Management practice-related and modifiable factors associated with paediatric emergency return visits

Quynh Doan, Ran D. Goldman, Garth D. Meckler

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: We explored practice-related factors associated with preventable unscheduled return visits to an emergency department (RTED). Methods: We conducted a retrospective cohort study, using standardized review of health records. We included all visits with at least one RTED within 7 days of the index visit. Cases were reviewed by investigators and clinicians to identify: 1) the proportion of unscheduled RTED, 2) the proportion deemed clinically unnecessary and 3) the contribution of clinical practice pattern and system factors. Results: There were 2809 (7.3%) index visits associated with at least one RTED. Of these, 1983 (70.6%) were unscheduled, 784 (39.5%) were considered clinically unnecessary and 739 out of 784 medically unnecessary RTEDs (94.3%) were attributed to a mismatch between parental expectations and natural progression of disease that did not require Emergency Department (ED) reassessment or interventions. Eighty per cent of reviewed written discharge instructions lacked any anticipatory guidance around symptom range and duration and 21.2% contained instructions to return to the ED for signs and symptoms which do not require ED care. An administrative or system challenge was noted as the reason for the unnecessary and unscheduled RTED in 17.5%. In 3.4% of cases, nonemergency consultants were responsible for the disposition decision and discharge process. Conclusions: Unscheduled unnecessary return visits to our ED contribute to a significant proportion of our annual volume. Providing discharge instructions that help families distinguish expected range and duration of symptoms from signs requiring ED care was identified as a potential strategy to impact the frequency of unscheduled RTED.

Original languageEnglish (US)
Pages (from-to)E1-E7
JournalPaediatrics and Child Health (Canada)
Issue number1
StatePublished - Feb 15 2019
Externally publishedYes


  • Discharge process
  • Pediatric emergency
  • Quality improvement
  • Return visits

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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