Clinical Predictors of Emergency Department Revisits within 48 Hours of Discharge; a Case Control Study
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e1
https://doi.org/10.22037/aaem.v9i1.891
Abstract
Introduction: Emergency department (ED) revisits increase overcrowding and predicting which patients may need to revisit could increase patient safety. This study aimed to identify clinical variables that could be used to predict the probability of revisiting ED within 48 hours of discharge.
Methods: A retrospective case-control study was conducted between July 2018 and January 2019 at the Emergency Medicine Department in Ramathibodi Hospital, Bangkok, Thailand. Patients who revisited the ED within 48 hours of discharge (case group) and patients who did not (control group) participated. The predictive factors for ED revisit were identified through multivariate logistic regression analysis.
Results: The case group consisted of 372 patients, who revisited the ED within 48 hours, and the control group consisted of 1488 patients. The most common reason for revisiting the ED was recurring gastrointestinal illness, in 107 patients (28.76%). According to the multivariate data analysis , five factors influenced the probability of revisiting the ED: age of more than 60 years (p < 0.001, OR = 2.04, 95%CI: 1.51-2.77), initial Emergency Severity Index (ESI) triage level of 2 (p = 0.007, OR = 1.20, 95%CI: 0.93-1.56), ED stay duration of 4 hours or longer (p = 0.013, OR = 1.12, 95%CI: 0.87-1.44), body temperature of ≥37.5ºC on discharge (p = 0.034, OR = 1.34, 95%CI: 1.00-1.80), and pulse rate of less than 60 (OR = 1.55, 95%CI: 0.87-2.77) or more than 100 beats/minute (OR = 1.53, 95%CI: 1.10-2.11) (p = 0.011).
Conclusion: According to the findings, the most important and independent predictive factor of ED revisit within 48 hours of discharge were, age ≥ 60 years, ESI triage level 2, ED length of stay ≥ 4 hours, temperature ≥ 37.5 C, and 60 > pulse rate ≥ 100 beats/minute.
- Emergency service, hospital; patient discharge; clinical decision rules; triage; Thailand
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References
Fan J-S, Kao W-F, Yen DH-T, Wang L-M, Huang C-I, Lee C-H. Risk factors and prognostic predictors of unexpected intensive care unit admission within 3 days after ED discharge. The American journal of emergency medicine. 2007;25(9):1009-14.
Hu S-C. Analysis of patient revisits to the emergency department. The American journal of emergency medicine. 1992;10(4):366-70.
Keith KD, Bocka JJ, Kobernick MS, Krome RL, Ross MA. Emergency department revisits. Annals of emergency medicine. 1989;18(9):964-8.
Abualenain J, Frohna WJ, Smith M, Pipkin M, Webb C, Milzman D, et al. The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department. The Journal of Emergency Medicine. 2013;45(2):281-8.
Cheng S-Y, Wang H-T, Lee C-W, Tsai T-C, Hung C-W, Wu K-H. The characteristics and prognostic predictors of unplanned hospital admission within 72 hours after ED discharge. The American journal of emergency medicine. 2013;31(10):1490-4.
Pierce JM, Kellerman AL, Oster C. “Bounces”: an analysis of short-term return visits to a public hospital emergency department. Annals of emergency medicine. 1990;19(7):752-7.
Wu C-L, Wang F-T, Chiang Y-C, Chiu Y-F, Lin T-G, Fu L-F, et al. Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan. The Journal of emergency medicine. 2010;38(4):512-7.
Kelly A, Chirnside A, Curry C. An analysis of unscheduled return visits to an urban emergency department. The New Zealand medical journal. 1993;106(961):334-6.
Nunez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? BMJ Quality & Safety. 2006;15(2):102-8.
Jin B, Zhao Y, Hao S, Shin AY, Wang Y, Zhu C, et al. Prospective stratification of patients at risk for emergency department revisit: resource utilization and population management strategy implications. BMC emergency medicine. 2016;16(1):10.
Lerman B, Kobernick MS. Return visits to the emergency department. The Journal of emergency medicine. 1987;5(5):359-62.
Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, et al. Risk prediction models for hospital readmission: a systematic review. Jama. 2011;306(15):1688-98.
Hao S, Jin B, Shin AY, Zhao Y, Zhu C, Li Z, et al. Risk prediction of emergency department revisit 30 days post discharge: a prospective study. PloS one. 2014;9(11):e112944.
Sri-On J, Nithimathachoke A, Tirrell GP, Surawongwattana S, Liu SW. Revisits within 48 hours to a Thai emergency department. Emergency medicine international. 2016;2016.
Asomaning N, Loftus C. Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results. Journal of Emergency Nursing. 2014;40(4):357-64. e1.
de Almeida Tavares JP, Sá-Couto P, Boltz M, Capezuti E. Identification of Seniors at Risk (ISAR) in the emergency room: A prospective study. International emergency nursing. 2017;35:19-24.
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