Evaluation of revisits to an emergency department

Abstract

Objectives: Two to eleven percent of emergency department (ED) visits are revisits defined as another visit for the same complaint within 5 days. Forty percent of these revisits were shown to be preventable. The aim of this study was to determine the frequency of these revisits, the presenting complaints of patients with revisits, admission rates, rate of preventable revisits, recommendation made by physicians and compliance of patients.
Materials and Methods: Between February 1, 2003 and May 31, 2003 patients presenting to the ED of Akdeniz University Hospital were included into this prospective study when they had been seen by another physician with in the last 5 days before their visit to our ED. Patients who were transferred to our hospital were excluded. The demographic data, presenting complaints, health care unit visited before, time between the first and the second presentations, therapies recommended, diagnoses, and therapy information told to the patients by their last visit and compliance with recommended therapy was questioned. Phoning the patients 7-10 days after discharged from emergency department compliance and follow up were questioned. Data gathered in our ED were compared with the previous visit’s data.
Results: During the study period, 13.414 patients presented to the emergency department. 266 (2%) patients who met our criteria were analyzed. A hundred and fifty five (58.2%) of these patients were female. This ratio was significantly different from the gender ratio of overall presenting patients. A total of 33 (12.5%) patients were admitted to the hospital and there was no difference between overall admission rate. Nevertheless, the rate of admission significantly increases with the 3rd, 4th and 5th visits. Fifteen (22.3%) patients with coexisting diseases were admitted to the hospital and the admission rate was significantly higher then the patients without coexisting diseases. Non-compliance was detected in 19.9% of patients. Different diagnosis was made and therapy was changed for 17.2% of patients. Patients without health insurance account for less revisits and more therapy changes then the patients with health insurance.
Conclusion: Revisits for the same complaints increases the workload of EDs but do not play a significant role in crowding. Providing more information to patients and physicians’ education on this topic will decrease the rate of revisits approximately 37.1%. Revisits despite of these means, patients have to be evaluated carefully for wrong diagnosis, wrong therapy, and indications for admission, especially if the patient has coexisting diseases.