Effect of multifaceted interventions on reducing return visits within 72 h after non-traumatic emergency department visits.
OBJECTIVE
The objective of the present study is to develop new multifaceted interventions to reduce return visits (RVs) based on identified risk factors related to RVs in the ED and to compare the RV rate before and after the implementation of the intervention.


METHODS
The present study was a controlled before and after study that was conducted in the ED of a 900-bed tertiary hospital in an urban area. The primary outcome was the rate of unplanned RVs to the ED and hospital admission after RV. The risk and predictive factors of RVs were identified by a retrospective study of all unscheduled RVs to the ED within 72 h in 2011. We developed five new multifaceted interventions based on the results: (i) daily RV feedback; (ii) prescription set of drugs; (iii) creation of a discharge instruction sheet; (iv) early follow-up appointments of outpatient department (OPD); and (v) enhancement of referral system. A prospective interventional study in which the interventions were implemented was then conducted over 10 months, from 1 June 2012 to 31 March 2013.


RESULTS
The five new multifaceted interventions significantly reduced the mean early RV rate and RV admission rate after ED discharge by an average of approximately 25%, with a maximum of approximately 55% and 47%, respectively, compared with the pre-intervention period (RV rate: P < 0.001, RV admission rate: P < 0.001).


CONCLUSIONS
Multifaceted interventions based on identified risk factors for early RV after ED discharge had a positive effect on reducing RVs and the admission rate after RVs for adult patients within 72 h of non-traumatic ED visits.
Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Soo Hoon
SH
Lee
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Kyuseok
K
Kim
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Hooyoung
H
Kim
Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Jin Hee
JH
Jeong
Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Changwoo
C
Kang
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Joong Eui
JE
Rhee
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Young Im
YI
Byeon
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Yeon Sook
YS
Im
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Chanjong
C
Park
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea.
Joonghee
J
Kim
Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
Seung Sik
SS
Hwang
D000328:Adult; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D063886:Patient Discharge Summaries; D055553:Prescription Drugs / Q000627:therapeutic use; D012017:Referral and Consultation; D012307:Risk Factors
D055553:Prescription Drugs
emergency department; intervention; return visit