Which unscheduled return visits indicate a quality-of-care issue?
BACKGROUND
The rate of unscheduled return visits is often used as a quality-of-care indicator in EDs, although its validity is not yet fully established. Our aim was to identify the characteristics of return visits that may be attributed to problems in quality of care.


METHODS
Retrospective paired review of medical charts in a random sample of return visits during the 72 hours following discharge from the ED in three hospitals of Andalusia, Spain in 2013. Charts were reviewed by senior medical physicians to determine which return visits reflected quality-of-care problems. Time frame for return visit, index and return visit acuity, disposition and diagnosis were compared with determine which variables were associated with a quality problem. Sensitivity and specificity for each variable to indicate a quality problem were determined.


RESULTS
We studied the causes of 895 return visits, finding that 65 (7.3%) were due to inadequate quality of care in the index visit. Potentially avoidable return visits were more common in more severely ill patients, in those with greater severity in the return than in the index visit and in patients hospitalised after the return. The combination of this three variables presented sensitivity 66% and specificity 68% in identification of quality-related returns.


CONCLUSIONS
The overall level of return visits cannot be considered a valid indicator of quality of care. However, certain specific variables, including the level of severity of the patient's condition or the discharge destination following the return visits, could be considered valid in this respect.
Evaluation Unit, Costa del Sol Public Health Care Agency, Marbella, Málaga, Spain.|Health Services Research on Chronic Patients Network (REDISSEC), Marbella, Spain.
Alberto
A
Jiménez-Puente
Medical Documentation Department, Virgen de la Victoria University Hospital, Málaga, Spain.
José
J
Del Río-Mata
Emergency Department, Costa del Sol Public Health Care Agency, Marbella, Málaga, Spain.
José Luís
JL
Arjona-Huertas
Emergency Department, Virgen de la Victoria University Hospital, Málaga, Spain.
Begoña
B
Mora-Ordóñez
Medical Documentation Department, Virgen de la Victoria University Hospital, Málaga, Spain.
Alfonso
A
Martínez-Reina
Emergency Department, Costa del Sol Public Health Care Agency, Marbella, Málaga, Spain.
Miguel
M
Martínez Del Campo
Emergency Department, Virgen de la Victoria University Hospital, Málaga, Spain.
Lourdes
L
Nieto-de Haro
Medical Documentation Department, Costa del Sol Public Health Care Agency, Marbella, Málaga, Spain.
Antonio
A
Lara-Blanquer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
emergency department utilisation; quality assurance; research, epidemiology