Improvement in safety measures to reduce ED returns.

Area of Science:

• Healthcare Quality Improvement
• Emergency Medicine
• Patient Safety

Background:

• Emergency department (ED) return cases, particularly those involving critical or deceased patients, represent a significant concern for healthcare organizations.
• Addressing these return visits is crucial for improving patient outcomes and organizational performance.

Purpose of the Study:

• To implement a quality improvement initiative aimed at reducing return visits by critical/deceased adult patients to the ED within 72 hours by 50%.
• To evaluate factors contributing to hospital admissions or revisits within 72 hours of ED discharge.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) cycles for intervention development and implementation, starting in January 2022.
• Implemented daily systemic trigger notifications and analysis of ED return cases by quality improvement specialists.
• Introduced patient safety leadership meetings within 24 hours of return visits and integrated a comprehensive consultation checklist into the Hospital Information System (HIS).

Main Results:

• A significant reduction in ED return patients by 46.60% was observed, decreasing from 0.13% in 2021 to 0.08% in 2022-2023.
• Statistical process control charts demonstrated sustained improvements in ED return rates.

Conclusions:

• The quality improvement initiative was highly effective in reducing patient morbidity and mortality associated with ED return visits.
• While effective, the initiative also led to an increase in immature admissions, highlighting the need for continuous monitoring and analysis of ED return cases.