The evaluation of patient who revisited to emergency department in early period (72 hours)

Introduction: Re-Visit to Emergency Departments in Early Period is defined as the re-visit of the patients who discharged from ED, with the same basic complaints within 72 hours. The reasons such as the increasing of hospital workloads and more health care spendings caused by Early Re-Visit to Emergency Department (ERED) could not be fully understood.The purpose of this study, is to determine the demographic, sociological, and clinical features of the patients who had experienced the ERED, and determine the ERED patients?s medical, institutional or individual risk factors.Materials and methods: This study is a two-stage study which is including, retrospective, descriptive records of screening and a telephone survey which contains of 11 questions. Patients who are older than 17 years old and who admitted Gazi University Faculty of Medicine adult ED between the dates of 01.06.2009-31.05.2010, has been determined by the billing unit. Their records and files which were in hospital?s information system (Avicenna®) were scanned and examined. Their comorbidity, complaints, admission and discharge times, their old admission procedures, diagnoses, vital signs, consultations, ED length of stay, hospital admissions were recorded. Reaching the patients by phone, a 5 question survey which is accessing demographic information (education level, marital status, social security) and a 6 questions survey for reasons of ERED (given a prescription, use, advising, complaints) has been conducted to the patients. Their first admission and ERED complaints were classified as same, different, and related. Chi-Square ve Fisher Exact tests were used for statiscal analysis of obtained data. The p-value of less than 0.05 (p<0.05 ) was considered statistically significant in this study.Results : During the study period, in total, 46.800 patients has been visited to ED and 799 (%1.66) of them has been detected as ERED patients.Because of 192 of these patient?s files can not be reached and 55 of these patients have inadequate data and 103 of these patients either could not be reached by phone or refuse to answer to the survey questions, they have been excluded from the study. 51.7% of the patients were male and 48.7% 's were female. The percentage of university graduates were 30.8% (p = 0.001). It has seen that for the patients, whose duration in ED less than 3 hours in their first visit, has made ERED more frequently (59.0%) than others (p = 0.001). The most frequent ERED complaints were gastrointestinal system with 20%, respiratory system with 12.4%, and genitourinary system with 11.9%. For the both two visits the first two of the most frequent diagnosis were renal colic (10.3% - 10.7%) and urticaria (7.9% to 7.1%). It has been found that, in the rates that, 47.1% of the patients has the same diagnosis, 24% of the patients had associated with the first diagnosis and 28.4% of the patients had different diagnosis at their ERED (p=0,001). 15% of the patients who made ERED received treatment in clinics, and 5 of them (1.2%) has died in ED(p=0,001). Their corresponding reason to make ERED were found as 60.4% of the underlying causes of disease, 20% doctors, 12.1% patients and 7.5% the system (p=0,001). For the reasons which are related to physicians, it has been found that, associated with a higher incidence of elderly patients hospitalization and the diagnosis with EDTB (p = 0.001).Conclusion: In the study, as a cause of ERED, doctors, had determined the preventable causes which are related to the patient and the system. It should not be forgetten that the patients who made ERED are consisting of high-risk group and ERED is a second chance for both patients and doctors.