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Initial emergency department diagnosis and return visits: risk versus perception
J A Gordon1, L C An, R A Hayward
1Robert Wood Johnson Clinical Scholars Program, the Section of Emergency Medicine, Department of Surgery, and the Division of General Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
Annals of Emergency Medicine
|October 31, 1998
Summary
Dehydration is a common emergency department diagnosis and a significant predictor of early return visits and hospital admission. Healthcare providers often underestimate the risk associated with dehydration, highlighting a need for targeted prevention strategies.
Area of Science:
- Emergency Medicine
- Health Services Research
- Clinical Epidemiology
Background:
- Emergency Department (ED) revisits represent a significant burden on healthcare systems.
- Identifying predictors of early return visits is crucial for developing effective patient management and resource allocation strategies.
Purpose of the Study:
- To identify diagnostic predictors of early return emergency department (ED) visits.
- To compare the actual and perceived associations between initial ED diagnoses and revisits.
- To identify target diagnoses for prevention strategies.
Main Methods:
- A retrospective observational study of ED patients with 2 or more visits within 3 days.
- Analysis of billing records to determine initial diagnoses of return visitors.
- A survey of ED health professionals to assess perceived risk of diagnoses for return visits.
Main Results:
- Dehydration was the most common diagnosis in general, early-return, and return-admit populations.
- Dehydration posed the highest risk for early return (RR 2.3) and subsequent admission (RR 1.8).
- Two-thirds of health professionals underestimated the risk of dehydration for return visits and admissions.
Conclusions:
- Initial ED diagnosis is a valuable predictor of early return visits and admissions.
- Patients with an initial diagnosis of dehydration are at high risk for early return and admission.
- Underrecognized high-frequency diagnoses, such as dehydration, represent key targets for prevention strategies.