Table 5

Secondary analyses of HRURV cases, disposition, peer-review classification and reasons for URV

HRURV cases
n=270
DispositionICU30 (11.1)
Regular floor238 (88.1)
Death2 (0.7)
Required surgery 60 (22.2)
Peer-Review Severity Score*1193 (71.5)
247 (17.4)
323 (8.5)
47 (2.6)
50 (0.0)
Reason for URV
Illness related Total 166 (61.5)
Progression of disease83 (50.0)
Failure of outpatient treatment39 (23.5)
Recurrent disease process33 (19.9)
New problem10 (6.0)
Complication1 (0.6)
Physician related Total 45 (16.7)
Admission indicated but consultant recommended outpatient management14 (31.1)
Failure of reassessment9 (20.0)
Misdiagnosis9 (20.0)
Treatment error8 (17.8)
Admission indicated on initial visit and ED attending did not attempt to admit5 (11.1)
Patient related Total 53 (19.6)
Discharge against medical advice48 (90.6)
Social issues2 (3.8)
Habitual use of ED1 (1.9)
Missed clinic follow-up1 (1.9)
Psychiatric disorder1 (1.9)
Non-compliance0 (0.0)
Healthcare system related Total 6 (2.2)
Called back because of missed radiograph abnormalities4 (66.7)
Instructed to return for re-evaluation1 (16.7)
Sent from clinics1 (16.7)
Patient unable to get medication0 (0.0)
  • 1: Appropriate with no identified physician issues; 2: Appropriate with no physician issues, but system factors that need improvement; 3: Appropriate, but minor physician issues need improvement or differing opinions on management; 4: Inappropriate requiring performance improvement without change in scope of practice; 5: Inappropriate requiring performance improvement with change in scope of practice until remediation is complete.

  • ED, emergency department; HRURV, high-risk unscheduled return visit; ICU, intensive care unit; URV, unscheduled return visit.