title: Unscheduled return visits to a Dutch inner-city emergency department.
abstract: BACKGROUND
  Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems.
  
  
  METHODS
  All unscheduled return visits occurring within 1 week and related to the initial ED visit were selected. Multivariable logistic regression was conducted to determine independent factors associated with unscheduled return, using patient information available at the initial visit. Reasons for returning unscheduled were categorized into illness-, patient- or physician-related. Post-ED disposition was compared between patients with unscheduled return visits and the patients who did not return.
  
  
  RESULTS
  Five percent (n = 2,492) of total ED visits (n = 49,341) were unscheduled return visits. Patients with an urgent triage level, patients presenting during the night shift, with a wound or local infection, abdominal pain or urinary problems were more likely to return unscheduled. Reasons to revisit unscheduled were mostly illness-related (49%) or patient-related (41%). Admission rates for returning patients (16%) were the same as for the patients who did not return (17%).
  
  
  CONCLUSIONS
  Apart from abdominal complaints, risk factors for unscheduled return differ from previous studies. Short-term follow-up at the outpatient clinic or general practitioner for patients with urgent triage levels and suffering from wounds or local infections, abdominal pain or urinary problem might prevent unscheduled return.
authors.affiliation: Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands.
authors.forename: M Christien
authors.initials: MC
authors.lastname: van der Linden
authors.affiliation: Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Lindeboom
authors.affiliation: Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: de Haan
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam 3000 DR, The Netherlands.
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.affiliation: Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands.
authors.forename: Ernie Rjt
authors.initials: ER
authors.lastname: de Deckere
authors.affiliation: Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Lucas
authors.affiliation: Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Rhemrev
authors.affiliation: Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
keywords: Emergency department; Emergency service; Hospital; Unscheduled return visits