Elderly patients with emergency department return visit: descriptive analysis of adverse events

Elham  Pishbin; Kosar  Deldar; Roohie  Farzaneh; Azadeh  Soltanifar

doi:10.18502/fem.v9i1.18065

Elham Pishbin Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Kosar Deldar Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Azadeh Soltanifar Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.

DOI: https://doi.org/10.18502/fem.v9i1.18065

Keywords: Adverse Event; Elderly; Emergency Department; Geriatrics; Quality Improvement; Return Visit

Abstract

Objective: An emergency department (ED) visit is a critical event for elderly patients, often associated with an increased likelihood of early return visits (RVs), functional decline, and adverse events (AEs). This study aimed to investigate the proportion of ED RVs within 72 hours that were due to AE among elderly patients.

Methods: We conducted a retrospective review of hospital records for elderly patients aged 65 years and older who returned to the ED within 72 hours of discharge. The study focused on identifying AEs as a primary cause of RV and characterizing their type, severity, and preventability.

Results: Over a 6-month period, 69,557 patients presented to the ED, of whom 9,439 patients (13.6%) were aged 65 years and older, with a median age of 75. Among these elderly patients, 373 (3.9%) returned within 72 hours. Of these, 201 patients underwent a secondary review to detect AEs which revealed that 49 RVs (24.4%) were attributed to AEs. Diagnostic errors were the most common type of AEs, accounting for 34.7% of cases. Severe AE occurred in 36.7% of patients, and more than half (63.4%) were deemed preventable.

Conclusion: The results of our study indicate a concerning correlation between RV and AE in elderly patients. A substantial portion of these AEs is due to diagnostic and management errors, highlighting the necessity for strategies to enhance the quality of care for this vulnerable group. The study advocates for utilizing 72-hour ED RV as a trigger for identifying AEs.