Objectives & Background Unplanned emergency re-attendance within seven days is a national quality indicator set at 1–5% by the Department of Health. Newham University Hospital (NUH), one of three hospitals forming Barts Health NHS Trust, recorded rates exceeded this target in October 2012, with a spike at 10% in April 2013 prompting investigation of the root cause. A review was carried out to determine the potential causes and provide solutions.
Methods Records of all patients who attended twice or more within seven days with the same problem were analysed retrospectively over a two week period in October 2012. Spot check analyses were also made over the following two months. Over 250 re-attendances were reviewed. All patients presenting to the common front door of the ED (ED, Urgent Care Centre and GP co-operative) were included, as per DoH definition. Clinical notes were reviewed to establish the initial presenting complaint and reason for subsequent re-attendance.
Results The total number of recorded unplanned returns was 119. However, the true number was 90 (24% less than the recorded figure); including five missed unplanned returns.16 patients were wrongly coded and 18 patients left without treatment on at least one occasion.
One in five re-attenders were ‘frequent flyers’, presenting repeatedly with minor chronic conditions, intoxication, homelessness and mental health issues. Reasons for re-attendance given by patients included being unable to get primary care appointments, lack of GP registration and dissatisfaction with GP or Urgent Care Centre advice.
Conclusion We discovered that different definitions across the three Barts Health ED sites were being applied. Following presentation of results a unified definition was drawn up. Coding error was the main reason for our blip of 10% in April 2013 and was rectified by education of reception staff. We have now instigated bimonthly review of ‘frequent fliers’ so that case-management plans can be implemented with relevant Trust and community teams. This review has highlighted several issues contributing to inaccurate figures which are likely to apply to many emergency departments and has shown how useful it is to qualify as well as quantify unplanned returns.
- emergency care systems
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