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Characteristics and determinants of high-risk unscheduled return visits to the emergency department

BACKGROUND: High-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the charact...

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Autores principales: Hiti, Eveline A, Tamim, Hani, Makki, Maha, Geha, Mirabelle, Kaddoura, Rima, Obermeyer, Ziad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027026/
https://www.ncbi.nlm.nih.gov/pubmed/31806725
http://dx.doi.org/10.1136/emermed-2018-208343
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author Hiti, Eveline A
Tamim, Hani
Makki, Maha
Geha, Mirabelle
Kaddoura, Rima
Obermeyer, Ziad
author_facet Hiti, Eveline A
Tamim, Hani
Makki, Maha
Geha, Mirabelle
Kaddoura, Rima
Obermeyer, Ziad
author_sort Hiti, Eveline A
collection PubMed
description BACKGROUND: High-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED. METHODS: Case–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation. RESULTS: Out of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75). CONCLUSION: HRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs.
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spelling pubmed-70270262020-02-28 Characteristics and determinants of high-risk unscheduled return visits to the emergency department Hiti, Eveline A Tamim, Hani Makki, Maha Geha, Mirabelle Kaddoura, Rima Obermeyer, Ziad Emerg Med J Original Research BACKGROUND: High-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED. METHODS: Case–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation. RESULTS: Out of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75). CONCLUSION: HRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs. BMJ Publishing Group 2020-02 2019-12-05 /pmc/articles/PMC7027026/ /pubmed/31806725 http://dx.doi.org/10.1136/emermed-2018-208343 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Hiti, Eveline A
Tamim, Hani
Makki, Maha
Geha, Mirabelle
Kaddoura, Rima
Obermeyer, Ziad
Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title_full Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title_fullStr Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title_full_unstemmed Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title_short Characteristics and determinants of high-risk unscheduled return visits to the emergency department
title_sort characteristics and determinants of high-risk unscheduled return visits to the emergency department
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027026/
https://www.ncbi.nlm.nih.gov/pubmed/31806725
http://dx.doi.org/10.1136/emermed-2018-208343
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