title: Emergency Department Bouncebacks: Is Lack of Primary Care Access the Primary Cause?
abstract: BACKGROUND
  National emergency department (ED) bounceback rates within 30 days of previous ED discharge have been found to be as high as 26%. We hypothesize that having a primary care physician (PCP) would prevent bouncebacks to the ED because a patient would have a medical resource for follow-up and continued care.
  
  
  METHODS
  We performed a prospective, consecutive, anonymous survey study of adult ED patients at a suburban teaching hospital with 88,000 visits annually, from July 5, 2011 through August 8, 2011. Using chi-squared and Fisher's exact tests, we compared patients with an initial visit to those returning within 30 days of a previous visit to our ED.
  
  
  RESULTS
  We collected 1084 surveys. Those in the bounceback group were more likely to have no insurance (10.2% vs. 4.4%) or Medicaid (17.7% vs. 10.8%) and less likely to have a PCP (79% vs. 86%). Of those with a PCP, 9% in both groups had seen their PCP that day, 58% (initial visit) and 49% (bouncebacks) could have been seen that day, and 35% & 36%, respectively, within 1 week. Of those with a PCP, 38% of initial visits and 32% of bouncebacks stated they had already seen their physician at least once.
  
  
  CONCLUSIONS
  Our results suggest that patients who bounce back to the ED might have already contacted their PCP. Although insurance status and the lack thereof predict a higher likelihood to bounce back to the ED, many bouncebacks are insured patients with PCPs able to be seen the same day.
authors: Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.
authors: Joshua B
authors: JB
authors: Moskovitz
authors: R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
authors: Zachary
authors: Z
authors: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
keywords: access to care; bouncebacks; emergency medicine; primary care; quality; revisits