Key result
Five multifaceted interventions reduced the mean early return visit rate and admission rate after ED discharge by an average of ~25% compared with the pre-intervention period (both P<0.001).
Why the study?
Do multifaceted interventions reduce unplanned return visits and hospital admissions within 72 hours in adult patients with non-traumatic ED visits?
Do multifaceted interventions reduce unplanned return visits and hospital admissions within 72 hours in adult patients with non-traumatic ED visits?
p-value: p=<0.001
Multifaceted interventions targeting identified risk factors significantly reduce early return visits and subsequent admissions for adult patients after non-traumatic ED visits.
May support multifaceted ED interventions to reduce early returns; leaves open confirmation in randomized trials.
OBJECTIVE: The objective of the present study is to develop new multifaceted interventions to reduce return visits (RVs) based on identified risk factors related to RVs in the ED and to compare the RV rate before and after the implementation of the intervention. METHODS: The present study was a controlled before and after study that was conducted in the ED of a 900-bed tertiary hospital in an urban area. The primary outcome was the rate of unplanned RVs to the ED and hospital admission after RV. The risk and predictive factors of RVs were identified by a retrospective study of all unscheduled RVs to the ED within 72 h in 2011. We developed five new multifaceted interventions based on the results: (i) daily RV feedback; (ii) prescription set of drugs; (iii) creation of a discharge instruction sheet; (iv) early follow-up appointments of outpatient department (OPD); and (v) enhancement of referral system. A prospective interventional study in which the interventions were implemented was then conducted over 10 months, from 1 June 2012 to 31 March 2013. RESULTS: The five new multifaceted interventions significantly reduced the mean early RV rate and RV admission rate after ED discharge by an average of approximately 25%, with a maximum of approximately 55% and 47%, respectively, compared with the pre-intervention period (RV rate: P < 0.001, RV admission rate: P < 0.001). CONCLUSIONS: Multifaceted interventions based on identified risk factors for early RV after ED discharge had a positive effect on reducing RVs and the admission rate after RVs for adult patients within 72 h of non-traumatic ED visits.
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Lee et al. (2015) studied Non-traumatic emergency department visits. Multifaceted interventions (RV feedback, prescription sets, discharge sheets, early follow-up, referral enhancement) vs. Pre-intervention period was evaluated on Rate of unplanned return visits (RVs) to the ED and hospital admission after RV within 72 h (p=<0.001). Five multifaceted interventions reduced the mean early return visit rate and admission rate after ED discharge by an average of ~25% compared with the pre-intervention period (both P<0.001).
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