Unscheduled return visits to a pediatric emergency department

Sigita Burokienė; Ignė Kairienė; Marius Strička; Liutauras Labanauskas; Rimantė Čerkauskienė; Juozas Raistenskis; Emilija Burokaitė; Vytautas Usonis

doi:10.1016/j.medici.2017.01.003

Unscheduled return visits to a pediatric emergency department

Medicina (Kaunas). 2017;53(1):66-71. doi: 10.1016/j.medici.2017.01.003. Epub 2017 Jan 31.

Authors

Sigita Burokienė¹, Ignė Kairienė², Marius Strička³, Liutauras Labanauskas⁴, Rimantė Čerkauskienė², Juozas Raistenskis⁵, Emilija Burokaitė², Vytautas Usonis²

Affiliations

¹ Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania. Electronic address: sigita.burokiene@vuvl.lt.
² Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania.
³ Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁴ Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁵ Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Lithuania.

PMID: 28233682
DOI: 10.1016/j.medici.2017.01.003

Abstract

Background and objective: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania.

Materials and methods: A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n=44097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression.

Results: Of the overall ED population, 33889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72h, giving a RV rate of 3.0%. Being a 0-7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01a.m. to 4:00p.m. and underwent radiological test were less likely to return to the ED within 72h. Diseases such as gastrointestinal disorders or respiratory tract/earth-nose-throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%).

Conclusions: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.

Keywords: Children; Overcrowding; Pediatric emergency department; Return visit; Urgent care.

MeSH terms

Adolescent
Child
Child, Preschool
Emergency Service, Hospital / organization & administration*
Female
Hospitals, Pediatric / organization & administration*
Humans
Infant
Infant, Newborn
Lithuania
Male
Patient Discharge / statistics & numerical data
Patient Readmission / statistics & numerical data*
Retrospective Studies
Time Factors