Background Emergency Department (ED) return visits leading to admission (RVs) are a well-recognized quality metric that can potentially signal gaps in care. Through capture and investigation, potential learning for future improvements are possible.

Objectives To develop a sustainable database that routinely tracks and analyzes pediatric ED RVs in the largest children's hospital in Canada to understand recurring themes and inform QI initiatives.

Methods All 72-hour RVs are collected and reviewed for patient and visit-level variables. Clinicians receive monthly notification of their RVs and assist with completing root cause analyses. Ongoing cumulative analyses using descriptive statistics and t-test analysis are reviewed to identity trends and predictors of RVs. Targeted solutions are sought to address system-level themes.

Results Our RV database contains over 2.5 years of data analyzing 1,300 cases, equaling 0.75% of annual ED patient volumes. RVs have higher acuity scores on both their index and return visit (P=0.001) and children under 12 months of age have significantly higher rates of return (24% vs 16%, P<0.001). 31% of patients had a consultation service involved during their index ED visit, with the top three consultants being Hematology/Oncology (23%), General Surgery (12%), and Neurology (8%). The majority of RVs were related to disease progression (65%), while 8% were call-backs for positive blood cultures or discrepant results, and 6% were misdiagnoses.

Conclusions Routine monitoring and investigation of ED RVs provides a proactive approach to seeking improvement opportunities. With a better understanding of specific patient and visit-level factors associated with RVs, future system-level quality improvement initiatives can be targeted.⇓⇓⇓

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