Incidence of and Predictors for Early Return Visits to the Emergency Department

The aim of this study is to estimate the proportion of and predictors for early return visits (ERVs) to the emergency department (ED) in Taiwan.This is a population-based study using data of 1 million people randomly selected from all beneficiaries of the Taiwan National Health Insurance. All ED visits in 2012 were analyzed. The ERVs to the ED were defined as those ED revisits within 3 days after the initial ED visit. We employed a generalized estimation equation model to investigate the independent effects of various characteristics associated with the initial ED visit on ERVs.The overall proportion of ERVs within 3 days with a same dichotomous diagnostic category according to injury or noninjury was 4.3% (6740/158,132), and the overall proportion of hospitalizations after ERVs was 24.1% (1627/6740). Male subjects (4.3%) were more likely to have ERVs with an adjusted odds ratio (AOR) of 1.10 (95% confidence interval [CI]: 1.04-1.16). Compared with patients aged 18 to 64 years (4.0%), those aged >64 years had a significantly increased risk of ERVs (6.2%, AOR: 1.49, 95% CI: 1.39-1.59). In comparison to patients with injury diagnoses (2.2%), those with noninjury diagnoses had a higher risk of ERVs (5.2%, AOR: 2.50, 95% CI: 2.33-2.70). Compared with patients initially treated at medical centers (3.7%), those initially treated at regional (4.5%, AOR: 1.28, 95% CI: 1.20-1.37) or district hospitals (4.5%, AOR: 1.38, 95% CI: 1.27-1.49) had significantly higher risks of ERVs. Among the 6740 patients with ERVs, 2622 (38.9%) returned to a different hospital, and these patients tended to be those aged 18 to 64 years and initially treated at district hospitals.The risk of ERVs was associated with demographic characteristics and accreditation level of hospital. We noted a large proportion of patients with ERVs to a different hospital. The reason underlying this phenomenon warrants further investigations.