Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study

Geirsson, Óli Páll; Gunnarsdóttir, Oddný Sigurborg; Baldursson, Jón; Hrafnkelsson, Birgir; Rafnsson, Vilhjálmur

doi:10.1136/emermed-2012-201129

Cited by 14 publications

(16 citation statements)

References 28 publications

(52 reference statements)

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“…Some studies use 72-h return visits [[2],[7],[9]–[11],[14],[16],[21]] while others have used a 30-day delay between the two visits [[26],[27]]. Applying the 72-h time frame in our results, our percentage of unscheduled return visits (2.7%) compares well with published 72-h return rates, ranging from 2.2% to 5.5% [[2],[7],[9]–[11],[14],[16],[21]].…”

Section: Discussionmentioning

confidence: 99%

Unscheduled return visits to a Dutch inner-city emergency department

et al. 2014

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BackgroundUnscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems.MethodsAll unscheduled return visits occurring within 1 week and related to the initial ED visit were selected. Multivariable logistic regression was conducted to determine independent factors associated with unscheduled return, using patient information available at the initial visit. Reasons for returning unscheduled were categorized into illness-, patient- or physician-related. Post-ED disposition was compared between patients with unscheduled return visits and the patients who did not return.ResultsFive percent (n = 2,492) of total ED visits (n = 49,341) were unscheduled return visits. Patients with an urgent triage level, patients presenting during the night shift, with a wound or local infection, abdominal pain or urinary problems were more likely to return unscheduled. Reasons to revisit unscheduled were mostly illness-related (49%) or patient-related (41%). Admission rates for returning patients (16%) were the same as for the patients who did not return (17%).ConclusionsApart from abdominal complaints, risk factors for unscheduled return differ from previous studies. Short-term follow-up at the outpatient clinic or general practitioner for patients with urgent triage levels and suffering from wounds or local infections, abdominal pain or urinary problem might prevent unscheduled return.

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Section: Discussionmentioning

confidence: 99%

Unscheduled return visits to a Dutch inner-city emergency department

et al. 2014

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“…Patients who leave against medical advice have a higher rate of repeated ED visits, hospital admissions, and mortality. [5][6][7][8][9][10][11][12] From the 148,810 discharges from Montefiore Medical Center in Bronx, NY, 2.4% of patients were discharged against medical advice, and they had a higher 30-day mortality (odds ratio 2.05) and higher 30-day readmission (odds ratio 1.84). 8 Among the 857 patients of 31,252 who were discharged against medical advice from the Johns Hopkins University Emergency Department, 4.4% had a return to the ED for an emergency hospitalization at 30 days.…”

Section: Introductionmentioning

confidence: 99%

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations

Marco

Brenner

Kraus

et al. 2017

Annals of Emergency Medicine

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Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans.

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“…In adults, admitted patients who DAMA have an eightfold risk of readmission within 14 days for a similar diagnosis and threefold risk of mortality within 12 months compared with their non-DAMA counterparts 2. Emergency department (ED) patients who DAMA were reported to have 7.5 times and 6.9 times the risk to re-present to the ED within 15 days and 30 days, respectively 3. Little is known about DAMA in the paediatric population.…”

Section: Introductionmentioning

confidence: 99%

Discharge against medical advice in culturally and linguistically diverse Australian children

et al. 2019

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ObjectivesThis study quantifies the prevalence and rates of discharge against medical advice (DAMA) in culturally and linguistically diverse (CALD) children and assesses the independent association between CALD status and DAMA accounting for key demographic confounders in a large tertiary Australian hospital network.MethodsProspectively collected data between 2010 and 2018 were extracted from the hospital network electronic medical records system for admitted patients (n=192 037), outpatients (n=268 904) and between 2015 and 2018 for emergency department (ED) patients (n=158 903). CALD status was defined as ‘preferred language being not English’ and DAMA was measured as ‘discharge at own risk’ in admissions, ‘no show’ in outpatients, ‘left without being seen’ and ‘did not wait’ in ED. Data were analysed using χ² test, bivariate analysis and multivariate logistic regression.ResultsThe prevalence of DAMA was 1.34% in admitted patients, 19.31% in outpatients and 12.64% in ED patients. Rates of DAMA were higher among CALD children compared to non-CALD children (1.75% vs 1.29% in admitted patients, 26.53% vs 17.92% in outpatients and 18.74% vs 11.61% in ED patients). CALD status was independently associated with DAMA in admitted children (OR=1.30, 95% CI 1.15 to 1.44), outpatients (OR=1.55; 95% CI 1.51 to 1.58) and ED patients (OR=1.60; 95% CI 1.53 to 1.66).ConclusionBeing from a CALD background places children at increased risks to DAMA. Implementing appropriate health service responses may ensure equitable access and quality care for children from CALD backgrounds to reduce the rates of DAMA and its associated ramifications.

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Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study

Abstract: During 30 days follow-up, AMA and WBS patients had an increased rate of repeat ED visits compared with those patients who completed their ED visits. AMA patients also had an increased rate of hospitalisations.

Cited by 14 publications

References 28 publications

Unscheduled return visits to a Dutch inner-city emergency department

Unscheduled return visits to a Dutch inner-city emergency department

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations

Discharge against medical advice in culturally and linguistically diverse Australian children

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