Factors Associated with Early Revisits and Hospitalization after a Revisit to the Emergency Department in Elderly Patients

Lee, Byoung Cheon; Choi, Kwang Jin; Sun, Mao Lung

Abstract

BACKGROUND
The purpose of this study was to find out what factors affect revisits by elderly patients to the emergency department (ED) with the same symptoms within 72 hours and hospitalization after a revisit. Delineating these factors can reduce unnecessary revisits to the ED and minimize problems with diagnosing and treating, improving the quality of treatment provided and of discharge decisions.
METHODS
This is a retrospective study involving 3790 elderly patients who presented initially to a general hospital ED between May 1, 2007 to June 30, 2009. Of these, 176 cases revisited the ED within 72 hours with the same symptoms. Their medical records were reviewed. A comparative analysis was conducted of the early revisit group by classifying them into 'discharge' and 'admission' considering age, gender, insurance status, means of arrival, chief complaint, diagnosis, length of stay, time of arrival, comorbidity disease, time lapse, and day of the week.
RESULTS
The factors affecting revisits were age (< or =79 years), insurance status (medical aid), means of arrival (walk-in), and chief complaint (dysuria.flank pain, skin rash). The factors affecting hospitalization after a revisit were age (> or =80 years), means of arrival (by ambulance), increasing length of stay, and high comorbidity index (> or =2).
CONCLUSION
The factors affecting revisits to the ED or hospitalization after a revisit were age, insurance status, means of arrival, chief complaint, length of stay, and comorbidity index. Physicians should be more careful when deciding discharge for elderly patients, especially those with the above factors.