Quality Matters: EDs Should Deliberately Bounceback High-Risk Patients
Abstract
ImageIs there anything more disconcerting to an emergency physician reporting for a shift than being approached by a colleague who says, “Do you remember that patient you saw?” Of the more than 120 million visits to emergency departments each year in the United States, approximately three percent of these patients return within 72 hours. (Ann Emerg Med 1990: 19[7]:752.) One in four of these bouncebacks require admission (Ann Emerg Med 1998;32[5]:569), and in up to 30 percent of these cases, the return visit is related to a possible medical error or mismanagement during the first visit. This number is difficult to get a handle on because EDs increasingly are tasked with providing follow-up care for patients who have nowhere else to go. The pressure to manage patients as outpatients is particularly acute in the emergency department. Return visits are highest for patients with headache, back pain, and abdominal pain and lowest for chest pain. (Ann Emerg Med 2010 Mar 17 [Epub].) Painful conditions have the highest rates of recidivism. In one study from Singapore, abdominal pain accounted for a quarter of unscheduled return visits, and more than half were admitted. (Singapore Med J 2009;50[11]:1068.) Advanced age and dyspnea also were associated with unscheduled returns to the ED that required admission. Patients over 65 had a greater risk of admission after an unscheduled return (Am J Emerg Med 2004;22[6]:448), and patients with an initial diagnosis of dehydration had the…
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