ABSTRACT
BACKGROUND: Emergency departments (EDs) serve as an accessible gateway to healthcare system wherein numerous patients consider it a prime choice for medical complaints. Frequency of ED revisits, causes, and its burden are necessary to assess quality of care provided to patients and identify factors that leads to revisit. PATIENTS AND METHODS: Electronic and printed medical records of all patients who revisited ED from January to May 2016 within 72 hours of initial visit were reviewed. Patients' cause of revisit were classified to three categories: patient-, physician- and system-related factors. Common complaints that require revisits were also collected. Descriptive analysis was performed and categorical variables were represented by the frequency; percentages and continuous variables were presented as median, and range if data did not follow normal distribution. RESULTS: Of the 79,279 patients who visited ED during the study period, 1.3% (1000) patients revisited within 72 hours; 51.3% (n=513) were males, with a mean age of 31.5 years (SD=17.7 years) where majority (57.1%) had no comorbidity recorded. The most attributed factors for revisit were as follows: patient-related causes 635 patients (63.5%), physician-related factors 167 patients (16.7%), and system-related factors 42 patients (4.2%); 15.6% were found not related to the initial visit. Recurrence of the same complaint was the highest among patient-related factors (80.5%), inadequate management and no improvement of symptoms in 71.3% among the physician-related factors. The most common ED revisit complaint was fever 29.1% (n=291). Outcomes of the revisit were mainly patient discharge 96.7% (n=967), admission 1.2% (n=12) and death in 0.2% (n=2). CONCLUSION: Recurrence of the same complaint with no symptoms improvement and suboptimal management of physicians contributed to most of the ED revisits within 72 hours. Encouraging physicians to provide clear instructions in educating patients on discharge regarding disease progression and its red flags as to when a return to ED, might help in reducing revisit rate.
ABSTRACT
BACKGROUND: Human H1N1 Influenza A virus was first reported in 2009 when seasonal outbreaks consistently occurred around the world. H1N1 patients present to the emergency departments (ED) with flu-like symptoms extending up to severe respiratory symptoms that require hospital admission. Developing a prediction model for patient outcomes is important to select patients for hospital admission. To date, there is no available data to guide the hospital admission of H1N1 patients based on their initial presentation. OBJECTIVE: The aim of this study was to investigate the predictors of hospital admission of H1N1 patients presenting in the ED. METHODS: We conducted a retrospective review of all laboratory-confirmed H1N1 cases presenting to the ED of a tertiary university hospital in the Eastern region of Saudi Arabia within the period from November 2015 to January 2016. We retrieved data of the initial triage category, vital signs, and presenting symptoms. Multivariate logistic regression analysis was performed to evaluate risk factors for hospital admission among H1N1patients presented to the ED. RESULTS: We identified 333 patients with laboratory-confirmed H1N1. Patients were classified into two groups: admitted group (n=80; 24%) and non-admitted group (n=253; 76%). Sixty patients (75%) were triaged under category IV. Triage category of level III and less were the most predictive for hospital admission. Multivariate regression analysis showed that of all vital signs, tachypnea was a significant risk factor for hospital admission (OR=1.1; 95% CI 1.02 to 1.13, p<0.01). The association between lower triage category and hospital stay was statistically significant (χ2 =6.068, p=0.037). Also, patients with dyspnea were 4.5 times more likely to have longer hospital stay (OR=4.5; 95% CI 1.2 to 17.1, p=0.025). CONCLUSION: Lower triage category and increased respiratory rate predict the need for hospital admission of H1N1 infected patients; while patients with dyspnea or bronchial asthma are likely to stay longer in the hospital. Further prospective studies are needed to evaluate the accuracy of using the CTAS and other clinical parameters in predicting hospitalization of H1N1 patients during outbreaks.
