Academic journal article Australian Health Review

Unplanned Return Visits to Emergency in a Regional Hospital

Academic journal article Australian Health Review

Unplanned Return Visits to Emergency in a Regional Hospital

Article excerpt

Background

Researchers have proposed unplanned return visits (URVs) to hospital for the same condition within 28 days of the index admission as an indicator of quality of care.1,2 Collection and analysis of URV data is therefore of interest to hospitals. There is debate about whether URVs represent possible treatment failure.3 URVs may be associated with poor access to alternative services.

Although quality of care and access to alternative services are hospital-specific, inter-hospital comparisons of URVs, how- ever, give a valuable perspective to interpret the results and develop possible solutions. McLean and colleagues3 in a study in an Australian regional hospital reported that the conditions responsible for returns to hospital were chronic conditions such as heart failure and chronic obstructive pulmonary disease (COPD), acute conditions such as complications of procedures, pneumonia, angina and acute bronchiolitis. Marcantonio et al.4 in the USA reported patient factors associated with unplanned readmission within 30 days included age 80 years or older, comorbidities, depression and lack of documented patient or family education. The latter finding suggests that patients might be encouraged to stay away from hospital if they are given information about other services or about managing their disease. Foran et al.5 in a study at a rural Canadian hospital, reported that return visits within 72 h were for low acuity con- ditions, the most common of which was abdominal pain. These authors contended that 'bounce-back' patients might return be- cause of poor access to primary care services and possibly because they were provided with inadequate information about self care. On the other hand, it is reasonable to suggest that reoccurrence of abdominal pain should be regarded as serious and therefore, treatment in hospital is the safest option. Unscheduled returns within 72 h were associated with medical errors in prognosis, treatment, follow-up care, and information, and with dyspnoea and advanced age as reported by Nunez et al.6 in a hospital in the Canary Islands. It was their contention that longer observation times in emergency would lead to a reduction in unplanned returns for serious conditions. Kind et al. showed that stroke patients were more likely to 'bounce back' with return visits within 30 days.7 However, as the chances of further transient ischaemic accidents would be high in this group of patients,returntohospitalisthesafest option.URV('recidivism') rates were reported in a US hospital to be higher in emergency observation unit patients with painful conditions, although characteristics such as age, sex, or initial length of stay were similar to patients who do not return.8 The finding that age was not a factor in this study might be due to the restricted sample from the observation unit patients. Jencks et al. found that re-hospitalisations among Medicare beneficiaries in the US are prevalent, costly and modifiable.9 Cardin and others reported on emergency department (ED) interventions such as increased physician coverage, physician coordinators, and fast tracking diagnostics and admission procedures without resulting in increased return visits to the ED or hospital readmis- sion.10 Although some URVs may be avoidable, URVs associ- ated with more serious conditions are appropriate because hospital treatment is a safer option than treatment in the community.

In summary, the literature indicates that URVs are usually associated with age, minor conditions and chronic comorbidities, many of which can be prevented. Limited access to alternative services was implicated in the occurrence of URVs. The purpose of this study was to identify the factors associated with URVs in a regional hospital using routinely collected hospital data, with a view to assisting in the development of strategies to reduce their occurrence. Our hypothesis was that URV patients as a group had different characteristics from the rest of the patient population, and that URVs may be associated with poor access to alternative services such as primary care. …

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