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Evaluation of unplanned reattendances to the pediatric emergency department - a five-year study
Liying Toh1,2, Jin Wee Lee3, Siok Hoon Ang4,5
1Department of Pediatric Emergency Medicine, KK Women's and Children's Hospital (KKH), 100 Bukit Timah Road, Singapore, 229899, Singapore. toh.liying@singhealth.com.sg.
Insights
Unplanned reattendances (UR) in pediatric emergency departments are linked to young age, high patient acuity, and specific diagnoses like gastrointestinal and respiratory issues. Identifying these risk factors can help optimize care and resources for at-risk children.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Clinical Epidemiology
Background:
- Unplanned reattendances (UR) are a key quality indicator in emergency departments (ED).
- Understanding UR risk factors aids in resource allocation and patient counseling.
- This study compares characteristics of children with and without UR in a pediatric ED.
Purpose of the Study:
- To compare patient characteristics between children with and without unplanned reattendances (UR) in a pediatric ED.
- To investigate healthcare delivery factors associated with UR rates.
- To identify independent risk factors for UR in pediatric patients.
Main Methods:
- Retrospective, single-center cohort study of patients under 18 years old (January 2018 - March 2023).
- UR defined as revisit within 72 hours of the initial ED visit.
- Logistic regression used to identify independent factors associated with UR, adjusting for covariates.
Main Results:
- 4.5% of eligible children (24,733/544,699) had UR.
- Independent risk factors for UR included young age (<3 years), high patient acuity (P2+), and evening/night attendance.
- Gastrointestinal and respiratory diagnoses were significantly associated with increased UR rates.
Conclusions:
- Identified independent risk factors for UR can guide resource allocation in pediatric EDs.
- Further research is needed to explore targeted interventions for at-risk populations to reduce UR.
Background:
Unplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of UR.
Study Design:
We performed a retrospective, single-center cohort study of patients < 18 years old who visited the ED between January 2018 and March 2023. UR was defined as a revisit within 72 h of the index ED visit. We collected data on demographics, attendance data and clinical characteristics. Logistic regression was performed for factors independently associated with UR, after adjusting for age, patient acuity, timing of attendance, presence of senior doctor supervision, rotation months for junior doctors, and diagnostic category.
Results:
Out of the 544,699 eligible children, 24,733 (4.5%) reattended the ED within 72 h, of which 10,915 (44.1%) of them were hospitalized on their reattendance visit. The independent factors associated with UR were young age (age < 3 years old: aOR 1.585 95%CI 1.481-1.698, p < 0.001), high acuity P2+ (aOR 1.398 95%CI 1.354-1.444, p < 0.001), attendance in the evening (aOR 1.086 95%CI 1.055-1.117, p < 0.001) and night (aOR 1.365 95%CI 1.314-1.417, p < 0.001), gastrointestinal diagnosis (aOR 1.528, CI 1.469-1.588; p < 0.001) and respiratory diagnosis (aOR 1.155, CI 1.121-1.189, p < 0.001).
Conclusions:
We identified independent risk factors for UR that could guide resource allocation. Future studies should investigate if targeted interventions may reduce UR in these at-risk populations.
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