Abstract
Background
Return visits to the emergency department (RTED) contribute to overcrowding and may
be a quality of care indicator. Previous studies focused on factors predicting returns
to and from the same center. Little is known about RTEDs across a range of community
and specialty hospitals within a large geographic area.
Objective
We sought to measure the frequency of pediatric RTEDs and describe their directional
pattern across centers in a large catchment area.
Methods
We conducted a multicenter, retrospective cross-sectional study of pediatric emergency
visits in the Vancouver lower mainland within 1 year. Visits were linked across study
sites, including one pediatric quaternary care referral center and 17 sites ranging
from large regional centers to smaller community emergency departments (EDs). Returns
were defined as subsequent visits to any site with a compatible diagnosis within 7 days
of an index visit.
Results
Among a total of 139,278 index ED visits by children, 12,133 (8.7% [95% confidence
interval 8.6–8.9%]) were associated with 14,645 return visits to an ED. Three quarters
of all index visits occurred at a general ED center, of which 8.9% had at least one
RTED and 22% of these returns occurred at the pediatric ED (PED). Among PED index
visits, 8.2% had at least one RTED and 13.6% of these returned to a general center. Overall,
38.9% of all RTEDs occurred at the PED. Multivariate regression did not identify any
statistically significant association between ED crowding measures and likelihood
of RTEDs.
Conclusions
Compared to single-center studies, this study linking hospitals within a large geographic
area identified a higher proportion of RTEDs with a disproportionate burden on the
PED.
Keywords
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Article info
Publication history
Published online: February 19, 2017
Accepted:
January 4,
2017
Received in revised form:
December 30,
2016
Received:
November 15,
2016
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
