title: Seventy-Two-Hour Returns Are Not Useful in Identifying Emergency Department Patients With a Concerning Intra-Abdominal Process.
abstract: BACKGROUND
  Seventy-two-hour returns to the emergency department (ED) have been used to identify patients who are believed to have been more likely to have suffered medical errors, missed diagnoses, or failure or inadequacy of previous treatment or discharge planning. This approach has been criticized as arbitrary, however, citing the lack of evidence to support its homogenous application to all organ system-based complaints and the unclear implication of returns.
  
  
  OBJECTIVE
  Given the significant burden of gastrointestinal (GI)-related illness, our objective was to determine if an audit of 72-hour returns of GI-related diagnoses appropriately captures patients who return with a concerning diagnosis (CD) on their second visit.
  
  
  METHODS
  Ten emergency physicians were surveyed and a list of concerning, "not to be missed" diagnoses were generated. The demographic and clinical variables were collected and analyzed on all patients with a GI International Classification of Diseases, 9th revision code presenting to an urban, university-affiliated ED between July 2013 and March 2014.
  
  
  RESULTS
  There were 10,012 patient visits during the study period, including 1006 patients (10%) with ≥ 1 return visits. One hundred forty-seven patients (15%) returned within 72 hours, and 859 patients (85%) returned in > 72 hours. Patients that returned within 72 hours were no more likely to have a CD than those that returned at a later time (13.6% vs. 14.4%; p = 0.79).
  
  
  CONCLUSIONS
  An audit of 72-hour returns only captures a small percentage of patients that return with a CD, and these patients are at no greater risk of harboring a CD than those that return at a later date.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Emily
authors.initials: E
authors.lastname: Aaronson
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Theodore
authors.initials: T
authors.lastname: Benzer
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pierre
authors.initials: P
authors.lastname: Borczuk
mesh_terms: D003951:Diagnostic Errors; D004066:Digestive System Diseases / Q000175:diagnosis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D019300:Medical Errors; D008875:Middle Aged; D010147:Pain Measurement; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
keywords: emergency medicine; health care quality; health care safety; performance measures; quality assessment; quality measurement