@article {Ostrow993, author = {Olivia Ostrow and Andrea Shim and Syed Azmat and Lucas Chartier}, title = {PEDIATRIC EMERGENCY DEPARTMENT RETURN VISITS: A PROACTIVE APPROACH TO QUALITY IMPROVEMENT}, volume = {25}, number = {12}, pages = {993--994}, year = {2016}, doi = {10.1136/bmjqs-2016-IHIabstracts.1}, publisher = {BMJ Publishing Group Ltd}, abstract = {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{\textquoteright}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.⇓⇓⇓Figure~1 Figure~2 Figure~3}, issn = {2044-5415}, URL = {https://qualitysafety.bmj.com/content/25/12/993.2}, eprint = {https://qualitysafety.bmj.com/content/25/12/993.2.full.pdf}, journal = {BMJ Quality \& Safety} }