Alshahrani Mohammed, Katbi Faisal, Bahamdan Yazeed, Alsaihati Ahrar, Alsubaie Aisha, Althawadi Dana, Perlas-Asonto Laila
Departments of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 31952, Kingdom of Saudi Arabia.
Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
J Multidiscip Healthc. 2020 Dec 22;13:2003-2010. doi: 10.2147/JMDH.S282192. eCollection 2020.
Emergency departments (EDs) serve as an accessible gateway to healthcare system wherein numerous patients consider it a prime choice for medical complaints. Frequency of ED revisits, causes, and its burden are necessary to assess quality of care provided to patients and identify factors that leads to revisit.
Electronic and printed medical records of all patients who revisited ED from January to May 2016 within 72 hours of initial visit were reviewed. Patients' cause of revisit were classified to three categories: patient-, physician- and system-related factors. Common complaints that require revisits were also collected. Descriptive analysis was performed and categorical variables were represented by the frequency; percentages and continuous variables were presented as median, and range if data did not follow normal distribution.
Of the 79,279 patients who visited ED during the study period, 1.3% (1000) patients revisited within 72 hours; 51.3% (n=513) were males, with a mean age of 31.5 years (SD=17.7 years) where majority (57.1%) had no comorbidity recorded. The most attributed factors for revisit were as follows: patient-related causes 635 patients (63.5%), physician-related factors 167 patients (16.7%), and system-related factors 42 patients (4.2%); 15.6% were found not related to the initial visit. Recurrence of the same complaint was the highest among patient-related factors (80.5%), inadequate management and no improvement of symptoms in 71.3% among the physician-related factors. The most common ED revisit complaint was fever 29.1% (n=291). Outcomes of the revisit were mainly patient discharge 96.7% (n=967), admission 1.2% (n=12) and death in 0.2% (n=2).
Recurrence of the same complaint with no symptoms improvement and suboptimal management of physicians contributed to most of the ED revisits within 72 hours. Encouraging physicians to provide clear instructions in educating patients on discharge regarding disease progression and its red flags as to when a return to ED, might help in reducing revisit rate.
急诊科是医疗系统的一个便捷入口，许多患者将其视为就医投诉的首选。评估急诊科复诊的频率、原因及其负担对于评估提供给患者的医疗质量以及识别导致复诊的因素至关重要。
回顾了2016年1月至5月期间在首次就诊后72小时内复诊急诊科的所有患者的电子和纸质病历。将患者复诊的原因分为三类：患者相关因素、医生相关因素和系统相关因素。还收集了需要复诊的常见投诉。进行了描述性分析，分类变量用频率表示；百分比，连续变量以中位数表示，若数据不呈正态分布则给出范围。
在研究期间就诊于急诊科的79279名患者中，1.3%（1000名）患者在72小时内复诊；51.3%（n = 513）为男性，平均年龄31.5岁（标准差 = 17.7岁），其中大多数（57.1%）没有合并症记录。复诊的最主要因素如下：患者相关原因635例患者（63.5%），医生相关因素167例患者（16.7%），系统相关因素42例患者（4.2%）；15.6%被发现与首次就诊无关。在患者相关因素中，同一投诉的复发率最高（80.5%），在医生相关因素中，管理不足和症状无改善的占71.3%。急诊科最常见的复诊投诉是发热，占29.1%（n = 291）。复诊结果主要是患者出院96.7%（n = 967），入院1.2%（n = 12），死亡0.2%（n = 2）。
同一投诉复发且症状无改善以及医生管理欠佳是导致72小时内大多数急诊科复诊的原因。鼓励医生在患者出院时就疾病进展及其红色警示（即何时返回急诊科）向患者提供明确的指导，可能有助于降低复诊率。
