title: Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital.
abstract: BACKGROUND
  72-hour emergency department (ED) reattendance is a widely-used quality indicator for quality of care and patient safety. It is generally assumed that patients who return within 72 hours of ED discharge (72-hour re-attendees) received inadequate treatment or evaluation. The current literature also suggests considerable variation in probable causes of 72-hour ED reattendances internationally. This study aimed to understand the characteristics of these patients at the ED of a Singapore tertiary hospital.
  
  
  METHODS
  We conducted a retrospective cohort study on all ED visits between 1 January 2013 and 31 December 2013. 72-hour re-attendees were compared against non-re-attendees based on patient demographics, mode of arrival, patient acuity category status (i.e. P1/P2/P3/P4), seniority ranking of doctor-in-charge and medical diagnoses. Multivariate analysis using the generalised linear model was conducted on variables associated with 72-hour ED re-attendance.
  
  
  RESULTS
  Among 104,751 unique patients, 3,065 (2.93%) were in the 72-hour re-attendees group. Multivariate analysis showed that the following risk factors were associated with higher risk of returning within 72 hours: male gender, older age, arrival by ambulance, triaged as P2, diagnoses of heart problems, abdominal pain or viral infection (all p < 0.001), and Chinese ethnicity (p = 0.006). There was no significant difference in the seniority ranking of the doctor-in-charge between both groups (p = 0.419).
  
  
  CONCLUSIONS
  Several patient and event factors were associated with higher risk of being a 72-hour re-attendee. This study forms the basis for hypothesis generation and further studies to explore reasons behind reattendances so that interventions can be developed to target high-risk groups.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Amy Hui Sian
authors.initials: AH
authors.lastname: Chan
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Shu Fang
authors.initials: SF
authors.lastname: Ho
authors.affiliation: Division of Research, Singapore General Hospital, Singapore.
authors.forename: Stephanie Man Chung
authors.initials: SM
authors.lastname: Fook-Chong
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Sherman Wei Qiang
authors.initials: SW
authors.lastname: Lian
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.|Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.|Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D015746:Abdominal Pain; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D057225:Data Mining; D057286:Electronic Health Records; D004635:Emergency Medicine / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission; D061214:Patient Safety; D011787:Quality of Health Care; D012189:Retrospective Studies; D012306:Risk; D012846:Singapore; D062606:Tertiary Care Centers; D014218:Triage / Q000379:methods; D055815:Young Adult
keywords: 72-hour emergency department reattendance; 72-hour emergency department return; emergency department reattendance; emergency department return