Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Emergency Department, Canterbury Hospital, Campsie, Sydney, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia; Illawarra Shoalhaven Local Health District, NSW, Australia.
Australas Emerg Care. 2021 Mar;24(1):34-42. doi: 10.1016/j.auec.2020.05.007. Epub 2020 Jun 24.
Patients who return to the Emergency Department (ED) for the same complaint are known to be at risk of adverse events. Monitoring of return visits is considered a way to measure the quality of care provided in the ED, although the most commonly used benchmark of 48h lacks evidence. This study aimed to describe the incidence, characteristics and outcomes of patients with unplanned return visits. The study also aimed to determine the capture rate of the 48-h benchmark using an all-inclusive method of return visit identification.
A retrospective cross-sectional study was conducted across three EDs in Sydney, New South Wales from July 1st, 2017 to June 30th, 2018. Visits that occurred within 28 days with the same or similar presenting complaint following discharge from the ED were classified as a return visit. Data were grouped by index and return visit. Descriptive statistics were used to summarise incidence, patient characteristics and outcomes for all presentations. Categorical data were analysed using Chi square tests. Continuous data were analysed using Mann-Whitney when data were not normally distributed and t-tests when normally distributed.
Of all ED presentations (n=164,598), 5860 (3.6%) were identified as a return visit. Return patients were younger than non-return patients, but those that required admission were older (43 vs 33 years, p=<0.01). Abdominal problems were the most common reason for return followed by urological and mental health. The median time to return was 64:51h (IQR 20:35-226:37). Only 43% of return visits occurred within 48h. Return visits to a different ED accounted for 13.2% of return visits.
More than half of ED return visits are missed when the existing benchmark of 48h is used. Current policy makers should consider increasing the 48-h benchmark to more accurately reflect the incidence of return visits. Further investigation into the causal factors for return visits is warranted, particularly in patients with abdominal, urological or mental health complaints.
已知因同一主诉返回急诊科（ED）的患者存在发生不良事件的风险。监测复诊被认为是衡量 ED 提供的医疗质量的一种方法，尽管最常用的 48 小时基准缺乏证据。本研究旨在描述无计划复诊患者的发生率、特征和结局。本研究还旨在通过一种全面的复诊识别方法确定 48 小时基准的捕获率。
这是一项 2017 年 7 月 1 日至 2018 年 6 月 30 日在新南威尔士州悉尼的 3 家 ED 进行的回顾性横断面研究。在从 ED 出院后 28 天内，以相同或类似主诉就诊的就诊被归类为复诊。根据就诊和复诊将数据分组。使用描述性统计对所有就诊的发生率、患者特征和结局进行总结。使用卡方检验分析分类数据。当数据不符合正态分布时使用 Mann-Whitney 检验，当数据符合正态分布时使用 t 检验分析连续数据。
在所有 ED 就诊中（n=164598），有 5860 例（3.6%）被确定为复诊。复诊患者比非复诊患者年轻，但需要入院的患者年龄较大（43 岁比 33 岁，p<0.01）。腹部问题是复诊最常见的原因，其次是泌尿系统和心理健康问题。复诊的中位数时间为 64:51h（IQR 20:35-226:37）。只有 43%的复诊发生在 48 小时内。在不同的 ED 进行复诊占复诊的 13.2%。
当使用现有的 48 小时基准时，超过一半的 ED 复诊会被遗漏。当前的政策制定者应考虑将 48 小时基准延长，以更准确地反映复诊的发生率。需要进一步调查复诊的因果因素，特别是在有腹部、泌尿系统或心理健康问题的患者中。
