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Unscheduled return visits to the pediatric emergency department-one-year experience
Ran D Goldman1, Michael Ong, Alison Macpherson
1Pediatric Research in Emergency Therapeutics Program, Division of Pediatric Emergency Medicine, The Research Institute, The Hospital for Sick Children, University of Toronto, Ontario, CA. goldman@sickkids.ca
Insights
Five percent of pediatric emergency department (ED) visits are by children returning within 72 hours. Younger children with high acuity visiting during evening hours are most likely to return to the ED.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
Background:
- Return visits to the emergency department (ED) within 72 hours may indicate issues with initial assessment, treatment, or follow-up.
- Understanding return visit patterns is crucial for optimizing pediatric ED (PED) operations and patient care.
Purpose of the Study:
- To determine the rate of return visits to a tertiary care pediatric ED.
- To identify characteristics of children who return to the PED within 72 hours.
Main Methods:
- Retrospective review of 37,725 patient records from a pediatric ED in Toronto during 2003.
- Exclusion of patients who left without being seen, against medical advice, or were admitted.
- Univariate and multivariate analyses to identify factors associated with return visits.
Main Results:
- 5.2% (1990) of eligible children returned within 72 hours.
- Younger children, higher initial visit acuity, and visits between 8 pm and midnight were associated with higher return rates.
- No significant seasonal differences in return visits were observed.
Conclusions:
- Approximately 5% of pediatric ED visits are repeat visits within a 72-hour period.
- Key predictors for return visits include young age, high acuity of the initial visit, and timing of the visit during late evening hours.
- These findings can inform strategies to reduce return visits and improve care quality in pediatric emergency settings.
Objectives:
Patients returning to the emergency department (ED) within 72 hours of their visit may contribute to crowding and might indicate failure to give a proper assessment, treatment, or follow-up instructions. The aim of this study was to describe the rate of return visits in a tertiary care pediatric ED (PED) and find characteristics of children who return to the ED.
Methods:
We retrospectively reviewed all records of patients visiting our PED in Toronto during 2003. We collected demographic data, time of visit(s), and acuity. We excluded patients who left without being seen, left against medical advice, or were admitted to the hospital. We conducted univariate and multivariate analyses to determine odds ratio of variables associated with returning.
Results:
Of 37,725 eligible children, 1990(5.2%) returned within 72 hours. One hundred fifty-six returned for a third visit, and 10 returned for a fourth visit. A quarter of the children who returned were younger than 1 year, and the younger the child, the higher the likelihood of returning; the higher the acuity of the first (index) visit, the higher the likelihood that a patient will return. Patients coming during the busiest hours, between 8 pm and midnight, were more likely to return. We found no significant seasonal differences in univariate or multivariate analysis.
Conclusions:
Five percent of our PED visits are return visits of children seen in the 72 hours before the visit. Younger children, with high acuity who come to the ED in the late evening hours, are most likely to return to the ED.