[Adverse events in emergency departments. Review of reconsultations as a data source]

To identify potential adverse events that occur in an emergency department by reviewing cases of patients who make repeat visits.

A retrospective study of clinical data of patients returning to the emergency department within a period of less than one week in October 2006 with the aim of identifying problems that occurred in the first visit. The review was conducted by senior doctors of the same service who measured the reliability of the first intervention, by checking between observer agreement. The Chi square test was used to calculate the comparison ratios.

We studied 311 cases. Of these, 203 cases (79.6%) returned to the department without been given a previous appointment and for a reason connected with the first visit. The progress was poor in 83.7% of cases. We reviewed the causes of the poor outcomes, with the most frequent being "natural progress of the process" in 75 cases (44.1%), followed by problems in treatment in 73 cases (42.9%). The effects on the patient were evaluated, and it was shown that there were consequences for the patient in 36 cases (21.2%). Of these 36 cases, 11 were considered as avoidable (30.5%) by the evaluators and 1% of clear failures in performance in patients returning to emergency rooms. In the part of if, in opinion of the evaluadores, there had been a clear failure in the first performance zoned like such 3 cases, two with consequences for the patient and 1 without consequences.

In the conditions of the study, the internal evaluation of the reconsultas allows to identify the adverse events occurred and know his causes. This could facilitate the learning and the improvement of the culture of security.