Almugren Ghadah F, Al Katheri Mufareh, Al Khathaami Ali M, Al-Qahtani Abdul Hadi, Al Saawi Abdulmohsen, Javellana Shiela, Basakran Mashael, Al Yehya Sara, Al Qarni Mohammed S
Quality and Patient Safety Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
Quality and Patient Safety Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
BMJ Open Qual. 2025 May 2;14(2):e003015. doi: 10.1136/bmjoq-2024-003015.
Emergency department (ED) return cases as critical or deceased pose a significant concern for any healthcare organisation and need to be evaluated and addressed.
A quality improvement initiative was implemented to reduce 50% of the return visits from the baseline proportion of return visits by critical/deceased adult patients to the ED within 72 hours of discharge during 1 year (January 2022-January 2023), which is a robust quality indicator. Additionally, factors that contribute to an admission or revisit within 72 hours of ED discharge were evaluated.
The implementation of initiatives began in January 2022 to monitor the ED return cases. Interventions were developed using the plan-do-study-act cycles in January 2022. Cycle 1 captured ED returns within 72 hours that were flagged by daily systemic trigger notifications received through the email by the dashboard and the cases were analysed by our quality improvement specialists team daily in January 2022. In any sentinel or severe event, an escalation via SMS to the leadership ensured immediate attention and action. Cycle 2 included patient safety leadership meetings within 24 hours of the return visit. This was initiated in April 2022 and discussed with all stakeholders for the immediate implementation of recommendations and action plans to improve the system and address individual concerns. Cycle 3 included a comprehensive consultation checklist integrated into the HIS in July 2023 to ensure that all necessary steps and consultations were completed during discharge. This included specific questions regarding the consultant's awareness about the treatment plan provided to the patient.
A statistical process control chart was used to present the data through the dashboard from January 2021 to January 2023 and continued until December 2023. The results revealed significant improvements. Overall, the number of return patients in the ED reduced by 46.60% from 0.13% in 2021 to 0.08% in 2022 and 2023.
The project was highly effective for patients. It reduced the morbidity and mortality for these patients over time; however, it also increased immature admissions. Continuous monitoring and application of different measures to analyse ED return cases are recommended.
急诊科（ED）的复诊病例若为危急或死亡情况，对任何医疗机构来说都是重大问题，需要进行评估和处理。
实施一项质量改进举措，在1年（2022年1月至2023年1月）内，将危急/死亡成年患者出院后72小时内返回急诊科的复诊比例从基线水平降低50%，这是一项有力的质量指标。此外，还评估了导致急诊科出院后72小时内再次入院或复诊的因素。
2022年1月开始实施各项举措以监测急诊科复诊病例。2022年1月采用计划-执行-研究-行动循环制定干预措施。第1阶段捕捉2022年1月通过仪表盘电子邮件每日系统触发通知标记的72小时内的急诊科复诊病例，质量改进专家团队每天对这些病例进行分析。在任何哨兵事件或严重事件中，通过短信向领导层汇报以确保立即关注并采取行动。第2阶段包括复诊后24小时内的患者安全领导会议。该阶段于2022年4月启动，并与所有利益相关者进行讨论，以便立即实施改进系统和解决个人问题的建议及行动计划。第3阶段包括2023年7月集成到医院信息系统（HIS）中的综合咨询检查表，以确保出院时完成所有必要步骤和咨询。这包括关于顾问对提供给患者的治疗计划的知晓情况的具体问题。
使用统计过程控制图通过仪表盘展示2021年1月至2023年1月的数据，并持续到2023年12月。结果显示有显著改善。总体而言，急诊科复诊患者数量从2021年的0.13%降至2022年和2023年的0.08%，降幅达46.60%。
该项目对患者非常有效。随着时间推移，它降低了这些患者的发病率和死亡率；然而，它也增加了未成熟的入院病例。建议持续监测并应用不同措施来分析急诊科复诊病例。
