Incidence, characteristics and outcomes of patients that return to Emergency Departments. An integrative review

Hutchinson, Claire; McCloughen, Andrea; Curtis, Kate

doi:10.1016/j.auec.2018.12.003

Cited by 23 publications

(20 citation statements)

References 77 publications

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“…The number of boarding patients gradually increased from Monday to Friday, and then decreased on Friday afternoon. The median (IQR) value was 56 (44-68) for the total number of patients, 35 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for the number of evaluating patients, and 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) for the number of boarding patients. Therefore, the third quartile, the critical point of overcrowding, was 68, 44, and 26, for total, evaluating, and boarding indicators, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The entire 72 h RV rate has been most commonly used for monitoring ED performance [4,5,21,23], but many of the RVs are caused by patient factors such as worry about health, or illness factors such as disease progression, rather than medical error [1,9,20,23], and several researchers suggested that the rate of RVA may be a better indicator for reflecting the quality of healthcare [3,46]. In this study, the 72 h RVA rate was 0.9% of total ED visits, similar to the 0.5-1.5% reported in previous studies [1,11,20].…”

Section: Discussionmentioning

confidence: 99%

“…We defined the RV as returning to the ED within a short-term period of 72 hours from the ED departure time of the index visit. Despite a lack of supporting evidence, 72 hours is the time period used in 63% of previously reported studies [21]. Furthermore, the RV was divided into the RVA and RVNA, according to the treatment outcome when the patient returned to the ED.…”

Section: Definition and Data Processingmentioning

confidence: 99%

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Influence of Overcrowding in the Emergency Department on Return Visit within 72 H

Kim

Park

et al. 2020

JCM

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This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 h. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 h from ED arrival time and the last 1 h before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3743 (4.3%) returned to the ED within 72 h. Of the crowding indicators pertaining to total patients, the last 1 h significantly affected decrease in RV (p = 0.0046). Boarding patients were found to increase RV occurrence during the first 1 h (p = 0.0146) and 4 h (p = 0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 h (p = 0.0166) and 4 h (p = 0.0335) and evaluating patients during the first 1 h (p = 0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Definition and Data Processingmentioning

confidence: 99%

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Influence of Overcrowding in the Emergency Department on Return Visit within 72 H

Kim

Park

et al. 2020

JCM

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“…The number of boarding patients gradually increases from Monday to Friday, and then decreases on Friday afternoon. The median (IQR) value was 56 (44-68) for the total number of patients, 35 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for the number of evaluating patients, and 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) for the number of boarding patients. Therefore, the third quartile, the critical point of overcrowding was 68, 44, and 26, for total, evaluating, and boarding indicators, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The entire 72-hour RV rate has been most commonly used for monitoring ED performance [4,5,23,44], but many of the RVs are caused by patient's factors such as worry about health or illness's factors such as disease progression rather than medical error [1,9,20,23], and several researchers suggested that the rate of RVA may be a better indicator for reflecting the quality of healthcare [3,45]. In this study, the 72-hour RVA rate was 0.9% of total ED visits, similar to the 0.5-1.5% reported in previous studies [1,11,20].…”

Section: Discussionmentioning

confidence: 99%

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Kim

Park

et al. 2020

Preprint

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This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 hour before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3,743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 hour significantly affected decrease in RV (p=0.0046). Boarding patients were found to increase RV occurrence during the first 1 hour (p=0.0146) and 4 hours (p=0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 hour (p=0.0166) and 4 hours (p=0.0335) and evaluationg patients during the first 1 hour (p=0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

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Extending emergency care beyond discharge: Piloting a virtual after care clinic

Oostema,

Mullennix,

Chassee

et al. 2024

JACEP Open

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ObjectiveMany unscheduled return visits to the emergency department (ED) stem from insufficient access to outpatient follow‐up. We piloted an emergency medicine‐staffed, on‐demand, virtual after care clinic (VACC) as an alternative for discharged ED patients.MethodsProspective cohort study of discharged ED patients who scheduled VACC appointments within 72 hours of index ED visit. We performed descriptive analyses and compared risks of ED return at 72 hours and 30 days between patients who did/did not attend their appointment.ResultsFrom March to December 2022, 309 patients scheduled VACC appointments and 210 (68%) attended them. Patients who scheduled appointments were young (median 37 years), non‐Hispanic white (80%), females (75%) with a primary care physicians (PCP) (90%), and commercial insurance (72%). Most VACC visits reinforced ED testing and/or treatment (64%) or adjusted medications (26%). VACC attendees were less likely to return to the ED within 72 h (3.3% vs. 13.1%; risk difference 9.3% [95% confidence interval, CI 2.7%‒19.8%]) and 30 days (16.2% vs. 30.3%; risk difference 14.1% [95% CI 3.8%‒24.4%]) compared to those who scheduled but did not attend a VACC appointment. VACC attendance was associated with lower odds of 72‐h (adjusted odds ratio [aOR] 0.0; 95% CI 0.0‒0.4) and 30‐day (aOR 0.4; 95% CI 0.2‒0.7) return ED visits.ConclusionsIn this pilot study, younger, white, female, commercially insured patients with a PCP preferentially scheduled VACC appointments. Among patients who scheduled VACC appointments, those who attended their appointments were less likely to return to the ED within 72 hours and 30 days than those who did not.

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Incidence, characteristics and outcomes of patients that return to Emergency Departments. An integrative review

Cited by 23 publications

References 77 publications

Influence of Overcrowding in the Emergency Department on Return Visit within 72 H

Influence of Overcrowding in the Emergency Department on Return Visit within 72 H

Influence of Overcrowding in the Emergency Department on Return Visit within 72 Hours

Extending emergency care beyond discharge: Piloting a virtual after care clinic

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