Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan.

BACKGROUND

When patients return to the emergency department (ED) shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate.

OBJECTIVES

The purpose of this study was to determine the rates and causes of revisits to the ED of a 710-bed secondary teaching referral hospital (Kuang Tien General Hospital), to identify areas for improvement, and to define the initial ED presentations that are associated with such revisits.

METHODS

The study period was from January 1, 2006 to December 31, 2006. There were 34,714 patients seen and discharged in the ED; 1899 patients returned within 72 h. Monthly revisit rates were calculated. The patients who revisited the ED within 72 h were retrospectively identified by the authors, and their charts were examined to determine the causes of the revisits.

RESULTS

There were 1899 patients (5.47% of total) found to have revisited the ED within 72 h after their initial visit. The monthly revisit rates ranged from 2.85% to 6.25% (average, 5.47%). The rates of revisits that were related to factors of illness, patients, and doctors were 80.9%, 10.9%, and 8.2%, respectively. Among the factors related to doctors, 3.7% (70 cases) were misdiagnosis, and abdominal pain was the most common presentation (55.7%, 39/70). The most common initial ED presentations were for abdominal pain (12.9%), fever (12.6%), vertigo (4.5%), headache (2.1), and upper respiratory infection (2.1%).

CONCLUSIONS

Unplanned ED revisits are associated with medical errors in prognosis, treatment, follow-up care, and information. Differentiation between the natural course of a disease, suboptimal therapy, over-anxious reaction of the patient, and medical errors is difficult. Although this study indicates that most revisits are illness-related, further prospective studies are needed to evaluate the most common and the most serious causes of revisits to see if improvements can be made.