Care complexity factors associated with revisits to an emergency department
Andrea Urbina1-3, Maria-Eulàlia Juvé-Udina3,4, Marta Romero-García2,3,5, Pilar Delgado-Hito2,3,5, Maribel González-Samartino2,3,6, Jordi Adamuz2,3,6
Affiliation of the authors
1Emergency Department, Hospital Universitario de Bellvitge Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. 2Department of Fundamental and Medical-Surgical Surgical Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain. 3IDIBELL, Institute of Biomedical Research Bellvitge, L’Hospitalet de Llobregat Llobregat, Barcelona, Spain. 4Catalan Institute of Health, Barcelona, Spain. 5International Research Project for the Humanization of Health Care, HU-CI Project. Health Care, HU-CI Project. 6Quality, Knowledge and Methodology and Methodology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain.
Urbina A, Juvé-Udina ME, Romero-García M, Delgado-Hito P, González-Samartino M, Adamuz J. Care complexity factors associated with revisits to an emergency department. Emergencias. 2023;35:245-51
Summary
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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