Socioeconomic Disparities in 72-Hour Emergency Department Return Visits (Bouncebacks): A Multicenter Analysis

Emergency department (ED) return visits within 72 h, commonly referred to as ``bouncebacks," are used as a quality metric and may reflect issues related to care delivery, follow-up, or patient understanding. Previous studies suggest that race and insurance status may influence ED utilization, yet data on their association with bounceback visits remain limited.

To determine if patient race was associated with increased ED bounceback rates.

We conducted a retrospective cohort study of 562,131 ED encounters across 17 EDs in a large integrated health system from January 1, 2021 to December 31, 2022. Patient demographics, insurance type, comorbidities, triage acuity, and visit characteristics were extracted from the electronic medical record. Poisson and logistic regression analyses assessed the association between race, sex, insurance, and 72-h return visits, adjusting for confounders.

Of all encounters, 32,075 (8%) resulted in a 72-h return visit. Non-White patients have 21% higher odds than White patients to return within 72 h (adjusted odds ratio 1.21; 95% confidence interval 1.17-1.24). Medicaid recipients were 49% more likely and Medicare recipients 25% more likely to have bouncebacks than those with private insurance. Non-White patients had higher overall ED utilization, were younger, and were more likely to be insured by Medicaid.

Race and socioeconomic status are independently associated with increased ED bounceback visits. These disparities may reflect systemic barriers to outpatient care access and warrant targeted quality improvement initiatives, including improved discharge processes and enhanced follow-up support for high-risk populations.