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J Korean Soc Emerg Med > Volume 25(5); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(5): 529-535.
Unplanned Revisit to Pediatric Emergency Department: Patients' Characteristics and Relationship with Overcrowding
Dong Hyun Jang, Young Ho Kwak, Do Kyun Kim, Jae Yun Jung, Dong Bum Suh, Ikwan Chang, Je Hyun Jung, Hye Hyang Seo, Ju Won Kim, Ji Hye Choo
1Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. birdbeak@snuh.org
2Emergency Nursing & Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Revisit to the pediatric emergency department (ED) in the short-term period may be due to inadequate evaluation during the previous visit, which may indicate a problem with quality in emergency care. The aims of this study are to analyze the characteristics of patients who revisited the pediatric ED within 48 hours after discharge and to evaluate the relation between overcrowding and revisit rates.
Retrospectively, we reviewed the charts of patients who returned within 48 hours after visiting a PED during a one-year period between June 1st, 2011 and December 31st, 2011. We determined the rate of return visits and review the characteristics of patients, emergency severity index (ESI) level at visits, cause of revisit, diagnosis, and crowding degree of the pediatric ED at the patient's first visit.
A total of 16,688 patients visited the pediatric ED and 13,716 patients were discharged from the PED during the period. Of these discharged patients, 534 patients revisited inevitably within 48 hours. The most common cause of revisit was relapse or worsened symptoms (70.0%). There was no significant difference in sex, severity of patient, and crowding degree of the pediatric ED at the first visit, however, patients who revisited were younger than those who did not (p=0.005). The ESI level at the return visit was significantly higher irrespective of admission after revisit (p<0.001). In diagnosis grouping, patients with gastrointestinal diseases, respiratory diseases, and neoplastic diseases showed a higher rate of revisit.
Approximately 4% of our pediatric ED visits were for children returning within 48 hours. Patients who revisited were younger and patients with gastrointestinal diseases, neoplastic diseases, and respiratory diseases were more likely to revisit. Careful explanation of the possibility of worsened symptoms is necessary for these patients.
Key words: Overcrowding, Pediatric emergency department, Revisits
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