Elderly patients with emergency department return visit: descriptive analysis of adverse events
,
Abstract
Objective: An emergency department (ED) visit is a critical event for elderly patients, often associated with an increased likelihood of early return visits (RVs), functional decline, and adverse events (AEs). This study aimed to investigate the proportion of ED RVs within 72 hours that were due to AE among elderly patients. Methods: We conducted a retrospective review of hospital records for elderly patients aged 65 years and older who returned to the ED within 72 hours of discharge. The study focused on identifying AEs as a primary cause of RV and characterizing their type, severity, and preventability. Results: Over a 6-month period, 69,557 patients presented to the ED, of whom 9,439 patients (13.6%) were aged 65 years and older, with a median age of 75. Among these elderly patients, 373 (3.9%) returned within 72 hours. Of these, 201 patients underwent a secondary review to detect AEs which revealed that 49 RVs (24.4%) were attributed to AEs. Diagnostic errors were the most common type of AEs, accounting for 34.7% of cases. Severe AE occurred in 36.7% of patients, and more than half (63.4%) were deemed preventable. Conclusion: The results of our study indicate a concerning correlation between RV and AE in elderly patients. A substantial portion of these AEs is due to diagnostic and management errors, highlighting the necessity for strategies to enhance the quality of care for this vulnerable group. The study advocates for utilizing 72-hour ED RV as a trigger for identifying AEs.
2- Griffey RT, Schneider RM, Adler LM, Capp R, Carpenter CR, Farmer BM, et al. Development of an emergency department trigger tool using a systematic search and modified delphi process. J Patient Saf. 2020;16(1):7-11.
3- Griffey RT, Schneider RM, Todorov AA. The emergency department trigger tool: a novel approach to screening for quality and safety events. Ann Emerg Med. 2020;76(2):230-40.
4- Lee WH, Zhang E, Chiang CY, Yen YL, Chen LL, Liu MH, et al. Comparing the outcomes of reporting and trigger tool methods to capture adverse events in the emergency department. J Patient Saf. 2019;15(1):61-8.
5- Griffey RT, Schneider RM, Sharp BR, Pothof JJ, Hodkins S, Capp R, et al. Description and yield of current quality and safety review in selected US academic emergency departments. J Patient Saf. 2020;16(4):e245-9.
6- Griffey RT, Schneider RM, Kocher KE, Kwok ES, Salmo E, Malone N, et al. The emergency department trigger tool: Multicenter trigger query validation. Acad Emerg Med. 2024;00:1-12.
7- Trivedy CR, Cooke MW. Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Emerg Med J. 2015;32(4):324-9.
8- McLaren JT, Bhate TD, Taher AK, Chartier LB. Return visit audits, quality improvement infrastructure, and a culture of safety: a theoretical model and practical assessment tool. CJEM. 2023;25(8):649-52.
9- Pham JC, Kirsch TD, Hill PM, DeRuggerio K, Hoffmann B. Seventy-two-hour returns may not be a good indicator of safety in the emergency department: a national study. Acad Emerg Med. 2011;18:390-7.
10- Calder L, Pozgay A, Riff S, Rothwell D, Youngson E, Mojaverian N, et al. Adverse events in patients with return emergency department visits. BMJ quality & safety. 2015;24(2):142-8.
11- Ling DA, Sung CW, Fang CC, Ko CH, Chou EH, Herrala J, et al. High-risk return visits to United States emergency departments, 2010–2018. West J Emerg Med. 2022;23(6):832.
12- Hutchinson CL, McCloughen A, Curtis K. Incidence, characteristics and outcomes of patients that return to emergency departments. An integrative review. Australas Emerg Care. 2019;22(1):47-68.
13- Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts‐Mills TF, Rothman RE, et al. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta‐analysis. Acad Emerg Med. 2015;22(1):1-21.
14- Deschodt M, Devriendt E, Sabbe M, Knockaert D, Deboutte P, Boonen S, et al. Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study. BMC geriatrics. 2015;15:1-10.
15- McCusker J, Ionescu‐Ittu R, Ciampi A, Vadeboncoeur A, Roberge D, Larouche D, et al. Hospital characteristics and emergency department care of older patients are associated with return visits. Acad Emerg Med. 2007;14(5):426-33.
16- Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, et al. Strategies to improve care for older adults who present to the emergency department: a systematic review. BMC Health Services Research. 2024;24(1):178.
17- Wang LH, Lee HL, Lin CC, Lan CJ, Huang PT, Han CY. Factors associated with return visits by elders within 72 hours of discharge from the emergency department. Healthcare. 2023;11(12):1726.
18- Baartmans MC, Hooftman J, Zwaan L, Van Schoten SM, Erwich JJ, Wagner C. What can we learn from in-depth analysis of human errors resulting in diagnostic errors in the emergency department: an analysis of serious adverse event reports. J Patient Saf. 2022;18(8):e1135-41.
19- Griffin FA, Resar RK. IHI global trigger tool for measuring adverse events (Second Edition). IHI innovation series white paper. Cambridge, MA: Institute for Healthcare Improvement. 2009. Available: at ihi.org
20- Ragsdale L, Southerland L. Acute abdominal pain in the older adult. Emerg Med Clin North Am. 2011;29(2):429-48.
21- Anderson Jr RS, Hallen SA. Generalized weakness in the geriatric emergency department patient: an approach to initial management. Clin Geriatr Med. 2013;29(1):91-100.
22- Piroozi B, Mohamadi-Bolbanabad A, Shokri A. The growth of aging population in Iran: an achievement or a challenge?. J Gerontol Soc Work. 2024;12:1-4.
23- Pereira L, Choquet C, Perozziello A, Wargon M, Juillien G, Colosi L, et al. Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study. PLoS One.2015;10(4):e0123803.
| Files | ||
| Issue | Vol 9 No 1 (2025): Winter (February) | |
| Section | Original article | |
| Keywords | ||
| Adverse Event Elderly Emergency Department Geriatrics Quality Improvement Return Visit | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
