Seventy-Two-Hour Returns Are Not Useful in Identifying Emergency Department Patients With a Concerning Intra-Abdominal Process.
Seventy-two-hour returns to the emergency department (ED) have been used to identify patients who are believed to have been more likely to have suffered medical errors, missed diagnoses, or failure or inadequacy of previous treatment or discharge planning. This approach has been criticized as arbitrary, however, citing the lack of evidence to support its homogenous application to all organ system-based complaints and the unclear implication of returns. Given the significant burden of gastrointestinal (GI)-related illness, our objective was to determine if an audit of 72-hour returns of GI-related diagnoses appropriately captures patients who return with a concerning diagnosis (CD) on their second visit. Ten emergency physicians were surveyed and a list of concerning, "not to be missed" diagnoses were generated. The demographic and clinical variables were collected and analyzed on all patients with a GI International Classification of Diseases, 9th revision code presenting to an urban, university-affiliated ED between July 2013 and March 2014. There were 10,012 patient visits during the study period, including 1006 patients (10%) with ≥ 1 return visits. One hundred forty-seven patients (15%) returned within 72 hours, and 859 patients (85%) returned in > 72 hours. Patients that returned within 72 hours were no more likely to have a CD than those that returned at a later time (13.6% vs. 14.4%; p = 0.79). An audit of 72-hour returns only captures a small percentage of patients that return with a CD, and these patients are at no greater risk of harboring a CD than those that return at a later date.