TY - JOUR
T1 - Emergency Department Return Visits Within a Large Geographic Area
AU - Truong, Mimi
AU - Meckler, Garth
AU - Doan, Quynh H.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/6
Y1 - 2017/6
N2 - Background Return visits to the emergency department (RTED) contribute to overcrowding and may be a quality of care indicator. Previous studies focused on factors predicting returns to and from the same center. Little is known about RTEDs across a range of community and specialty hospitals within a large geographic area. Objective We sought to measure the frequency of pediatric RTEDs and describe their directional pattern across centers in a large catchment area. Methods We conducted a multicenter, retrospective cross-sectional study of pediatric emergency visits in the Vancouver lower mainland within 1 year. Visits were linked across study sites, including one pediatric quaternary care referral center and 17 sites ranging from large regional centers to smaller community emergency departments (EDs). Returns were defined as subsequent visits to any site with a compatible diagnosis within 7 days of an index visit. Results Among a total of 139,278 index ED visits by children, 12,133 (8.7% [95% confidence interval 8.6–8.9%]) were associated with 14,645 return visits to an ED. Three quarters of all index visits occurred at a general ED center, of which 8.9% had at least one RTED and 22% of these returns occurred at the pediatric ED (PED). Among PED index visits, 8.2% had at least one RTED and 13.6% of these returned to a general center. Overall, 38.9% of all RTEDs occurred at the PED. Multivariate regression did not identify any statistically significant association between ED crowding measures and likelihood of RTEDs. Conclusions Compared to single-center studies, this study linking hospitals within a large geographic area identified a higher proportion of RTEDs with a disproportionate burden on the PED.
AB - Background Return visits to the emergency department (RTED) contribute to overcrowding and may be a quality of care indicator. Previous studies focused on factors predicting returns to and from the same center. Little is known about RTEDs across a range of community and specialty hospitals within a large geographic area. Objective We sought to measure the frequency of pediatric RTEDs and describe their directional pattern across centers in a large catchment area. Methods We conducted a multicenter, retrospective cross-sectional study of pediatric emergency visits in the Vancouver lower mainland within 1 year. Visits were linked across study sites, including one pediatric quaternary care referral center and 17 sites ranging from large regional centers to smaller community emergency departments (EDs). Returns were defined as subsequent visits to any site with a compatible diagnosis within 7 days of an index visit. Results Among a total of 139,278 index ED visits by children, 12,133 (8.7% [95% confidence interval 8.6–8.9%]) were associated with 14,645 return visits to an ED. Three quarters of all index visits occurred at a general ED center, of which 8.9% had at least one RTED and 22% of these returns occurred at the pediatric ED (PED). Among PED index visits, 8.2% had at least one RTED and 13.6% of these returned to a general center. Overall, 38.9% of all RTEDs occurred at the PED. Multivariate regression did not identify any statistically significant association between ED crowding measures and likelihood of RTEDs. Conclusions Compared to single-center studies, this study linking hospitals within a large geographic area identified a higher proportion of RTEDs with a disproportionate burden on the PED.
KW - epidemiology
KW - health care utilization
KW - pediatrics
KW - quality improvement
KW - return visits to the emergency department
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U2 - 10.1016/j.jemermed.2017.01.009
DO - 10.1016/j.jemermed.2017.01.009
M3 - Article
C2 - 28228344
AN - SCOPUS:85013106468
VL - 52
SP - 801
EP - 808
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
IS - 6
ER -