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Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors
Karen LeDuc1, Heidi Rosebrook, Michael Rannie
1The Children's Hospital/Denver, Denver, Colorado 80210, USA. LeDuc.Karen@tchden.org
Insights
Emergency department overcrowding is worsened by patient recidivism. Age, race, and diagnosis predict return visits, especially in pediatric patients with specific diseases, guiding targeted interventions.
Area of Science:
- Emergency Medicine
- Health Services Research
- Pediatric Healthcare
Background:
- Emergency department (ED) overcrowding is a persistent national crisis.
- Increased patient volume and illness severity exacerbate ED crowding.
- Recidivists, a small patient group, account for a disproportionate number of ED visits.
Purpose of the Study:
- To examine demographic and diagnostic characteristics of ED recidivists.
- To clarify the national issue of frequent ED utilization by specific patient groups.
- To identify predictors of return visits to the emergency department.
Main Methods:
- Utilized hospital decision support systems to identify readmission indicators (3-month and 48-hour return visits).
- Employed descriptive statistics and multiple regression to analyze recidivist characteristics.
- Conducted chart reviews and telephone interviews to explore ED utilization patterns.
Main Results:
- 25% of the sample had at least one visit in the previous 3 months; 4% had a 48-hour return visit.
- Traditional predictors like insurance and symptom chronicity were not reliable for return visits.
- Age, race, and diagnosis were significant predictors (p < .05), particularly for pediatric patients.
Conclusions:
- Findings help understand pediatric recidivism and identify high-risk patients.
- Specific diseases (nervous system, sense organ, digestive, infectious, parasitic) in children under 1 year are associated with higher return visit risk.
- ED nurses may consider nurse-initiated treatment protocols for at-risk pediatric populations.
Introduction:
Overcrowding in emergency departments remains a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. Demographic and diagnostic characteristics were examined in an attempt to describe this national issue with more clarity.
Methods:
The hospital decision support system was used to identify 2 readmission indicators (3-month return visits and 48-hour returns). Descriptive statistics and multiple regression techniques were used to analyze the characteristics of recidivists. Chart reviews and telephone interviews were conducted to further explore ED utilization.
Results:
Twenty-five percent of the sample (N = 932) had at least one visit during the previous 3 months (N = 237). Four percent of the sample had a 48-hour return visit (N = 38). The findings revealed that the traditional determinants of ED utilization such as insurance and chronicity of symptoms are not reliable predictors of return visits. The risk factors of age, race, and diagnosis were significantly associated with return visit at a significance level less than .05. The findings confirm that some demographic and diagnostic predictability of return visits is indeed evident for pediatric patients.
Discussion:
Although the sample is not representative, the data are helpful in identifying some of the issues of pediatric recidivism. Findings provide some understanding of parents' utilization of the emergency department and identified high-risk pediatric recidivists. Data also revealed specific disease entities warranting focused attention, such as nervous system diseases, sense organ diseases, digestive system diseases, infectious diseases, and parasitic diseases for children younger than 1 year. Patients with these problems may be at greater risk for return visits. ED nurses might consider nurse-initiated treatment protocols.
