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Table 1 Reasons for unscheduled return and definitions

From: Unscheduled return visits to a Dutch inner-city emergency department

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