Unplanned return presentations of older patients to the emergency department: a root cause analysis
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RESEARCH ARTICLE
Open Access
Unplanned return presentations of older patients to the emergency department: a root cause analysis Babiche E. J. M. Driesen1,2* , Hanneke Merten2, Cordula Wagner2,3, H. Jaap Bonjer4 and Prabath W. B. Nanayakkara5
Abstract Background: In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was to provide insight into the root causes and potential preventability of unplanned return presentations (URP) to the ED within 30 days for older patients. Methods: A prospective observational study was conducted from February 2018 to November 2018 in an academic hospital in Amsterdam. We included 83 patients, aged 70 years and older, with an URP to the ED within 30 days of the initial ED presentation. Patients, GPs and doctors at the ED were interviewed by trained interviewers and basic administrative data were collected in order to conduct a root cause analysis using the PRISMA-method. Results: One hundred fifty-one root causes were identified and almost half (49%) of them were disease-related. Fiftytwo percent of the patients returned to the ED within 7 days after the initial presentation. In 77% of the patients the URP was related to the initial presentation. Patients judged 17% of the URPs as potentially preventable, while doctors at the ED judged 25% and GPs 23% of the URPs as potentially preventable. In none of the cases, there was an overall agreement from all three perspectives on the judgement that an URP was potentially preventable. Conclusion: Disease-related factors were most often identified for an URP and half of the patients returned to the ED within 7 days. The majority of the URPs was judged as not preventable. However, an URP should trigger healthcare workers to focus on the patient’s process of care and their needs and to anticipate on potential progression of disease. Future research should assess whether this may prevent that patients have to return to the ED. Keywords: Acute care, Emergency department, Older patients, Elderly, Preventability, Return presentations, Root causes
Background There is a steady increase in the number of older patients (age ≥ 70 years) presenting at the Emergency Department (ED) each year, accounting for up to 30% of all ED presentations worldwide [1]. This growing group of * Correspondence: [email protected] 1 Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands 2 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands Full list of author information is available at the end of the article
older patients is mentioned as one of the reasons why ED crowding occurs. ED crowding is a major challenge worldwide,
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