Evaluation of patients who re-admitted to the emergency department within 24 hours

Abstract

Aim: It was conducted to investigate the demographic and clinical characteristics of patients who re-admitted to the emergency department within 24 hours and to contribute to studies on reducing the re-admission rate. Methods: The data of patients who re-admitted to the emergency department within 24 hours between November 2021 and September 2023 in a secondary level public hospital were retrospectively examined. Data regarding the patients' demographic information, admission dates and times, clinical characteristics, examinations, diagnoses, consultations, hospitalization and referral status were obtained from the hospital automation system. Results: 496270 patients admitted to the emergency department during the study period. 6991 (1.4%) of the patients were admitted to the emergency department again within 24 hours. 40.3% of these patients were between the ages of 19-35 and 52.4% were women. The most common reason for re-admission to the emergency department was upper respiratory tract diseases. It was determined that 66.7% of the patients applied to the emergency department again 13-24 hours after their first admission. In their second admission, 43 patients were hospitalized or transferred for various reasons; It was determined that 1 of these patients died 5 months after being admitted to the intensive care unit. Conclusion: Effective triage practices, directing green area patients to family physicians, making the referral chain effective, increasing health literacy, making an accurate diagnosis, allocating appropriate time to patients and explaining the treatment and expectations from treatment, ensuring that patients referred to polyclinics are evaluated as soon as possible and returned to the emergency department will significantly reduce applications.

Keywords

• emergency department
• readmission
• 24 saat

References

1. Beştemir A, Aydın H. 300 million Patient Examinations annually; Evaluation of Emergency Department and Polyclinic Services of Secondary and Tertiary Public Health Facilities in Turkey. Sakarya Medical Journal. 2022;12(3):496-502. doi.org/10.31832/ smj.1128439
2. Derlet RW, Nishio D, Cole LM, Silva J Jr. Triage of patients out of the emergency department: three-year experience. Am J Emerg Med. 1992;10(3):195-199. doi:10.1016/0735-6757(92)90207-E
3. Pope D, Fernandes CM, Bouthillette F, Etherington J. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017-1020.
4. Rieffe C, Oosterveld P, Wijkel D, Wiefferink C. Reasons why patients bypass their GP to visit a hospital emergency department. Accid Emerg Nurs. 1999;7(4):217-225. doi:10.1016/ s0965-2302(99)80054-x
5. Lavoie FW, Carter GL, Danzl DF, Berg RL. Emergency department violence in United States teaching hospitals. Ann Emerg Med. 1988;17(11):1227-1233. doi:10.1016/s0196-0644(88)80076-3
6. Sağlıkta Kalite Standartları[Internet]. 2016 [cited May 2024] Available from: https://shgmkalitedb.saglik.gov.tr/TR-9081/ indikator-uygulamalari.html.
7. Slankamenac K, Zehnder M, Langner TO, Krähenmann K, Keller DI. Recurrent Emergency Department Users: Two Categories with Different Risk Profiles. J Clin Med. 2019;8(3):333. Published 2019 Mar 9. doi:10.3390/jcm8030333
8. Gordon JA, An LC, Hayward RA, Williams BC. Initial emergency department diagnosis and return visits: risk versus perception. Ann Emerg Med. 1998;32(5):569-573. doi:10.1016/ s0196-0644(98)70034-4

9. Karcıoğlu Ö, Topaçoğlu H. Emergency department triage in war and terrorist disasters. Eur Arch Med Res. 2017; 33(1):1-8. doi:10.5222/otd.2017.001.
10. Sultanoğlu H, Gamsızkan Z, Cangür Ş. Examination of repeated applications in patients who applied to the emergency department in a year and suggestions for solutions. DÜ Sağlık Bil Enst Derg. 2021;11(1):50-55. doi:10.33631/duzcesbed.751317
11. Oktay C, Cete Y, Eray O, Pekdemir M, Gunerli A. Appropriateness of emergency department visits in a Turkish university hospital. Croat Med J. 2003;44(5):585-591.
12. Grover CA, Crawford E, Close RJ. The Efficacy of Case Management on Emergency Department Frequent Users: An Eight- Year Observational Study. J Emerg Med. 2016;51(5):595-604. doi:10.1016/j.jemermed.2016.06.002
13. Lowthian J, Straney LD, Brand CA, et al. Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project. Age Ageing. 2016;45(2):255-261. doi:10.1093/ageing/afv198
14. Miró O, Jiménez S, Alsina C, et al. Revisitas no programadas en un servicio de urgencias de medicina hospitalario: incidencia y factores implicados [Unscheduled revisits in medical emergency units at the hospital: incidence and related factors]. Med Clin (Barc). 1999;112(16):610-615.
15. Kelly AM, Chirnside AM, Curry CH. An analysis of unscheduled return visits to an urban emergency department. N Z Med J. 1993;106(961):334-336.
16. Akyol C, Oktay C, Hakbilir O, Janitzky Akyol A, Çalışkan Tür F. Evaluation of revisits to an emergency department. Turk J Emerg Med 2006;6(3):108-116.
17. Goh SH, Masayu MM, Teo PS, Tham AH, Low BY. Unplanned returns to the accident and emergency department--why do they come back? Ann Acad Med Singap. 1996;25(4):541-546.
18. Chan AH, Ho SF, Fook-Chong SM, Lian SW, Liu N, Ong ME. Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital. Singapore Med J. 2016;57(6):301-306. doi:10.11622/ smedj.2016104
19. Incesu E, Beylik U, Kucukkendirci H. The problem of re-admission to emergency services: a case study for a state hospital emergency service in Turkey. Academic Overview Journal. 2016;5381:1-13.