Publication: A study on factors and outcome of unscheduled early revisit to Emergency Department of Hospital USM
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Date
2018
Authors
Ling, Loi Siew
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Abstract
Introduction: Unscheduled revisits to the emergency department (ED) may present a
considerable additional workload. This study investigated the risk factors contributing
to adverse event during unscheduled early revisit to ED Hospital Universiti Sains
Malaysia (USM).
Methods: A retrospective cohort study was conducted from January 2014 to January
2015 to character the nature of unscheduled early revisits to ED Hospital USM. It
included all patients 18 years old and above, revisited ED within 9 days post discharge
from ED.
Results: Data was collected from 492 case records. The rate of ED unplanned revisits
within 9 days of previous ED discharge was 0.66% for the study period. Risk factors for
revisit included advance age, pre-existing co-morbids, duration spent during first ED
visit and health care system related error. The independent predictors of morbidity were
diabetes mellitus (OR, 2.07; 95% CI, 1.08-3.96), respiratory disease (OR, 2.42; 95% CI,
1.18-4.98), gastrointestinal disease (OR, 5.93; 95% CI, 1.29-27.35), nervous system
disease (OR, 4.65; 95% CI, 1.27-17.02), duration spent more than 6 hours during first
ED visit (OR, 3.05; 95% CI, 1.53-6.07), and medical error leading to admission (OR,
8.85; 95% CI, 4.43-17.67). The overall mortality rate was 0.2% (1/492).
Conclusion: ED personnel need to be extra vigilant when managing patients with risk
factors particularly the modifiable risk factors to curb ED revisit.
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Keywords
Emergency medical services