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{
    "pk": 11671,
    "title": "Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nThe 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA).  \nMethods:\n We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 – December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA.\nResults:\n Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor.\nConclusion:\n We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Return Visits"
        },
        {
            "word": "Unscheduled"
        },
        {
            "word": "Quality and Safety"
        },
        {
            "word": "Metric"
        },
        {
            "word": "Emergency Medicine"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/4z7463vp",
    "frozenauthors": [
        {
            "first_name": "Jake",
            "middle_name": "",
            "last_name": "Hayward",
            "name_suffix": "",
            "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada",
            "department": "None"
        },
        {
            "first_name": "Reidar",
            "middle_name": "",
            "last_name": "Hagtvedt",
            "name_suffix": "",
            "institution": "University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada",
            "department": "None"
        },
        {
            "first_name": "Warren",
            "middle_name": "",
            "last_name": "Ma",
            "name_suffix": "",
            "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada",
            "department": "None"
        },
        {
            "first_name": "Aliyah",
            "middle_name": "",
            "last_name": "Gauri",
            "name_suffix": "",
            "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Vester",
            "name_suffix": "",
            "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "R.",
            "last_name": "Holroyd",
            "name_suffix": "",
            "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada\nAlberta Health Services, Emergency Strategic Clinical Network, Edmonton, Alberta, Canada",
            "department": "None"
        }
    ],
    "date_submitted": "2018-03-14T20:52:10Z",
    "date_accepted": "2018-03-14T20:52:10Z",
    "date_published": "2018-09-10T16:21:13Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11671/galley/6278/download/"
        }
    ]
}