The study of adult patients with return visits to the emergency department within 72 hours resulting in an inpatient admission

• Main Authors: Liu, Sung-Wei, 劉松維
• Other Authors: Chen, Shu-Yuan
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/11592988843427579118

碩士 === 慈濟大學 === 公共衛生學系碩士班 === 103 === Background：Return visits to emergency department (ED) are not uncommon among hospital of different levels. This phenomenon has been a clinical indicator of quality of care in ED for decades, and also as a topic of numerous journal articles in the literature. However, most of these articles focused on the characteristics of the patients returning within 72 hours after ED discharge, and articles focusing on those with subsequent admission are numbered. Objective：This study’s purpose is to identify risk factors for admission among 72-hour return visit in ED adult population. Hypothesis：Demographic and clinical characteristics will influence the risk for admission among ED 72-hour return visits. Method：This case-control study was conducted in a medical center in Eastern Taiwan by retrospectively reviewing medical records of patients returning within 72 hours after discharged from emergency department. The study period was from Jan 1, 2013 to Dec 31, 2013. The eligible cases were identified after fully reviewing their data, including demographic and clinical characteristics. We excluded patients who left against medical advice or without being seen, who was admitted or transferred at the index ED visit, whose medical records were incomplete, whose cause of revisit were unrelated to the index ED visit, and whose age was below 18 years old. Patients with 72-hour return visit and admission were defined as the case group; patients with 72-hour return visit and no admission were defined as the control group. Significant variables were selected based on univariate analysis and later entered into multivariate logistic regression analysis to identify risk factors for 72-hour return admission. Result：There were 1,575 eligible visits during study period. After excluding those meeting the exclusion criteria, there were 1,119 visits entering into the final analysis. Male gender (OR=1.44), ambulance-transport at return visit (OR=3.68), senior staff (OR=1.52), work-up at index visit (OR=3.03), and longer length of stay at index visit were associated with higher risks of admission among ED 72-h return visits. Age, comorbidity, mode of transport at index visit, consultation, triage, trauma/non-trauma, outpatient department visit between ED visits, and interval between index and return visits were not significantly associated with return admission. Conclusion：Gender, mode of transportation, staff experience, check-up, and length of stay are associated with ED return admission.