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. 2016 Jun;57(6):301-6.
doi: 10.11622/smedj.2016104.

Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital

Amy Hui Sian Chan  1 , Shu Fang Ho  2 , Stephanie Man Chung Fook-Chong  3 , Sherman Wei Qiang Lian  4 , Nan Liu  4   5 , Marcus Eng Hock Ong  4   6
Affiliations

Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital

Amy Hui Sian Chan et al. Singapore Med J. 2016 Jun.

Abstract

Introduction: 72-hour emergency department (ED) reattendance is a widely-used quality indicator for quality of care and patient safety. It is generally assumed that patients who return within 72 hours of ED discharge (72-hour re-attendees) received inadequate treatment or evaluation. The current literature also suggests considerable variation in probable causes of 72-hour ED reattendances internationally. This study aimed to understand the characteristics of these patients at the ED of a Singapore tertiary hospital.

Methods: We conducted a retrospective cohort study on all ED visits between 1 January 2013 and 31 December 2013. 72-hour re-attendees were compared against non-re-attendees based on patient demographics, mode of arrival, patient acuity category status (i.e. P1/P2/P3/P4), seniority ranking of doctor-in-charge and medical diagnoses. Multivariate analysis using the generalised linear model was conducted on variables associated with 72-hour ED re-attendance.

Results: Among 104,751 unique patients, 3,065 (2.93%) were in the 72-hour re-attendees group. Multivariate analysis showed that the following risk factors were associated with higher risk of returning within 72 hours: male gender, older age, arrival by ambulance, triaged as P2, diagnoses of heart problems, abdominal pain or viral infection (all p < 0.001), and Chinese ethnicity (p = 0.006). There was no significant difference in the seniority ranking of the doctor-in-charge between both groups (p = 0.419).

Conclusion: Several patient and event factors were associated with higher risk of being a 72-hour re-attendee. This study forms the basis for hypothesis generation and further studies to explore reasons behind reattendances so that interventions can be developed to target high-risk groups.

Keywords: 72-hour emergency department reattendance; 72-hour emergency department return; emergency department reattendance; emergency department return.

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Figures

Fig. 1
Fig. 1
Flowchart shows the study selection process. ABS: absconded; AOR: discharged at own risk; DOA: dead on arrival; LWBS: left without being seen
See this image and copyright information in PMC

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