title: Return visits to the emergency department: the patient perspective.
abstract: OBJECTIVE
  Reasons for recurrent emergency department (ED) visits have been examined primarily through administrative data review. Inclusion of patients' perspectives of reasons for ED return may help inform future initiatives aimed at reducing recurrent utilization. The objective of this study is to describe the personal experiences and challenges faced by patients transitioning home after an ED discharge.
  
  
  METHODS
  We performed semistructured qualitative interviews of adult patients with an unscheduled return to the ED within 9 days of an index ED discharge. Questions focused on problems with the initial discharge process, medications, outpatient care access, social support, and health care decisionmaking. Themes were identified with a modified grounded theory approach.
  
  
  RESULTS
  Sixty interviews were performed. Most patients were satisfied with the discharge process at the index discharge, but many had complaints about the clinical care delivered, including insufficient evaluation and treatment. The primary reason for returning to the ED was fear or uncertainty about their condition. Most patients had a primary care physician, but they rarely visited a physician before returning to the ED. Patients cited convenience and more expedited evaluations as primary reasons for seeking care in the ED versus the clinic.
  
  
  CONCLUSIONS
  Postdischarge factors, including perceived inability to access timely follow-up care and uncertainty and fear about disease progression, are primary motivators for return to the ED. Many patients prefer hospital-based care because of increased convenience and timely results. Further work is needed to develop alternative pathways for patients to ask questions and seek guidance when and where they want.
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. Electronic address: kristin.rising@jefferson.edu.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Rising
authors.affiliation: University of California San Francisco School of Medicine, San Francisco, CA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Padrez
authors.affiliation: Department of Internal Medicine, San Francisco, CA.
authors.forename: Meghan
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.affiliation: Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research; D013997:Time Factors; D055815:Young Adult