Characteristics of Unscheduled Emergency Department Return Visit Patients within 48 Hours in Thammasat University Hospital
Intanon Imsuwan MD*
Affiliation : *Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Background : Auditing the return visit charts of patients who returned within 48 hours is a very important method of quality
assurance. Several factors can be possible causes of unscheduled emergency return visits. Therefore, identifying these factors
is critical to decreasing the number of unnecessary visits in this group.
Objective : To determine rate, common initial presentation and cause of unscheduled emergency department return visits
within 48 hours at Thammasat University Hospital.
Material and Method: The present study design involves retrospective observational study of patients who returned to the
Emergency department (ED) within 48 hours after being discharged from the ED. Data was collected from August 1, 2009 to
July 31, 2010. Patient age, gender, triage level, patient-in time, patient-out time, length of stay, chief complaint, first and second
visit diagnoses and disposition after second visit were recorded by chart review. The factors and causes of revisits were
classified by the author as illness-related, patient-related, doctor-related and/or healthcare system-related.
Results : A total of 307(0.92%) patients returned visit to the ED within 48 hours during August 1, 2009 to July 31, 2010. The
most common chief complaint were dyspnea (75 cases or 24.4%), abdominal pain (53 cases or 17.3%), bleeding per vagina
(28 cases or 9.1%). The rates of revisit that were related to factors of illness, patients, doctors and healthcare system were
60.6, 8.5, 28.3 and 2.6, respectively. Chi-squared was used for categorical data.
Conclusion : Unscheduled ED return visit patients represent high risk patients. Patients in this group are associated with
various factors. The present study indicates that the most common factor behind return visits were illness-related. Illness-
related and patient-related factors were significantly associated with discharged patient. Observational units could reduce
unnecessary return visit in this group. Doctor-related and healthcare-related factors were significantly associated with
admitted return visit patients. Emergency physician training system and guideline implementation for doctors could reduce
unexpected early discharge in this group.
Keywords : Return visits, Emergency Department
