title: Implementation of clinical practices to reduce return visits within 72 h to a paediatric emergency department.
abstract: OBJECTIVE
  Return visits to the paediatric emergency department (PED) are an important measure of quality of healthcare and are associated with patients' and parents'/guardians' satisfaction. Previous studies have been limited to describing characteristics and factors related to return visits. The objectives of this study were to develop new clinical practices to reduce return visits to the PED and to see whether implementation of these practices had the desired effect.
  
  
  METHODS
  This was a controlled before-and-after study. New clinical practices were developed by analysing data for patients visiting in 2011 (before) and by surveying emergency physicians and nurses in the PED. New clinical practices were implemented between 16 July and 4 November 2012 (after). The rate of return visits and admission rates after return visits were compared between matched periods in 2011 and 2012. We also investigated return visits at three independent hospitals to overcome the limitation of the intervention application to a single hospital.
  
  
  RESULTS
  The new clinical practices included five protocols: set orders for common symptoms; management plans for patients at high risk of a return visit; a daily physician feedback system; protocolised discharge instructions; early planned visits to clinics. After implementation, the rate of return visits was reduced significantly, from 4.4% to 2.6% (p<0.01). The admission rate for return visits was also reduced, but not significantly so, from 22.3% to 17.5% (p=0.37). Return visits at the other hospitals were similar or significantly increased in 2012 compared with 2011.
  
  
  CONCLUSIONS
  The development and implementation of clinical practices were effective in reducing return visits of paediatric patients to the ED.
authors: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea.
authors: Jin Hee
authors: JH
authors: Jeong
authors: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
authors: Seung Sik
authors: SS
authors: Hwang
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Kyuseok
authors: K
authors: Kim
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Jin Hee
authors: JH
authors: Lee
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Joong Eui
authors: JE
authors: Rhee
authors: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea.
authors: Changwoo
authors: C
authors: Kang
authors: Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea.
authors: Soo Hoon
authors: SH
authors: Lee
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Hooyoung
authors: H
authors: Kim
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Yeon Sook
authors: YS
authors: Im
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Boeknam
authors: B
authors: Lee
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Young Im
authors: YI
authors: Byeon
authors: Department of Emergency Medicine, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea.
authors: Ji Sook
authors: JS
authors: Lee
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D012307:Risk Factors; D013997:Time Factors
keywords: Paediatrics; Quality Assurance