Pediatric Emergency Department Recidivism: Demographic Characteristics and Diagnostic Predictors

IntroductionOvercrowding in emergency departments remains a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. Demographic and diagnostic characteristics were examined in an attempt to describe this national issue with more clarity.MethodsThe hospital decision support system was used to identify 2 readmission indicators (3-month return visits and 48-hour returns). Descriptive statistics and multiple regression techniques were used to analyze the characteristics of recidivists. Chart reviews and telephone interviews were conducted to further explore ED utilization.ResultsTwenty-five percent of the sample (N = 932) had at least one visit during the previous 3 months (N = 237). Four percent of the sample had a 48-hour return visit (N = 38). The findings revealed that the traditional determinants of ED utilization such as insurance and chronicity of symptoms are not reliable predictors of return visits. The risk factors of age, race, and diagnosis were significantly associated with return visit at a significance level less than .05. The findings confirm that some demographic and diagnostic predictability of return visits is indeed evident for pediatric patients.DiscussionAlthough the sample is not representative, the data are helpful in identifying some of the issues of pediatric recidivism. Findings provide some understanding of parents' utilization of the emergency department and identified high-risk pediatric recidivists. Data also revealed specific disease entities warranting focused attention, such as nervous system diseases, sense organ diseases, digestive system diseases, infectious diseases, and parasitic diseases for children younger than 1 year. Patients with these problems may be at greater risk for return visits. ED nurses might consider nurse-initiated treatment protocols.