Tarumi Yoko, Harada Taku, Saito Tsukasa, Hiroshige Juichi, Dohi Kenji
Department of General Medicine, Showa University, Tokyo 142-8555, Japan.
Department of Emergency, Disaster and Critical Care Medicine, Showa University, Tokyo 142-8555, Japan.
Ther Clin Risk Manag. 2019 May 6;15:647-658. doi: 10.2147/TCRM.S193863. eCollection 2019.
Recently, unscheduled readmissions after discharge from the emergency department (ED) (bounce-back admissions, BBAs) have been monitored as a hospital performance measure in countries other than Japan. It has been suggested that BBAs may be caused by errors in diagnoses or treatments. This retrospective cohort study aimed to evaluate BBAs and improve the quality of medical care in the ED of Showa University Hospital by analyzing the data of adult patients (≥18 years) with index visits to the ED of Showa University Hospital between June 2011 and May 2013 (n=15,069). Patients were registered and followed up for unscheduled admissions to this hospital within 7 days. In order to understand the reasons for BBAs, individual diagnoses upon BBA were compared to the corresponding diagnoses upon discharge. Among the 11,669 discharged patients, 180 patients were admitted within 3 days after discharge (3-day BBAs), and 257 were admitted within 7 days after discharge (7-day BBAs). The main diagnoses upon admission (BBA) were pneumonia or exacerbation of chronic obstructive pulmonary disease (COPD) or asthma (n=40, 16%), cholecystitis or cholangitis (n=21, 8.2%), and urinary tract infection (n=16, 6.2%). Among the 7-day BBA cases, 117 patients had similar and 110 patients had different diagnoses upon discharge and admission; in the remaining 30 cases, the results could not be ascertained owing to incomplete diagnostic data. In the cases of pneumonia, exacerbation of COPD or asthma, and colitis or enterocolitis, there was a significantly higher "similar" diagnoses than "different", while the reverse was true for cases of stroke, ileus or bowel obstruction, and meningitis. These results were shared with the ED staff, and similar surveillances were periodically conducted. The frequency of admission within 7 days after discharge continuously declined from 2013 to 2016. Analyzing the discharge and admission diagnoses may help ED staff to understand the reasons for common errors in order to follow the plan-do-check-act cycle of medical care in the ED.
最近，在日本以外的国家，急诊部（ED）出院后的非计划再入院（反弹式入院，BBA）已被作为一项医院绩效指标进行监测。有人认为，BBA可能是由诊断或治疗错误引起的。这项回顾性队列研究旨在通过分析2011年6月至2013年5月期间在昭和大学医院急诊部进行首次就诊的成年患者（≥18岁）的数据（n = 15,069），评估BBA并提高昭和大学医院急诊部的医疗质量。对患者进行登记，并随访其在7天内非计划入院的情况。为了了解BBA的原因，将BBA时的个体诊断与出院时的相应诊断进行了比较。在11,669名出院患者中，180名患者在出院后3天内入院（3天BBA），257名患者在出院后7天内入院（7天BBA）。入院时（BBA）的主要诊断为肺炎或慢性阻塞性肺疾病（COPD）或哮喘加重（n = 40，16%）、胆囊炎或胆管炎（n = 21，8.2%）以及尿路感染（n = 16，6.2%）。在7天BBA病例中，117名患者出院和入院时诊断相似，110名患者诊断不同；其余30例因诊断数据不完整无法确定结果。在肺炎、COPD或哮喘加重以及结肠炎或小肠结肠炎病例中，“相似”诊断显著高于“不同”诊断，而中风、肠梗阻或肠阻塞以及脑膜炎病例则相反。这些结果与急诊部工作人员进行了分享，并定期进行类似监测。2013年至2016年期间，出院后7天内的入院频率持续下降。分析出院和入院诊断可能有助于急诊部工作人员了解常见错误的原因，以便遵循急诊部医疗护理的计划-执行-检查-行动循环。
