The Effects of a Recent Emergency Department Visit on Acuity Classification and Diagnostic Service Provision

Introduction: Return visits to the emergency department are a significant problem in the field of emergency medicine. Some studies suggest that patients often feel as if their original diagnosis was not correct or ineffective, and many times these patients are right. Additionally, a large number of return visits can be attributed to poor discharge instructions or a lack of understanding by the patient about their condition and treatment. The perceived ideas of convenience and speed also play a role in patient’s choosing to return to the emergency department versus a primary care provider. Yet little research has explored the effects of a recent visit on the services rendered.

Methods: The analysis examined a nationally representative sample of deidentified emergency department patient encounters from 2011 through 2016, gathered from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Multivariate linear and logistic regression analyses were adjusted for this weighted data set and controlled for potential confounders. The provision of diagnostic services, length of visit, and patient acuity were explored for patients presenting to the emergency department within 72 hours of a previous visit. 

Results: Drawing from the NHAMCS data set, 62,699 emergency department records were analyzed, weighted to represent 313.9 million estimated emergency department patient encounters. Findings suggest that patients who had been seen in the emergency department in the prior 72 hours were less likely to be classified as “emergent” (OR 0.864, p=0.006) and more likely to be classified as “nonurgent” (OR 1.139, p<0.000). Additionally, these patients received fewer total diagnostic services (B=[-0.462], p<0.000). There was no significant difference in length of visit. 

Conclusions: Patients who present to the emergency department within 72 hours of their previous visit are much more likely to be triaged as low-acuity and subsequently receive fewer diagnostic tests. These patients, however, do not appear to be expedited through the department. Many reasons contribute to return visits, among them inadequate discharge education and lack of primary care access. This study highlights that return visits are largely low-acuity and do not require extensive diagnostic testing.