Unscheduled Return Visits to the Pediatric Emergency Department-One-Year Experience

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Abstract
Patients returning to the emergency department (ED) within 72 hours of their visit may contribute to crowding and might indicate failure to give a proper assessment, treatment, or follow-up instructions. The aim of this study was to describe the rate of return visits in a tertiary care pediatric ED (PED) and find characteristics of children who return to the ED. We retrospectively reviewed all records of patients visiting our PED in Toronto during 2003. We collected demographic data, time of visit(s), and acuity. We excluded patients who left without being seen, left against medical advice, or were admitted to the hospital. We conducted univariate and multivariate analyses to determine odds ratio of variables associated with returning. Of 37,725 eligible children, 1990(5.2%) returned within 72 hours. One hundred fifty-six returned for a third visit, and 10 returned for a fourth visit. A quarter of the children who returned were younger than 1 year, and the younger the child, the higher the likelihood of returning; the higher the acuity of the first (index) visit, the higher the likelihood that a patient will return. Patients coming during the busiest hours, between 8 pm and midnight, were more likely to return. We found no significant seasonal differences in univariate or multivariate analysis. Five percent of our PED visits are return visits of children seen in the 72 hours before the visit. Younger children, with high acuity who come to the ED in the late evening hours, are most likely to return to the ED.