Characteristics and outcomes of patients with emergency department revisits within 72 hours and subsequent admission to the intensive care unit

Tsai, I‐Ting; Sun, Cheuk‐Kwan; Chang, Chia-Wen; Lee, Kuo-Hsin; Liang, Chih-Yu; Hsu, Chih‐Wei

doi:10.1016/j.tcmj.2016.07.002

Cited by 17 publications

(24 citation statements)

References 28 publications

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“…On the other hand, other parameters, namely, age and gender www.nature.com/scientificreports/ of patients, chief complaints, urgency of disease presentation, initial cause of ED visit, time of ED visit, seniority of emergency physicians, ICU diagnosis, and CCI, were not significant contributors to physician-related causes of ICU admissions. The incidence of ICU admission on ED revisits in the current study was 0.046%, which was comparable with that in previous reports (i.e., 0.04-0.07%) [11][12][13][14] . Albeit rare (i.e., 0.011% of all ED visits in the current study), physician-related causes of delayed ICU admission are a major target for patient safety and medical quality improvement.…”

Section: Discussionsupporting

confidence: 90%

Physician-related factors associated with unscheduled revisits to the emergency department and admission to the intensive care unit within 72 h

Chang

Lee

et al. 2020

Sci Rep

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investigation of physician-related causes of unscheduled revisits to the emergency department (eD) within 72 h with subsequent admission to the intensive care unit (ICU) is an important parameter of emergency care quality. Between 2012 and 2017, medical records of all adult patients who visited the ED and returned within 72 h with subsequent ICU admission were retrospectively reviewed by three experienced emergency physicians. Study parameters were categorized into "input" (Patient characteristics), "throughput" (Time spent on first ED visit and seniority of emergency physicians, and "output" (Charlson Comorbidity Index). Of the 147 patients reviewed for the causes of ICU admission, 35 were physician-related (23.8%). Eight belonged to more urgent categories, whereas the majority (n = 27) were less urgent. Patients who spent less time on their first ED visits before discharge (< 2 h) were significantly associated with physician-related causes of ICU admission, whereas there was no significant difference in other "input," "throughput," and "output" parameters between the "physician-related" and "non-physician-related" groups. Short initial management time was associated with physician-related causes of ICU admission in patients with initial less urgent presentations, highlighting failure of the conventional triage system to identify potentially lifethreatening conditions and possibility of misjudgement because of the patients' apparently minor initial presentations. An unscheduled revisit to the emergency department (ED) within 72 h is an important parameter for the assessment of emergency medical care quality 1,2. There are myriad factors affecting the rate of 72-h ED revisit, including patient demography, ethnical and cultural differences, epidemiology of diseases, and the accessibility to medical care 3. For instance, children and the elderly have been reported to have higher rates of ED revisits compared with those of other demographic groups 1,4. From the perspective of emergency healthcare quality improvement, a number of studies have focused on preventable medical errors 5-7. A previous study has reported a rate of medical error-related 72-h ED revisit between 5 and 45% 8. In addition to the lack of physician experience and absence of standard operation guidelines for diagnosis, other reasons include ineffective communication, staff shortage,

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Section: Discussionsupporting

confidence: 90%

Physician-related factors associated with unscheduled revisits to the emergency department and admission to the intensive care unit within 72 h

Chang

Lee

et al. 2020

Sci Rep

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“…Overcrowding in pediatric emergency departments (EDs) places a heavy burden on healthcare systems in terms of financial costs [ 1 , 2 ] and potential infection-related ED visits [ 3 ]. Recently, significant interest and research has focused on the number of return-to-emergency department (ED) visits, as it represents a quality benchmark for patient safety and care [ 4 – 6 ]. This number also contributes to overcrowding in EDs, as some visits are unnecessary [ 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the fact that revisits to the ED are well recognized as a key for quality improvement [ 4 – 6 ], no data exists in Saudi Arabia regarding the rate of ED revisits among children with chronic diseases. This study attempts to investigate the frequency of ED revisits at a major Saudi hospital and the common causes, and to identify factors among children with chronic diseases associated with the high rate of 72-h ED revisits after discharge.…”

