Return to the emergency department among elders: Patterns and predictors

Objectives: 1) To describe the pattern of return visits to the emergency de partment (ED) among elders over the six months following an index visit; 2) to identify the predictors of early return (within 30 days) and frequent r eturn (three or more return visits in six months); and 3) to evaluate a new ly developed screening tool for functional decline, Identification of Senio rs At Risk (ISAR), with regard to its ability to predict return visits. Met hods: Subjects were patients aged 65 years or more who visited the EDs of f our Canadian hospitals during the weekday shift over a three-month recruitm ent period. Excluded were patients who: could not be interviewed, due eithe r to their medical conditions or to cognitive impairment, and no other info rmant was available; refused linkage of study data; or were admitted to hos pital at the initial tinder) visit. Measures made at the index ED visit inc luded: 27 self-report screening questions on social, physical, and mental r isk factors, medical history, use of hospital services, medications, and al cohol. Six of these questions comprised the ISAR scale. Return visits and d iagnoses during the six months after the index visit were abstracted from t he utilization database. Results: Among 1,122 patients released from the ED , 492 (43.9%) made one or more return visits; 216 (19.3%) returned early an d 84 (7.5%) returned frequently. Earlier returns were more likely than late r returns to be for the same diagnosis (p = 0.003). Using logistic regressi on, hospitalization during the previous six months, feeling depressed, and certain diagnoses predicted both early and frequent returns. Also, a histor y of heart disease, having ever been married, and not drinking alcohol dail y predicted early return; a history of diabetes, a recent ED visit, and lac k of support predicted frequent use. Conclusions: In the first month after an ED visit, return rates are highest and are more likely to be for the sam e diagnosis. Both, medical and social factors predict early and frequent re turns to the ED; patients at increased risk of return can be quickly identi fied with a short, self-report questionnaire. The ISAR screening tool, deve loped to identify patients at increased risk of functional decline, can als o identify patients who are more likely to return to the ED.