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Authors: Majed H. Nasradeen , Muhannad I. Althunayan , Alwaleed K. Aljamaan , Abdulrahman M. Aljehani , Fajr B. Alqahtani , Nawfal Aljerian , Mohammed Alhelail , Aamir Omair

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Abstract

Introduction: Overcrowding in the emergency department (ED) seems to be a major barrier toward providing appropriate medical service and is associated with increasing in-hospital mortality. This study aimed to investigate unscheduled return visits to the ED within 72 hours, to identify the most common chief complaints/ diagnoses, and to estimate the mortality rate within 1 month of that visit. Methods: A cross-sectional retrospective study was conducted among patients above the age of 15 of both genders; Saudis and non-Saudis were included. The work was carried out at King Abdulaziz Medical City, Riyadh, from January to December 2017. The data were extracted from the BESTcare system, and there were 11,177 (6.1%) out of 182,602 visits to the ED which were unscheduled return visits. A computerized simple random sampling technique was used, and we enrolled a total of 375 revisits. The main variables were age, gender, chief complaints of the first and second visits, diagnoses of the first and second visits, comorbidities, admissions, and mortality rate within 1 month. Results: The mean age was 43.6 ± 19.4 years (range: 15-94 years). There were slightly more females (53%) than males. There were 228 subjects (60.8%) who returned with the same complaint as their previous visit. Abdominal pain (24%) was the most common chief complaint in the first return visit, followed by cough (8%). Upper respiratory tract infection was the most frequent diagnosis for the first (10%) and second (9%) return visits. Hypertension (25%) and diabetes mellitus (21%) were the most common comorbidities. There were 62 (17%) patients admitted to the ED in the second visit. Most were admitted under internal medicine (34%), general surgery (21%), and obstetrics and gynecology (13%). The mortality rate within 1 month of discharge was 0.8%. Conclusion: The incidental rate in our study is considered high and should be further explored by reassessing the admission and discharge policies. More attention and preventive treatment measures for common complaints may be needed to avoid ED return visits.

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Keywords: Emergency department, return visit, 72 hours visit, unscheduled return visit

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