Abualenain Jameel, Frohna William J, Smith Mark, Pipkin Michael, Webb Cynthia, Milzman David, Pines Jesse M
Department of Emergency Medicine, The George Washington University, Washington, DC 20037, USA.
J Emerg Med. 2013 Aug;45(2):281-8. doi: 10.1016/j.jemermed.2012.11.012. Epub 2013 Jan 24.
Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues.
We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.
Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed. Any substandard quality on the first visit or change in outcome on the return admission was considered "low quality." Multivariate logistic regression was used to assess the relationship between cases judged as low quality vs. not low quality.
Of 741,132 ED visits across 5 years, 3682 (0.5%) were 72-h return admissions. Of those, 192 (5%) were low quality. In 158 (4%) and 8 (0.2%) there were moderate and severe deviations from care standards, respectively. Similarly, in 53 (1%) and 14 (0.4%) there were moderate and severe changes in outcome. In adjusted analysis, there were higher rates of low-quality 72-h return admissions in ambulance arrivals (odds ratio [OR] 1.5, 95% confidence interval (CI) 1.1-2.1); and lower rates in Medicaid patients (OR 0.3, 95% CI 0.2-0.7). There were higher rates in low-quality 72-h return admissions in hospital 1 (OR 3.6, 95% CI 2.2-6.1) and hospital 3 (OR 3.2, 95% CI 2.0-4.7) compared to hospital 2.
Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality.
急诊科（ED）出院后72小时内再次返回并被收治的患者记录，常被用于审查潜在的质量问题。
我们对72小时内再次入院情况进行了探究，并确定了初次就诊时管理不达标或出现任何不良结局的发生率及预测因素。
对2006年至2010年三家医院72小时内再次入院的质量保证数据进行回顾性分析。初次就诊时的任何质量不达标情况或再次入院时结局的变化均被视为“低质量”。采用多因素逻辑回归分析来评估判定为低质量与非低质量病例之间的关系。
在5年的741,132次急诊科就诊中，3682例（0.5%）为72小时内再次入院。其中，192例（5%）为低质量。分别有158例（4%）和8例（0.2%）存在中度和重度偏离护理标准的情况。同样，分别有53例（1%）和14例（0.4%）出现了中度和重度结局变化。在调整分析中，救护车送来的患者72小时内再次入院低质量发生率较高（比值比[OR]为1.5，95%置信区间[CI]为1.1 - 2.1）；医疗补助患者发生率较低（OR为0.3，95% CI为0.2 - 0.7）。与医院2相比，医院1（OR为3.6，95% CI为2.2 - 6.1）和医院3（OR为3.2，95% CI为2.0 - 4.7）的72小时内再次入院低质量发生率较高。
在急诊科，初次就诊时护理不佳或72小时内再次入院时出现任何不良结局的情况相对少见。在不进行病历审查的情况下报告72小时内再次入院情况可能并非衡量临床质量的好方法。
