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Care complexity factors associated with revisits to an emergency department

Urbina A, Juvé-Udina ME, Romero-García M, Delgado-Hito P, González-Samartino M, Adamuz J

Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Departamento de Enfermería Fundamental y Médico-Quirúrgica, Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain. IDIBELL, Instituto de Investigación Biomédica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Instituto Catalán de la Salud, Barcelona, Spain. Proyecto Internacional de Investigación para la Humanización de la Asistencia Sanitaria, Proyecto HU-CI. 6Área de Calidad, Conocimiento y Metodología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain.

Objectives. To analyze the prevalence of care complexity factors (CCFs) in patients coming to an emergency department (ED) and to analyze their relation to 30-day ED revisits.
Methods. Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiary-level hospital ED were included over a period of 6 months. The main variables studied were 30-day revisits to the ED and 26 CCFs categorized in 5 domains: psychoemotional, mental-cognitive, sociocultural, developmental, and comorbidity/complications. Data were collected from hospital records for analysis of descriptive and inferential statistics.
Results. A total of 15 556 patient episodes were studied. A CCF was recorded in 12 811 patient records (82.4%), and 1088 (11.9%) of the patients discharged directly from the ED revisited within 30 days. The presence of more CCFs was associated with 30-day revisits (odds ratio, 1.26; 95% CI, 1.11-1.43; P < .05). The CCFs that were significantly associated with revisits were incontinence, hemodynamic instability, risk for bleeding, anxiety, very advanced age, anxiety and fear, cognitive impairment, and illiteracy.
Conclusions: The prevalence of CCFs is high in patients who seek ED care. Patients revisiting within 30 days of an episode have more CCFs. Early identification of such patients would help to stratify risk and develop preventive strategies to decrease the incidence of revisiting.

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