Return visits to the paediatric emergency department

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Clinical Epidemiology

Background:

• Unplanned return visits (uRVs) to pediatric emergency departments (EDs) represent a significant challenge in healthcare delivery.
• Understanding the factors contributing to uRVs is crucial for improving patient outcomes and optimizing ED resource allocation.

Purpose of the Study:

• To determine the incidence of unplanned return visits (uRVs) within 48 hours to a pediatric ED over a 12-month period.
• To identify and describe the key factors associated with these uRVs in a tertiary pediatric hospital.

Main Methods:

• A retrospective review of electronic health records was conducted for patients attending a tertiary pediatric hospital ED in Western Australia.
• Data from initial and follow-up visits were analyzed to identify patients with uRVs within 48 hours of their primary ED presentation.

Main Results:

• A total of 2322 patients (3.4%) presented for uRVs out of 68,352 ED visits.
• Infectious causes accounted for over 53% of uRVs. Triage category 3 (OR 1.11) and ages 3 months to 5 years (OR 1.37-1.32) were significantly associated with uRVs.
• Seasonal variations were observed, with higher uRV percentages in summer months (3.8-4.1%), and a notable increase in uRVs occurred following middle-grade doctor changeovers.

Conclusions:

• The study identified specific patient demographics and clinical presentations associated with increased risk of uRVs.
• Factors such as initial triage category, age group, infectious etiology, and healthcare provider transition periods are critical considerations for reducing pediatric ED uRVs.