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Ann Emerg Med. 2015 Apr;65(4):377-386.e3. doi: 10.1016/j.annemergmed.2014.07.015. Epub 2014 Aug 27.

Return visits to the emergency department: the patient perspective.

Author information

1
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA. Electronic address: kristin.rising@jefferson.edu.
2
University of California San Francisco School of Medicine, San Francisco, CA.
3
Department of Internal Medicine, San Francisco, CA.
4
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
5
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
6
Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Abstract

STUDY OBJECTIVE:

Reasons for recurrent emergency department (ED) visits have been examined primarily through administrative data review. Inclusion of patients' perspectives of reasons for ED return may help inform future initiatives aimed at reducing recurrent utilization. The objective of this study is to describe the personal experiences and challenges faced by patients transitioning home after an ED discharge.

METHODS:

We performed semistructured qualitative interviews of adult patients with an unscheduled return to the ED within 9 days of an index ED discharge. Questions focused on problems with the initial discharge process, medications, outpatient care access, social support, and health care decisionmaking. Themes were identified with a modified grounded theory approach.

RESULTS:

Sixty interviews were performed. Most patients were satisfied with the discharge process at the index discharge, but many had complaints about the clinical care delivered, including insufficient evaluation and treatment. The primary reason for returning to the ED was fear or uncertainty about their condition. Most patients had a primary care physician, but they rarely visited a physician before returning to the ED. Patients cited convenience and more expedited evaluations as primary reasons for seeking care in the ED versus the clinic.

CONCLUSION:

Postdischarge factors, including perceived inability to access timely follow-up care and uncertainty and fear about disease progression, are primary motivators for return to the ED. Many patients prefer hospital-based care because of increased convenience and timely results. Further work is needed to develop alternative pathways for patients to ask questions and seek guidance when and where they want.

[Indexed for MEDLINE]

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