Who should review the walking wounded? Reattendance at accident and emergency departments.

There has been great variation between District Health Authorities in the proportion of attenders at Accident and Emergency Departments who reattend for further care. Eight Accident and Emergency Departments were studied during 1987 to ascertain the extent to which this reflects different medical policies. Information extracted from a random sample of 4,682 first attendances found that the sample reattendance rates lay closer together than the reported ones, with only a three-fold, rather than a six-fold variation between departments. Important causes of the exaggerated variation in the reported rates were different ways of organising follow-up clinics, and differences in hospital and departmental practices of aggregating and reporting statistics on activities in these clinics. The variation between departments in their booked reattendance rates could not be explained by differences in case-mix or treatment practices. The results of this study suggest that differences in medical and organisational policies produce different reattendance rates. However, it is not known which of the different management policies on reattendance are the most cost-effective.