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Open AccessArticle

Risk Factors for Emergency Department Unscheduled Return Visits

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Emergency Medicine Department, National University Hospital, National University Health System, Singapore 119074, Singapore
2
Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 457; https://doi.org/10.3390/medicina55080457
Received: 17 June 2019 / Revised: 6 August 2019 / Accepted: 6 August 2019 / Published: 9 August 2019
(This article belongs to the Section Emergency Medicine)
Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs. View Full-Text
Keywords: unscheduled return visits; re-attendance; risk management; abdominal pain unscheduled return visits; re-attendance; risk management; abdominal pain
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Soh, C.H.W.; Lin, Z.; Pan, D.S.T.; Ho, W.H.; Mahadevan, M.; Chua, M.T.; Kuan, W.S. Risk Factors for Emergency Department Unscheduled Return Visits. Medicina 2019, 55, 457.

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Medicina, EISSN 1010-660X, Published by MDPI AG
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