Physician’s changes in management of return visits to the Emergency Department

Abstract

Return visits to the Emergency Department (ED) are estimated between 2-3.1%, which impacts ED care costs and wait times. Adverse events for unscheduled return visits (URVs) have been reported to be as high as 30%. The objective of this study was to characterize the attitudes and management of Emergency Medicine (EM) physicians regarding patients presenting with the same chief complaint to the ED for an URV. An online survey questionnaire was developed and sent to 160 accredited EM Graduate Medical Education programs in the United States. The questionnaire consisted of case vignettes wherein providers were asked to submit what orders they would place for each scenario. The mean numbers of tests and treatments were compared from initial visit to repeat visit with same chief complaint. Physicians also provided feedback regarding their management of URVs. There were estimated 6988 eligible participants with 397 responses (response rate 5.7%). There was a statistical significance (P<0.001) in provider management of URVs with pediatric fever, but there was no statistical significance for management of the other chief complaints. There were 77% of physicians that felt an increased work up is warranted for URVs. The results of this study indicate that majority of EM residents and staff working in training programs feel that they should approach the management of URV patients with a more extensive workup despite no clinical change. These findings suggest that further analysis should be performed regarding provider management of URVs and the associated healthcare costs.

Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases

“…Only one study has been performed in Italy to the best of our knowledge, and was mainly focused on evaluating resource utilization in management of AAP (19). The scarce information available so far is particularly concerning if one considers that abdominal pain represents one of the leading causes of repeated ED visits, often necessitating additional and expensive testing, and sometimes plagued by unfavorable outcomes (20)(21)(22)(23). Therefore, the aim of this study was to investigate the epidemiology of AAP in an adult patient population admitted to a large urban ED and, even more importantly, to analyze the clinical outcomes based on patients returning to the ED within 5 and 30 days after first admission and needing surgery.…”