Emergency Department Return Visits Within a Large Geographic Area

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Health Services Research

Background:

• Return visits to the emergency department (RTED) are a significant factor in emergency department overcrowding.
• Understanding RTED patterns is crucial for assessing healthcare quality.
• Limited research exists on RTEDs across diverse healthcare settings within a large geographic region.

Purpose of the Study:

• To quantify the incidence of pediatric RTEDs.
• To map the directional flow of pediatric RTEDs across multiple healthcare facilities.
• To analyze RTED patterns in a large, integrated healthcare system.

Main Methods:

• A retrospective, cross-sectional study was conducted over one year in the Vancouver lower mainland.
• Pediatric emergency visits were linked across one quaternary pediatric center and 17 community/regional emergency departments.
• Return visits were defined as subsequent visits with a compatible diagnosis within 7 days of an initial visit.

Main Results:

• Out of 139,278 index visits, 8.7% resulted in 14,645 RTEDs.
• While most index visits occurred at general EDs, 22% of their RTEDs were to the pediatric ED (PED).
• The PED experienced a disproportionate share (38.9%) of all RTEDs, with 13.6% of its index visits returning to general centers.

Conclusions:

• Linking hospitals across a large geographic area reveals a higher proportion of RTEDs than single-center studies.
• The pediatric emergency department bears a disproportionate burden of return visits.
• No significant association was found between ED crowding and the likelihood of RTEDs.