Unscheduled Return Visits to the Emergency Department: Case of University Hospital Center in Tunisia

Introduction: The re-consultation after short period of initial visit is an indicator of health care’s quality offered in the first consultation. They increase health expenditures and reflect a wrong medical care process. Aims: The aims of this work are to determine the rate of reconsultations in Farhat Hached‘s Emergency service, Sousse, Tunisia and analyze the demographic characteristics of these patients in short terms, medical history, their chief complaint in initial consultations and disease progression. Materials and Methods: We conducted a prospective descriptive study realized in the polyvalent emergency service of university hospital Farhat Hached over a period of 6 months, starting from January the 1 st 2015 to June 2015, covering patients reconsulting in an interval of 7 days. Results: Almost 200 patients needed a second consultation in the 07 next days. The period between 2 consultations in emergency department was 2.66(SD= 1.28) days. The median age of re-consultants was 48 (IQR=17) years old with extremes going from 16 to 84 years. We noticed a predominance of female gender. The most frequent complaints during the first and the second consultations were digestive. The prescribed treatments after first consultations were dominated by antibiotics (39%) and painkillers (34.5%). 49.5% of patients who needed second visit went back home after reconsultations while 50.5% of them needed hospitalization. We have noticed a diagnostic relation established between the two consultations among 140 patients (70%), an aggravation among 65 of them (32%) and 3 deaths (1.5%). Conclusion: We propose to include second and third health care institution as well as the private sector in order to generalize this study’s findings and make it multi-centric.

[1]  M. Ong,et al.  Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital. , 2015, Singapore medical journal.

[2]  Kevin A Padrez,et al.  Return visits to the emergency department: the patient perspective. , 2015, Annals of emergency medicine.

[3]  J. Hollander,et al.  Patient returns to the emergency department: the time-to-return curve. , 2014, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[4]  J Carel Goslings,et al.  Unscheduled return visits to a Dutch inner-city emergency department , 2014, International Journal of Emergency Medicine.

[5]  Adamu Ahmed,et al.  Appendicitis in the Elderly , 2012 .

[6]  R. Hemphill,et al.  The recidivism characteristics of an emergency department observation unit. , 2010, Annals of emergency medicine.

[7]  Chiu-Lung Wu,et al.  Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan. , 2010, The Journal of emergency medicine.

[8]  W. Kuan,et al.  Emergency unscheduled returns: can we do better? , 2009, Singapore medical journal.

[9]  E. Manias,et al.  Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery , 2007, BMC public health.

[10]  K. Schmader,et al.  Adverse Health Outcomes After Discharge from the Emergency Department—Incidence and Risk Factors in a Veteran Population , 2007, Journal of General Internal Medicine.

[11]  A. Macpherson,et al.  Unscheduled Return Visits to the Pediatric Emergency Department-One-Year Experience , 2006, Pediatric emergency care.

[12]  A. Aguirre-Jaíme,et al.  Unscheduled returns to the emergency department: an outcome of medical errors? , 2006, Quality and Safety in Health Care.

[13]  N. Adekoya,et al.  Patients seen in emergency departments who had a prior visit within the previous 72 h-National Hospital Ambulatory Medical Care Survey, 2002. , 2005, Public health.

[14]  K. Bennett,et al.  Patient and disease profile of emergency medical readmissions to an Irish teaching hospital , 2004, Postgraduate Medical Journal.

[15]  J. Collet,et al.  Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions? , 2003, Annals of emergency medicine.

[16]  M. Bullard,et al.  Rates and causes of emergency department revisits within 72 hours. , 1999, Journal of the Formosan Medical Association = Taiwan yi zhi.

[17]  J. Gordon,et al.  Initial emergency department diagnosis and return visits: risk versus perception. , 1998, Annals of emergency medicine.

[18]  D. Bourderont,et al.  L'admission des personnes âgées aux urgences médicales d'un hôpital général , 1996 .

[19]  A. Worth,et al.  Review: readmission of elderly patients to hospital. , 1995, Age and ageing.

[20]  A. Kelly,et al.  An analysis of unscheduled return visits to an urban emergency department. , 1993, The New Zealand medical journal.

[21]  M. Beckett,et al.  Audit of unexpected return visits to an accident and emergency department. , 1992, Archives of emergency medicine.

[22]  S. Hu,et al.  Analysis of patient revisits to the emergency department. , 1992, The American journal of emergency medicine.

[23]  G. Bodiwala,et al.  Unscheduled return visits by patients to the accident and emergency department. , 1991, Archives of emergency medicine.

[24]  A. Pennycook,et al.  Unplanned Re-Attendance in the Accident and Emergency Department , 1991, Scottish medical journal.

[25]  C. O'dell.  Atypical presentations of neurological illness in the elderly. , 1988, Geriatrics.

[26]  S. Gambert,et al.  Atypical presentation of endocrine disorders in the elderly. , 1988, Geriatrics.

[27]  M. Kobernick,et al.  Return visits to the emergency department. , 1987, The Journal of emergency medicine.