Rate, Mode, Reasons and Factors Associated With Re-Presentation in People Diagnosed With Musculoskeletal Conditions...

To explore the rate, mode, and reasons for re-presentations for emergency department (ED) patients with musculoskeletal diagnoses and examine factors associated with increased odds of re-presentation.

A retrospective cross-sectional audit of re-presentation patterns for patients with musculoskeletal diagnoses presenting to the study ED in 2023. The study ED was in a secondary hospital in Perth, Western Australia, which operates a diversion pathway (daily, 10 am-6 pm) for patients with musculoskeletal diagnoses.

In 2023, 3677 patients with musculoskeletal diagnoses were diverted from the ED, 972 provided research consent and of those, 143 (14.7%) re-presented. Importantly, 10 (1.0%) patients re-presented to the ED itself, and 133 (13.7%) re-presented to the physiotherapy outpatient diversion clinic. There were 65 scheduled and 78 unscheduled re-presentations, with telehealth the preferred mode of contact (n = 86, 60.1%). Clinician diagnostic uncertainty, identified patient psychosocial issues, and concern that the patient would re-present to the ED most commonly resulted in scheduled re-presentation (n = 31, 47.7%). Unscheduled re-presentations focused on administrative inquiries (e.g., hospital referrals, medical certificates) (n = 31, 39.7%) and concern for symptoms (n = 25, 32.1%). Older age, high pain severity, and lower limb affected body region were associated with increased odds of re-presentation.

ED clinicians may reduce re-presentation by employing targeted strategies such as shared decision-making about pain management, ensuring a shared understanding of the diagnosis, or stage of the diagnostic process and likely course of symptoms. Further, a follow-up plan that is clinically indicated and patient acceptable may be critical for those with increased odds of re-representation.