title: Emergency Department Return Visits Within a Large Geographic Area.
abstract: BACKGROUND
  Return visits to the emergency department (RTED) contribute to overcrowding and may be a quality of care indicator. Previous studies focused on factors predicting returns to and from the same center. Little is known about RTEDs across a range of community and specialty hospitals within a large geographic area.
  
  
  OBJECTIVE
  We sought to measure the frequency of pediatric RTEDs and describe their directional pattern across centers in a large catchment area.
  
  
  METHODS
  We conducted a multicenter, retrospective cross-sectional study of pediatric emergency visits in the Vancouver lower mainland within 1 year. Visits were linked across study sites, including one pediatric quaternary care referral center and 17 sites ranging from large regional centers to smaller community emergency departments (EDs). Returns were defined as subsequent visits to any site with a compatible diagnosis within 7 days of an index visit.
  
  
  RESULTS
  Among a total of 139,278 index ED visits by children, 12,133 (8.7% [95% confidence interval 8.6-8.9%]) were associated with 14,645 return visits to an ED. Three quarters of all index visits occurred at a general ED center, of which 8.9% had at least one RTED and 22% of these returns occurred at the pediatric ED (PED). Among PED index visits, 8.2% had at least one RTED and 13.6% of these returned to a general center. Overall, 38.9% of all RTEDs occurred at the PED. Multivariate regression did not identify any statistically significant association between ED crowding measures and likelihood of RTEDs.
  
  
  CONCLUSIONS
  Compared to single-center studies, this study linking hospitals within a large geographic area identified a higher proportion of RTEDs with a disproportionate burden on the PED.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mimi
authors.initials: M
authors.lastname: Truong
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Garth
authors.initials: G
authors.lastname: Meckler
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Emergency Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Quynh H
authors.initials: QH
authors.lastname: Doan
mesh_terms: D000293:Adolescent; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies
keywords: epidemiology; health care utilization; pediatrics; quality improvement; return visits to the emergency department