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Article << Previous     |     Next >>   Contents Vol 36(3)

Unplanned return visits to emergency in a regional hospital

Sue E. Kirby A B , Sarah M. Dennis A , Upali W. Jayasinghe A and Mark F. Harris A

A Centre for Primary Health Care and Equity, School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
B Corresponding author. Email: s.kirby@student.unsw.edu.au

Australian Health Review 36(3) 336-341 http://dx.doi.org/10.1071/AH11067
Submitted: 17 July 2011  Accepted: 22 December 2011   Published: 27 July 2012

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Objective. The aim of this study was to determine the patient characteristics associated with unplanned return visits, using routinely collected hospital data, to assist in developing strategies to reduce their occurrence.

Methods. Emergency department data from a regional hospital were analysed using univariate and multivariate methods to determine the influence of clinical, service usage and demographic patient characteristics on unplanned return visits.

Results. Around 80% of the 16 000 patients attending emergency presented on only one occasion in a year. Five per cent of patients presented with an unplanned return visit. Older patients, those with minor and low urgency conditions and with non-psychotic mental health conditions, those presenting during winter and after hours were significantly more likely to present as unplanned return visits.

Conclusion. Although patient characteristics associated with unplanned return visits have been identified, the reasons underpinning the unplanned return visit rate, such as patient service preference and attitudes, need to be more fully investigated.

What is known about the topic? Patients who present as unplanned return visits are older and have a range of chronic and acute conditions. Some unplanned return visits occur because of limited access to other non-hospital service.

What does this paper add? This paper adds to the field by providing information from a regional hospital in NSW Australia on the patient characteristics associated with unplanned return visits. It provides a basis for differentiating between other groups of frequent emergency department patients. However, the reasons behind the unplanned return visit rate need to be more fully investigated.

What are the implications for practitioners? The implications of the findings of this study for policy makers, administrators and clinicians are that access to alternative services for the conditions associated with unplanned return visits need to be further investigated in the context of the role for emergency department services.

Additional keywords: disease management, emergency medical services, health services accessibility, patient care management.


[1]  Halfon P, Eggli Y, Pretre-Rohrbach I, Meylan D, Marazzi A, Burnand B. Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Med Care 2006; 44: 972–81.
CrossRef | PubMed |

[2]  Halfon P, Eggli Y, van Melle G, Chevalier J, Wasserfallen J, Burnand B. Measuring potentially avoidable hospital readmissions. J Clin Epidemiol 2002; 55: 573–87.
CrossRef | PubMed |

[3]  McLean R, Kumara M, Canalese J. A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital. Aust Health Rev 2008; 32: 537–47.
CrossRef | PubMed |

[4]  Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med 1999; 107: 13–7.
CrossRef | CAS | PubMed |

[5]  Foran A, Wuerth-Sarvis B, Milne W. Bounce-back visits in a rural emergency department. Can J Rural Med 2010; 15: 108–12.
| PubMed |

[6]  Nunez S, Hexdall A, Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Health Care 2006; 15: 102–8.
CrossRef | CAS | PubMed |

[7]  Kind AJH, Smith MA, Frytak JR, Finch MD. Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke. J Am Geriatr Soc 2007; 55: 365–73.
CrossRef |

[8]  Ross M, Hemphill RR, Abramson J, Schwab K, Clark C. The recidivism characteristics of an emergency department observation unit. Ann Emerg Med 2010; 56: 34–41.
CrossRef | PubMed |

[9]  Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360: 1418–28.
CrossRef | CAS | PubMed |

[10]  Cardin S, Afilalo M, Lang E, Collet J, Colacone A, Tselios C,, et al Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions? Ann Emerg Med 2003; 41: 173–85.
CrossRef | PubMed |

[11]  Coxe SS. West G, Aiken LS. The analysis of count data: a gentle introduction to poisson regression and its alternatives. J Pers Assess 2009; 91: 121–36.
CrossRef |

[12]  Elhai JD, Calhoun PS, Ford JD. Statistical procedures for analyzing mental health services data. Psychiatry Res 2008; 160: 129–36.
CrossRef | PubMed |

[13]  Pallant J. SPSS survival manual. Sydney: Allen & Unwin; 2007.

[14]  Tabachnick BG, Fidell LS. Using multivariate statistics. Boston: Pearson; 2007.

[15]  Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979; 6: 65–70.

[16]  NSW Department of Health. Shellharbour hospital. 2011. Available at http://www.sesiahs.health.nsw.gov.au/hospitals/Shellharbour_Hospital.asp [verified 25 June 2012].

[17]  Illawarra Regional Information Service. Shellharbour: Illawarra Regional Information Service. 2009 Available at http://www.iris.org.au/index.pl?page=222 [verified 25 June 2012].

[18]  Illawarra Division of General Practice. IDGP Annual Report, 2008–09. IDGP: Wollongong; 2008/2009.

[19]  Nagelkerke NJD. A note on the general definition of the coefficient of determination. Biometrika 1991; 78: 691–2.
CrossRef |

[20]  Norusis MJ. SPSS professional statistics 6.1. Chicago, IL: SPSS Inc.; 1994.

[21]  Kirby SE, Dennis SM, Jayasinghe UW, Harris MF. Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice. BMC Health Serv Res 2010; 10: 216–24.
CrossRef | PubMed |

[22]  Illawarra Division of General Practice. Supply of GPs in the Shellharbour area. Illawarra Division of General Practice. 2010. Available at http://www.shellharbour.nsw.gov.au/FileData/pdf/AgedCareReport2008.pdf [verified 25 July 2012].

[23]  Frosch ES. DosReis S, Maloney K. Connections to outpatient mental health care of youths with repeat emergency department visits for psychiatric crises. Psychiatr Serv 2011; 62: 646–9.
CrossRef |

[24]  Kirby SE, Dennis SM, Bazeley P, Harris MF. What distinguishes clinicians who better support patients for chronic disease self-management? Aust J Primary Health ; : .

[25]  Nagree Y, Ercleve TN, Sprivulis PC. After-hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments. Aust Health Rev 2004; 28: 285–91.
CrossRef | PubMed |

[26]  Richardson DB, Mountain D. Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust 2009; 190: 369–74.
| PubMed |

[27]  Australian College for Emergency Medicine. Fact sheet. Re:urban emergency services – ATS 4 and 5 Patients. West Melbourne: ACEM; 2001. Available a http://www.health.gov.au/internet/main/publishing.nsf/Content/E6CAF670D550F646CA25747700074A51/$File/Our%20emergency%20departments.pdf [verified 25 July 2012].

[28]  Bernstein SL. Frequent emergency department visitors: the end of inappropriateness. Ann Emerg Med 2006; 48: 18–20.
CrossRef | PubMed |

[29]  Fleishman JA, Cohen JW, Manning WG, Kosinski M. Using the SF-12 health status measure to improve predictions of medical expenditures. Med Care 2006; 44: 145–63.

[30]  Liaw S-T, Chen H-Y, Maneze D, Taggart JR, Dennis SM, Vagholkar S. Emergency and primary care at a Melbourne hospital: reasons for attendance and satisfaction. Aust Health Rev 2001; 24: 120–34.
| CAS | PubMed |

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