An analysis of unscheduled return visits to an urban emergency department

This study was undertaken to identify the reasons for unscheduled return visits to an urban emergency department, particularly those relating to physician errors in diagnosis and management, and, where possible, to identify strategies to reduce unscheduled return visits.

All patients returning to the Emergency Department, Christchurch Hospital, within seven calendar days of initial visit were identified. These cases were reviewed to identify reasons for return visit.

Unscheduled return visits accounted for 2% of patient encounters. Sixty one per cent were due to illness related factors, 27% to patient related factors, 11% to physician related factors and 1% to system related factors. Significant management errors occurred in nine patients (4.4% of unscheduled return visits), three of whom were admitted. There were no ICU or CCU admissions and no deaths.

Significant physician errors were a minor reason for reattendance at the emergency department and no specific areas of deficiency were identified. These might be further reduced by increasing the seniority and experience of staff and by the introduction of regular audit, continuing medical education and vocational training programmes. Interventions to reduce patient related unscheduled return visits might include better explanation of the role of the emergency department and better communication with patients about their illness and treatment.