+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department



Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department



Western Journal of Emergency Medicine 19(6): 912-918



The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 - December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA. Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 065885441

Download citation: RISBibTeXText

PMID: 30429921

DOI: 10.5811/westjem.2018.38225


Related references

Unscheduled return visits with and without admission post emergency department discharge. Journal of Emergency Medicine 43(6): 1110-1118, 2012

Short-term unscheduled return visits of adult patients to the emergency department. Journal of Emergency Medicine 47(2): 131-139, 2014

Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study. Plos one 10(4): E0123803, 2015

Children's unscheduled return visits to an emergency department. Anales Espanoles de Pediatria 52(6): 542-547, 2000

Unscheduled return visits to a pediatric emergency department. Medicina 53(1): 66-71, 2017

Incidence, Admission Rates, and Predictors, and Economic Burden of Adult Emergency Visits for Acute Pancreatitis: Data From the National Emergency Department Sample, 2006 to 2012. Journal of Clinical Gastroenterology 53(3): 220-225, 2019

An analysis of unscheduled return visits to an urban emergency department. New Zealand Medical Journal 106(961): 334-336, 1993

Unscheduled return visits to the emergency department: consequences for triage. Academic Emergency Medicine 20(1): 33-39, 2013

Unscheduled return visits to a Dutch inner-city emergency department. International Journal of Emergency Medicine 7: 23, 2014

Unscheduled return visits by patients to the accident and emergency department. Archives of Emergency Medicine 8(3): 196-200, 1991

Unscheduled return visits to the emergency department: the impact of language. Pediatric Emergency Care 29(5): 579-583, 2013

Unscheduled return visits to a pediatric emergency department a prospective study. American Journal of Diseases of Children 144(4): 445-446, 1990

Unscheduled return visits to the pediatric emergency department-one-year experience. Pediatric Emergency Care 22(8): 545-549, 2006

Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Emergency Medicine Journal 32(4): 324-329, 2015

Factors Affecting Unscheduled Return Visits to the Emergency Department among Minor Head Injury Patients. Biomed Research International 2017: 8963102, 2017