title: Emergency Department Return Visits Resulting in Admission: Do They Reflect Quality of Care?
abstract: Prior studies have suggested that emergency department (ED) return visits resulting in admission may be a more robust quality indicator than all 72-hour returns. The objective was to evaluate factors that contribute to admission within 72 hours of ED discharge. Each return visit resulting in admission was independently reviewed by 3 physicians. Analysis was by descriptive statistics. Of 45 071 ED discharges, 4.1% returned within 72 hours; 0.96% returned for related reasons and were admitted to wards (91.2%), intensive care units (6.5%), or operating rooms (1.2%). Management was acceptable in 92.6%, suboptimal in 7.4%. Admissions were illness (94.9%), patient (1.6%), and physician related (3.5%). Almost all admissions within 72 hours after ED discharge are illness related, including all intensive care unit admissions and the majority of operating room admissions. Deficiencies in ED care are rarely the reason for admission on return. ED return visits resulting in admission may not be reflective of ED quality of care.
authors.affiliation: Pediatric Emergency Medicine Associates, LLC, Atlanta, GA john.cheng@pemaweb.com.|Children's Healthcare of Atlanta at Scottish Rite Children's Hospital, Atlanta, GA.
authors.forename: John
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Children's Emergency Center at Gwinnett Medical Center, Lawrenceville, GA.
authors.forename: Amita
authors.initials: A
authors.lastname: Shroff
authors.affiliation: Emory University, Atlanta, GA.|Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Naghma
authors.initials: N
authors.lastname: Khan
authors.affiliation: Emory University, Atlanta, GA.|Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jain
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
keywords: emergency department; pediatrics; quality of care; return visit