Patients who return to the emergency department within a few days of discharge do so principally because they are anxious about their symptoms and have lost trust in other parts of the health care system, according to the results of a study published online today in Annals of Emergency Medicine.
"When asked why they did not follow up as an outpatient, patients reported feeling that their symptoms were too severe to wait until their scheduled appointment or being instructed to return to the ER by the outpatient provider they contacted," said lead study author Kristin Rising, MD, of the Department of Emergency Medicine at Thomas Jefferson University in Philadelphia, Penn.
The paper goes on to say that patients' "decision to return to the emergency department [was] driven largely by fear and uncertainty regarding their medical conditions as well as a lack of trust in the system to be responsive to their needs." Other prominent themes related to patients' limited use of outpatient care included problems accessing care because of lack of insurance, dissatisfaction with a primary care physician and lack of trust in their primary physician.
Dr. Rising and her team conducted 60 in-person interviews with patients who returned to the emergency department within 9 days of discharge. The primary reason given for returning to the ER was fear or uncertainty about the medical condition that brought them to the emergency department in the first place. Neither discharge instructions from the original visit nor transportation were cited as particular post-discharge problems, though many patients reported that their current illness created problems getting around at home. Forty percent of the patients who returned were admitted to the hospital at the return visit. These patients were most likely to be experiencing a deterioration of what was a chronic or pre-existing condition (such as asthma).
The majority (70 percent) had a primary care physician. When asked about seeking follow-up care in an outpatient clinic instead of the emergency department, patients most often reported that clinics lack the necessary resources to complete the work-up or treatment and to sufficiently address their symptoms. Patients also reported delays in diagnosis associated with outpatient testing and inconvenience related to having multiple appointments on different days as limitations in seeking care in clinics.
"The medical community must learn to meet our patients when and where they need us," said Dr. Rising. "Sometimes, they may just need reassurance, especially when there is no clear explanation for what is causing their symptoms. Going forward, technology may play a role in facilitating connectedness with care teams to help patients stay healthy."
- Kristin L. Rising, Kevin A. Padrez, Meghan O’Brien, Judd E. Hollander, Brendan G. Carr, Judy A. Shea. Return Visits to the Emergency Department: The Patient Perspective. Annals of Emergency Medicine, 2014; DOI: 10.1016/j.annemergmed.2014.07.015
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