title: Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project.
abstract: BACKGROUND
  an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation.
  
  
  OBJECTIVE
  to determine factors associated with early re-presentation.
  
  
  METHODS
  prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days.
  
  
  RESULTS
  nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) re-presented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for re-presentation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93).
  
  
  CONCLUSIONS
  older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Lowthian
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Lahn D
authors.initials: LD
authors.lastname: Straney
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Brand
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Barker
authors.affiliation: Emergency & Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: P de Villiers
authors.initials: Pde V
authors.lastname: Smit
authors.affiliation: General Medicine, Alfred Health Melbourne, Victoria, Australia.
authors.forename: Harvey
authors.initials: H
authors.lastname: Newnham
authors.affiliation: Subacute and Medical Services Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hunter
authors.affiliation: Emergency & Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Cathie
authors.initials: C
authors.lastname: Smith
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Emergency & Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D000339:Affect; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D010351:Patient Discharge; D017064:Process Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014739:Victoria
keywords: emergency department; older age; older people; re-presentation risk