Unplanned return presentations of older patients to the emergency department: a root cause analysis
Abstract Background In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12877-020-01770-x |
| _version_ | 1818693608780333056 |
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| author | Babiche E. J. M. Driesen Hanneke Merten Cordula Wagner H. Jaap Bonjer Prabath W. B. Nanayakkara |
| author_facet | Babiche E. J. M. Driesen Hanneke Merten Cordula Wagner H. Jaap Bonjer Prabath W. B. Nanayakkara |
| author_sort | Babiche E. J. M. Driesen |
| collection | DOAJ |
| description | Abstract Background In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was to provide insight into the root causes and potential preventability of unplanned return presentations (URP) to the ED within 30 days for older patients. Methods A prospective observational study was conducted from February 2018 to November 2018 in an academic hospital in Amsterdam. We included 83 patients, aged 70 years and older, with an URP to the ED within 30 days of the initial ED presentation. Patients, GPs and doctors at the ED were interviewed by trained interviewers and basic administrative data were collected in order to conduct a root cause analysis using the PRISMA-method. Results One hundred fifty-one root causes were identified and almost half (49%) of them were disease-related. Fifty-two percent of the patients returned to the ED within 7 days after the initial presentation. In 77% of the patients the URP was related to the initial presentation. Patients judged 17% of the URPs as potentially preventable, while doctors at the ED judged 25% and GPs 23% of the URPs as potentially preventable. In none of the cases, there was an overall agreement from all three perspectives on the judgement that an URP was potentially preventable. Conclusion Disease-related factors were most often identified for an URP and half of the patients returned to the ED within 7 days. The majority of the URPs was judged as not preventable. However, an URP should trigger healthcare workers to focus on the patient’s process of care and their needs and to anticipate on potential progression of disease. Future research should assess whether this may prevent that patients have to return to the ED. |
| first_indexed | 2024-12-17T13:16:24Z |
| format | Article |
| id | doaj.art-0d5def9d93494fbea8deb61b32c095ca |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-17T13:16:24Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-0d5def9d93494fbea8deb61b32c095ca2022-12-21T21:46:59ZengBMCBMC Geriatrics1471-23182020-09-0120111010.1186/s12877-020-01770-xUnplanned return presentations of older patients to the emergency department: a root cause analysisBabiche E. J. M. Driesen0Hanneke Merten1Cordula Wagner2H. Jaap Bonjer3Prabath W. B. Nanayakkara4Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Surgery, Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAbstract Background In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was to provide insight into the root causes and potential preventability of unplanned return presentations (URP) to the ED within 30 days for older patients. Methods A prospective observational study was conducted from February 2018 to November 2018 in an academic hospital in Amsterdam. We included 83 patients, aged 70 years and older, with an URP to the ED within 30 days of the initial ED presentation. Patients, GPs and doctors at the ED were interviewed by trained interviewers and basic administrative data were collected in order to conduct a root cause analysis using the PRISMA-method. Results One hundred fifty-one root causes were identified and almost half (49%) of them were disease-related. Fifty-two percent of the patients returned to the ED within 7 days after the initial presentation. In 77% of the patients the URP was related to the initial presentation. Patients judged 17% of the URPs as potentially preventable, while doctors at the ED judged 25% and GPs 23% of the URPs as potentially preventable. In none of the cases, there was an overall agreement from all three perspectives on the judgement that an URP was potentially preventable. Conclusion Disease-related factors were most often identified for an URP and half of the patients returned to the ED within 7 days. The majority of the URPs was judged as not preventable. However, an URP should trigger healthcare workers to focus on the patient’s process of care and their needs and to anticipate on potential progression of disease. Future research should assess whether this may prevent that patients have to return to the ED.http://link.springer.com/article/10.1186/s12877-020-01770-xAcute careEmergency departmentOlder patientsElderlyPreventabilityReturn presentations |
| spellingShingle | Babiche E. J. M. Driesen Hanneke Merten Cordula Wagner H. Jaap Bonjer Prabath W. B. Nanayakkara Unplanned return presentations of older patients to the emergency department: a root cause analysis BMC Geriatrics Acute care Emergency department Older patients Elderly Preventability Return presentations |
| title | Unplanned return presentations of older patients to the emergency department: a root cause analysis |
| title_full | Unplanned return presentations of older patients to the emergency department: a root cause analysis |
| title_fullStr | Unplanned return presentations of older patients to the emergency department: a root cause analysis |
| title_full_unstemmed | Unplanned return presentations of older patients to the emergency department: a root cause analysis |
| title_short | Unplanned return presentations of older patients to the emergency department: a root cause analysis |
| title_sort | unplanned return presentations of older patients to the emergency department a root cause analysis |
| topic | Acute care Emergency department Older patients Elderly Preventability Return presentations |
| url | http://link.springer.com/article/10.1186/s12877-020-01770-x |
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