PT - JOURNAL ARTICLE AU - Olivia Ostrow AU - Andrea Shim AU - Syed Azmat AU - Lucas Chartier TI - PEDIATRIC EMERGENCY DEPARTMENT RETURN VISITS: A PROACTIVE APPROACH TO QUALITY IMPROVEMENT AID - 10.1136/bmjqs-2016-IHIabstracts.1 DP - 2016 Dec 01 TA - BMJ Quality & Safety PG - 993--994 VI - 25 IP - 12 4099 - http://qualitysafety.bmj.com/content/25/12/993.2.short 4100 - http://qualitysafety.bmj.com/content/25/12/993.2.full SO - BMJ Qual Saf2016 Dec 01; 25 AB - 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.⇓⇓⇓Figure 1 Figure 2 Figure 3