Table 1 Reasons for unscheduled return and definitions
From: Unscheduled return visits to a Dutch inner-city emergency department
Definition | |
|---|---|
Physician-related return | |
No painkillers prescribed | The disease or injury warranted pain medication but no prescription was given. The patient returned primarily because of continued pain |
Treatment error | The physician made the right diagnosis during the initial visit, but made an error in treatment |
Misdiagnosis | Medical record review reveals a diagnosis or problem missed by the physician who saw the patient on the initial visit |
Patient-related return | |
Left against medical advice | The patient was seen by a physician and left the ED against medical advice |
Non-compliance | There is evidence in the medical records that the patient did not follow instructions |
Psychiatric disorder and/or substance abuse | The patient has a psychiatric disorder and/or uses drugs or alcohol, which causes him/her to repeatedly visit the ED for the same or similar problems. Mentally, the patient is in a chronic stable state |
Left without being seen | The patient was registered in the ED but left before being seen by a physician |
Patient was instructed to visit own GP | The patient was instructed to return to the GP for re-evaluation but did not go |
Worrying about health | The patient's anxiety caused him/her to return to the ED for the same or similar problem. No ancillary diagnostics were performed and medical management consisted of reassurance only |
Illness-related return | |
Recurrent disease process | The patient has a disease that tends to have recurrent exacerbations (i.e. asthma, sickle cell disease). The patient was treated appropriately during the initial ED visit, with resolution of symptoms, but later returned with a second exacerbation of the disease |
Complication | The patient was treated appropriately during the initial ED visit but returned to the ED because of a complication of the disease or unpredictable side effect of treatment (e.g. allergic drug reaction) |
Progression of disease | The medical records reveal that the patient was treated appropriately at the initial visit and that admission was not indicated. Appropriate follow-up was arranged, but the patient's disease or problem got worse, and he/she returned to the ED as instructed |
Ancillary diagnostics performed, no change in diagnosis | The patient presented with the same or similar problem, ancillary diagnostics were performed but there was no change in the initial diagnosis or treatment |