Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

Abstract

Introduction: Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits.

Methods: Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed. We collected data on patient demographics, attendance data and clinical characteristics. Planned reattendances, recalled cases, reattendances for unrelated complaints and patients who left without being seen were excluded. A multivariate analysis was conducted to determine the odds ratio of variables associated with hospital admission for reattendances.

Results: Of 162,566 children, 6,968 (4.3%) returned within 72 hours, and 2,925 (42.0% of reattendance group) were admitted on their return visits. Children more likely to reattend were under three years of age, Chinese, triaged as Priority 2 at the first visit, and were initially diagnosed with respiratory or gastrointestinal conditions. However, children more likely to be admitted on their return visits were over 12 years of age, Malay, had a higher triage acuity or were uptriaged, had the presence of a comorbidity, and were diagnosed with gastrointestinal conditions.

Conclusion: We identified certain subgroups in the population who were more likely to be admitted if they reattended. These findings would help in implementing further research and directing strategies to reduce potentially avoidable reattendances and admissions.

Keywords: admission; emergency department; overcrowding; reattendances; return visits.

Fig. 1

Flowchart shows the reattendance visits, exclusion criteria and final disposition of patients who reattended the emergency department from 1 June 2013 to 31 May 2014. Exclusion criteria included planned reattendances (i.e. reviews for neonatal jaundice and dengue), recalled cases, reattendances for unrelated complaints and patients who left without being seen. AOR: discharged against medical advice.