Aerospace Medicine ; Emergencies ; Equipment and Supplies ; Ethics, Medical ; First Aid ; Humans ; Physicians ; Professional Competence ; Travel

INTRODUCTION72-hour emergency department (ED) reattendance is a widely-used quality indicator for quality of care and patient safety. It is generally assumed that patients who return within 72 hours of ED discharge (72-hour re-attendees) received inadequate treatment or evaluation. The current literature also suggests considerable variation in probable causes of 72-hour ED reattendances internationally. This study aimed to understand the characteristics of these patients at the ED of a Singapore tertiary hospital.

METHODSWe conducted a retrospective cohort study on all ED visits between 1 January 2013 and 31 December 2013. 72-hour re-attendees were compared against non-re-attendees based on patient demographics, mode of arrival, patient acuity category status (i.e. P1/P2/P3/P4), seniority ranking of doctor-in-charge and medical diagnoses. Multivariate analysis using the generalised linear model was conducted on variables associated with 72-hour ED re-attendance.

RESULTSAmong 104,751 unique patients, 3,065 (2.93%) were in the 72-hour re-attendees group. Multivariate analysis showed that the following risk factors were associated with higher risk of returning within 72 hours: male gender, older age, arrival by ambulance, triaged as P2, diagnoses of heart problems, abdominal pain or viral infection (all p < 0.001), and Chinese ethnicity (p = 0.006). There was no significant difference in the seniority ranking of the doctor-in-charge between both groups (p = 0.419).

CONCLUSIONSeveral patient and event factors were associated with higher risk of being a 72-hour re-attendee. This study forms the basis for hypothesis generation and further studies to explore reasons behind reattendances so that interventions can be developed to target high-risk groups.

Abdominal Pain ; Adult ; Aged ; Aged, 80 and over ; China ; Data Mining ; Electronic Health Records ; Emergency Medicine ; methods ; statistics & numerical data ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Discharge ; Patient Readmission ; Patient Safety ; Quality of Health Care ; Retrospective Studies ; Risk ; Singapore ; Tertiary Care Centers ; Triage ; methods ; Young Adult