Early Pediatric Emergency Department Return Visits A Prospective Patient-Centric Assessment

• Published in: Clinical pediatrics Vol. 51; no. 7; pp. 651 - 658
• Main Authors: Ali, Alliyia B., Place, Rick, Howell, John, Malubay, Sienna M.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-07-2012; Westminster Publications, Inc
• Subjects: Caregivers; Child, Preschool; Children & youth; Disease Progression; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Infant; Male; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patient Satisfaction - statistics & numerical data; Pediatrics; Prospective Studies; Statistics, Nonparametric; return visits; emergency department; administration
• ISSN: 0009-9228; 1938-2707
• DOI: 10.1177/0009922812440840

Background
A substantial percentage of emergency department (ED) patients return within 72 hours of their initial evaluation. Quality reviews typically demonstrate that most revisits do not seem to be directly related to problematic care provided on the first evaluation. We examined the possibility that return visits are related to nonmedical issues on the first visit, most notably patient discharge education.
Objective
We prospectively surveyed a convenience sample of caregivers in a pediatric ED to determine why they returned with their children within 72 hours of their initial ED visit.
Design/Methods
All patients who returned within 72 hours of a previous visit were identified and prospectively interviewed using a survey instrument with nominal (multiple choice) and brief descriptive responses.
Results
Caregivers of 124 children were prospectively surveyed; 93 children (75%) returned because their symptoms had not improved or worsened. Only 50 (53%) had contacted their primary medical doctor (PMD) prior to the second visit; of these, 14 (28%) could not get an appointment, and 32 (64%) were told to return to the ED. Discharge instructions were felt to be informative by 94% (n = 86) of caregivers with the same number (94%) reported being satisfied with the first ED physician. Twenty-nine children (30%) were admitted on the second visit.
Conclusions
Among children who are discharged from the emergency department and return within 72 hours, most caregivers are satisfied with the care and instructions provided on their first visits. Though most patients have a PMD, many do not call them prior to their return ED visit, and those who do either cannot schedule an appointment or are told to return to the ED. The majority of patients return for clinical progression of illness.