Section: Introductionmentioning

confidence: 99%

Emergency department 72-hour revisits among children with chronic diseases: a Saudi Arabian study

et al. 2018

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BackgroundEmergency Department (ED) revisits have often been used as an indicator of medical care quality. This study aimed to quantify the frequency of ED revisits within 72 h of discharge and identify its factors among children with chronic diseases.MethodsWe designed a retrospective cohort study of children with at least one chronic disease who were also under 18 years of age and had attended and were discharged from the ED at King Abdullah Specialist Children’s Hospital (KASCH-RD), Riyadh, Saudi Arabia between April 19, 2015 and July 29, 2017. The outcome measure was the frequency of ED revisits during a period of 72 h after discharge.ResultsThe study included 11,057 ED discharges of children with at least one chronic disease. Their revisit rate was 1211 (11%), with 83 (6.9%) having had a second ED revisit within 72 h of ED discharge. According to ICD-10 codes, the most common causes of ED revisits were respiratory, digestive, genitourinary, symptoms, and external causes. Factors of frequent ED revisits within 72 h were young age, institutional health insurance coverage, year of new health information system (2015), external causes, and genitourinary.ConclusionThe rate of 72-h ED revisits after discharge of children with chronic diseases treated at KASCH-RD was relatively high, and was associated with young age, institutional health insurance coverage, year of a new health information system implementation, and external causes of ED visit. These study findings amplify the need for intervention to reduce the rate of early ED revisits among children with chronic diseases.

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“… 3 An ED revisit within 72 hours has been used as a benchmark to improve the health care quality of services, work efficiency, and to ensure patient safety. 4 – 6 …”

Section: Introductionmentioning

confidence: 99%

“…The ED revisit within 72 hours has been widely reported in earlier studies, and its rate depends on the chronic disease status and the cultural background. 6 – 12 The rates of 72-hour ED revisits may depend on age, 10 , 11 gender, 10 , 13 disease categories, 6 – 8 , 12 medical errors, 7 , 8 patients, 7 and doctors. 7 Although data regarding ED revisits within 72 hours can be used to implement changes and modifications to improve the electronic medical record database, the rate of revisits to the ED within 72 hours has not been documented among adults with chronic diseases in Saudi Arabia, particularly in our center.…”

Section: Introductionmentioning

confidence: 99%

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

Ahmed

AlBuraikan

Almazroa

et al. 2018

TCRM

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BackgroundDespite the increase in adult emergency department (ED) utilization in Saudi Arabia, no studies have evaluated the 72-hour revisits. This study estimates the rate of 72-hour ED revisits and identifies its reasons and predictive factors among adults with chronic diseases.Patients and methodsA hospital-based retrospective study that included 24,206 ED discharges for adults with chronic diseases at the adult ED of King Abdulaziz Medical City, Riyadh between September 13, 2015 and July 29, 2017 was performed. We extracted data on demographic information, reasons for ED visits/revisits, health insurance coverage, weekend ED arrival, and mortality.ResultsA sample of 24,206 ED discharges for 19,697 adults with at least one chronic disease was included in the analysis. The rate of 72-hour revisits in this study population was high: 3,144/24,206 (13%) had the first revisit and 319/3,144 (10.1%) had the second ED revisit within 72 hours. Diseases of the circulatory (19%) and genitourinary (15.8%) systems were the major reasons for the first ED revisit. The adjusted relative rate (aRR) of 72-hour ED revisits was higher in adults with chronic diseases and aged ≥60 years (aRR=1.360, 95% CI: 1.41–1.83; P=0.001), patients of female gender (aRR=1.24, 95% CI: 1.09–1.41; P=0.001), patients with health insurance coverage (aRR=4.23, 95% CI: 2.60–6.90; P=0.001), patients arriving to ED on a weekend (aRR=2.13, 95% CI: 1.03–4.41; P=0.041), and new patients (aRR=1.47, 95% CI: 1.25–1.73; P=0.001).ConclusionThe rate of 72-hour revisits is high among adults with chronic diseases. Advancing age, female gender, health insurance coverage, weekend ED arrival, and new patients are the important predictive factors of the high rate of 72-hour revisits. Continuous quality assessment and monitoring of factors related to patients are needed to reduce the frequency of early ED revisits after discharge.

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Characteristics and outcomes of patients with emergency department revisits within 72 hours and subsequent admission to the intensive care unit

Cited by 17 publications

References 28 publications

Physician-related factors associated with unscheduled revisits to the emergency department and admission to the intensive care unit within 72 h

Physician-related factors associated with unscheduled revisits to the emergency department and admission to the intensive care unit within 72 h

Emergency department 72-hour revisits among children with chronic diseases: a Saudi Arabian study

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

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