PMID- 23570476
OWN - NLM
STAT- MEDLINE
DCOM- 20131106
LR  - 20130410
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 20
IP  - 1
DP  - 2013 Jan
TI  - Unscheduled return visits to the emergency department: consequences for triage.
PG  - 33-9
LID - 10.1111/acem.12052 [doi]
AB  - OBJECTIVES: The objective was to conduct a survey of unscheduled revisits (URs) 
      to the emergency department (ED) within 8 days of a prior visit, to test the 
      hypothesis that patients making these URs are disproportionately likely to suffer 
      short-term mortality or manifest a need for any admission to the hospital 
      (adverse events [AEs]) at the time of the UR, compared to patients triaged at the 
      same level who did not have an unscheduled ED revisit within 8 days. METHODS: 
      This was a 1-year retrospective study of patients with an UR to the ED of an 
      urban, 1,600-bed tertiary care center and teaching hospital. The criteria for 
      inclusion as an UR were: 1) making an emergency visit to our adult ED during 
      2008, without being admitted to our hospital nor being transferred to another 
      hospital; and 2) subsequently making an UR to the same ED within 8 days following 
      the first one. Patients who were contacted by members of our staff and 
      specifically asked to make return visits to our ED (such as those who returned 
      for wound care follow-up visits), and those who made more than five visits to our 
      ED during 2008, were excluded. AEs were defined as death or hospitalization 
      within 8 days of the second visit. RESULTS: During 2008, there were 946 patients 
      with URs (2% of patients treated and released after the first ED visit), and 931 
      were analyzed (n = 15 missing values). Associated with the second visit, an AE 
      was noted for 276 (30%) patients. Eight variables were significantly associated 
      with AE: age >/= 65 years, previously diagnosed cancer, previously diagnosed 
      cardiac disease, previously diagnosed psychiatric disease, presence of a relative 
      at the time of the UR, arrival with a letter from a general practitioner at the 
      time of the UR, a higher level of severity assigned at triage for the UR than for 
      the first ED visit, and having had blood sample analysis performed during the 
      first visit. The median triage score for the UR was not significantly different 
      from that group's median triage score for the first ED visit, whereas the 
      proportion of admissions to the hospital (29%) or to the intensive care unit 
      (ICU; 2%) was greater overall in the UR group than in the patients making their 
      first ED visit. CONCLUSIONS: The authors observed that 2% of patients had an UR. 
      This UR population was at greater risk of AE at the time of their URs compared to 
      their initial visits, but the median triage nurse score was not significantly 
      different between the first visit and the UR. This suggests that the triage score 
      should be systematically upgraded for UR patients.
CI  - (c) 2013 by the Society for Academic Emergency Medicine.
FAU - Sauvin, Gabrielle
AU  - Sauvin G
AD  - Emergency Department, Centre Hospitalo-Universitaire Pitie-Salpetriere, 
      Assistance-Publique Hopitaux de Paris, Universite Pierre et Marie Curie-Paris 6, 
      Paris, France.
FAU - Freund, Yonathan
AU  - Freund Y
FAU - Saidi, Khaled
AU  - Saidi K
FAU - Riou, Bruno
AU  - Riou B
FAU - Hausfater, Pierre
AU  - Hausfater P
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
EIN - Acad Emerg Med. 2013 Mar;20(3):327
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - *Appointments and Schedules
MH  - Cohort Studies
MH  - Emergencies
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Needs Assessment
MH  - Patient Readmission/*statistics & numerical data
MH  - Recurrence
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Sex Factors
MH  - Tertiary Care Centers
MH  - Time Factors
MH  - *Triage
MH  - United States
MH  - Urban Population
EDAT- 2013/04/11 06:00
MHDA- 2013/11/07 06:00
CRDT- 2013/04/11 06:00
PHST- 2012/02/03 00:00 [received]
PHST- 2012/05/24 00:00 [revised]
PHST- 2012/07/30 00:00 [revised]
PHST- 2012/07/31 00:00 [accepted]
PHST- 2013/04/11 06:00 [entrez]
PHST- 2013/04/11 06:00 [pubmed]
PHST- 2013/11/07 06:00 [medline]
AID - 10.1111/acem.12052 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2013 Jan;20(1):33-9. doi: 10.1111/acem.12052.