Kent Robinson1, Bonnie Lam. 1. Department of Emergency Medicine, Liverpool Hospital, Sydney, NSW 2170, Australia. Kent.Robinson@sswahs.nsw.gov.au
Abstract
OBJECTIVE: The present study aims to describe early ED representation rates and identify the causes for this commonly seen problem. METHODS: This was a retrospective chart review of all patients that represented within 72 h of discharge from a tertiary level ED in Sydney, Australia, over a 2 month period between 1 May 2010 and 30 June 2010. Presentations were categorised according to their diagnosis and cause for representation. Each representation was then classified as being avoidable or unavoidable. RESULTS: There were 10 141 presentations to the ED during the study period, with 497 patients (4.9%, 95% confidence interval [CI] 4.5-5.3) representing within 72 h of discharge. Disease-related causes of representation were seen in 55.1% (95% CI 50.7-59.5), with 39% (95% CI 34.8-43.4) of these caused by disease progression and 12.3% (95% CI 9.6-15.5) for scheduled review. Patient-related causes were seen in 32.2% (95% CI 28.2-36.4) of representations with 20.9% (95% CI 17.6-24.7) of these for patients who did not wait or left against medical advice. Physician-related causes were seen in 3.2% (95% CI 2.0-5.2) of representations. Furthermore, 23.7% (95% CI 20.2-27.7) of patients who represented to the ED required hospital admission. A total of 37.0% (95% CI 32.9-41.4) of representations were assessed as being preventable. CONCLUSION: Early ED representations are a common problem. The majority of preventable representations are patient related, and interventions to target these areas might be of benefit in reducing this problem.
OBJECTIVE: The present study aims to describe early ED representation rates and identify the causes for this commonly seen problem. METHODS: This was a retrospective chart review of all patients that represented within 72 h of discharge from a tertiary level ED in Sydney, Australia, over a 2 month period between 1 May 2010 and 30 June 2010. Presentations were categorised according to their diagnosis and cause for representation. Each representation was then classified as being avoidable or unavoidable. RESULTS: There were 10 141 presentations to the ED during the study period, with 497 patients (4.9%, 95% confidence interval [CI] 4.5-5.3) representing within 72 h of discharge. Disease-related causes of representation were seen in 55.1% (95% CI 50.7-59.5), with 39% (95% CI 34.8-43.4) of these caused by disease progression and 12.3% (95% CI 9.6-15.5) for scheduled review. Patient-related causes were seen in 32.2% (95% CI 28.2-36.4) of representations with 20.9% (95% CI 17.6-24.7) of these for patients who did not wait or left against medical advice. Physician-related causes were seen in 3.2% (95% CI 2.0-5.2) of representations. Furthermore, 23.7% (95% CI 20.2-27.7) of patients who represented to the ED required hospital admission. A total of 37.0% (95% CI 32.9-41.4) of representations were assessed as being preventable. CONCLUSION: Early ED representations are a common problem. The majority of preventable representations are patient related, and interventions to target these areas might be of benefit in reducing this problem.
Authors: M Christien van der Linden; Robert Lindeboom; Rob de Haan; Naomi van der Linden; Ernie Rjt de Deckere; Cees Lucas; Steven J Rhemrev; J Carel Goslings Journal: Int J Emerg Med Date: 2014-07-05