Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department
Introduction: The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits wi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2018-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/4z7463vp |
| _version_ | 1818600238948024320 |
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| author | Jake Hayward Reidar Hagtvedt Warren Ma Aliyah Gauri Michael Vester Brian R. Holroyd |
| author_facet | Jake Hayward Reidar Hagtvedt Warren Ma Aliyah Gauri Michael Vester Brian R. Holroyd |
| author_sort | Jake Hayward |
| collection | DOAJ |
| description | Introduction: The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). Methods: We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 – December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA. Results: Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (−1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion: We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission. |
| first_indexed | 2024-12-16T12:32:19Z |
| format | Article |
| id | doaj.art-9086cde3ae4640c8afb91d95149355b1 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-12-16T12:32:19Z |
| publishDate | 2018-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-9086cde3ae4640c8afb91d95149355b12022-12-21T22:31:40ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182018-10-0119610.5811/westjem.2018.38225wjem-19-912Predictors of Admission in Adult Unscheduled Return Visits to the Emergency DepartmentJake Hayward0Reidar Hagtvedt1Warren Ma2Aliyah Gauri3Michael Vester4Brian R. Holroyd5University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, CanadaUniversity of Alberta, Alberta School of Business, Edmonton, Alberta, CanadaUniversity of Alberta, Department of Emergency Medicine, Edmonton, Alberta, CanadaUniversity of Alberta, Department of Emergency Medicine, Edmonton, Alberta, CanadaUniversity of Alberta, Department of Emergency Medicine, Edmonton, Alberta, CanadaUniversity of Alberta, Department of Emergency Medicine, Edmonton, Alberta, CanadaIntroduction: The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). Methods: We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 – December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA. Results: Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (−1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion: We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.https://escholarship.org/uc/item/4z7463vp |
| spellingShingle | Jake Hayward Reidar Hagtvedt Warren Ma Aliyah Gauri Michael Vester Brian R. Holroyd Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department Western Journal of Emergency Medicine |
| title | Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department |
| title_full | Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department |
| title_fullStr | Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department |
| title_full_unstemmed | Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department |
| title_short | Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department |
| title_sort | predictors of admission in adult unscheduled return visits to the emergency department |
| url | https://escholarship.org/uc/item/4z7463vp |
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