quantified on an ordinal scale.
  
  
  RESULTS
  A total of 325 patients met the inclusion criteria. The most common diagnoses were distal radius and metacarpal fractures. There were 266 (82%) patients with nonurgent diagnoses. A junior-level orthopedic resident treated and discharged 97% of patients from the ED. Sixty-two percent of the patients were uninsured, 32% had Medicaid, and 6% had commercial insurance or Medicare. There was a disproportionate percentage of uninsured and Medicaid patients compared with the payer mix of our state, orthopedic department, and ED. Ninety percent of patients presented on weekdays, and 84% arrived between 6 am and 6 pm.
  
  
  CONCLUSIONS
  Most patients who met our inclusion criteria presented to our ED during regular business hours. Most were uninsured and did not have a condition that warranted urgent or emergent evaluation and treatment. With limited resources, it is important that an appropriate follow-up plan from the initial ED be in place so that patients do not have to present to a second ED for the same problem.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Department of Orthopaedics, Rutgers University-New Jersey Medical School, Newark, NJ.
authors.forename: Vishnu C
authors.initials: VC
authors.lastname: Potini
authors.affiliation: Department of Orthopaedics, Rutgers University-New Jersey Medical School, Newark, NJ.
authors.forename: Walter
authors.initials: W
authors.lastname: Bratchenko
authors.affiliation: Department of Orthopaedics, Rutgers University-New Jersey Medical School, Newark, NJ.
authors.forename: Glen
authors.initials: G
authors.lastname: Jacob
authors.affiliation: Department of Orthopaedics, Rutgers University-New Jersey Medical School, Newark, NJ.
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Rutgers University-New Jersey Medical School, Newark, NJ. Electronic address: tanvi@njms.rutgers.edu.
authors.forename: Virak
authors.initials: V
authors.lastname: Tan
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005383:Finger Injuries / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008484:Medicaid; D017057:Medically Uninsured / Q000706:statistics & numerical data; D050279:Metacarpal Bones / Q000293:injuries*; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States; D014954:Wrist Injuries / Q000601:surgery*
keywords: Emergency; insurance; transfer; trauma; walk-in