Related Experiment Video
Updated: Feb 26, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Hospital-Level Factors Associated with Pediatric Emergency Department Return Visits
Zachary Pittsenbarger1, Cary Thurm2, Mark Neuman3
1Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. zpittsenbarger@luriechildrens.org.
Insights
High return visit (RV) rates in pediatric emergency departments are linked to patient social determinants of health and lower specialist staffing, not hospital quality. Return visits with admission (RVA) rates showed no such associations.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Return visits (RVs) and return visits with admission (RVAs) are key emergency department (ED) quality metrics.
- While patient and visit factors are known to influence RV rates, hospital-specific factors remain understudied.
Purpose of the Study:
- To investigate hospital-level characteristics associated with elevated RV and RVA rates in pediatric EDs.
Main Methods:
- A multicenter, mixed-methods study utilizing the Pediatric Health Information System and ED director surveys.
- Generalized linear mixed-effects models were used to calculate adjusted return rates.
- Hospitals were stratified based on adjusted RV and RVA rates for comparative analysis.
Main Results:
- Across 24 hospitals and over 1.4 million visits, the adjusted RV rate was 3.7% and RVA rate was 0.7%.
- Hospitals with high RV rates served populations with higher rates of government insurance, lower median incomes, and less commercial insurance.
- Outlier hospitals for RV rates exhibited significantly lower pediatric emergency medicine specialist staffing (1.9 FTEs/10,000 visits) compared to others (2.9 FTEs/10,000 visits).
- No significant differences in population characteristics or staffing were observed between RVA groups.
Conclusions:
- Pediatric ED RV rates correlate with population social determinants of health and inversely with specialist staffing levels.
- Observed hospital-level variations in RV rates may reflect external socioeconomic factors rather than internal quality of care issues.
Background:
Return visits (RVs) and RVs with admission (RVAs) are commonly used emergency department quality measures. Visit- and patient-level factors, including several social determinants of health, have been associated with RV rates, but hospital-specific factors have not been studied.
Objective:
To identify what hospital-level factors correspond with high RV and RVA rates.
Setting:
Multicenter mixed-methods study of hospital characteristics associated with RV and RVA rates.
Data Source:
Pediatric Health Information System with survey of emergency department directors.
Measurements:
Adjusted return rates were calculated with generalized linear mixed-effects models. Hospitals were categorized by adjusted RV and RVA rates for analysis.
Results:
Twenty-four hospitals accounted for 1,456,377 patient visits with an overall adjusted RV rate of 3.7% and RVA rate of 0.7%. Hospitals with the highest RV rates served populations that were more likely to have government insurance and lower median household incomes and less likely to carry commercial insurance. Hospitals in the highest RV rate outlier group had lower pediatric emergency medicine specialist staffing, calculated as full-time equivalents per 10,000 patient visits: median (interquartile range) of 1.9 (1.5-2.1) versus 2.9 (2.2-3.6). There were no differences in hospital population characteristics or staffing by RVA groups.
Conclusion:
RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption