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  1. Olivia Ostrow1,
  2. Andrea Shim1,
  3. Syed Azmat1,
  4. Lucas Chartier2
  1. 1Hospital for Sick Children, Canada
  2. 2University Health Network, Canada


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.

  • Accreditation
  • Anaesthesia
  • Attitudes

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