Care complexity factors associated with revisits to an emergency department.

Andrea Urbina, Maria-Eulàlia Juvé-Udina, Marta Romero-García, Pilar Delgado-Hito, Maribel González-Samartino, Jordi Adamuz
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Abstract

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.

Material and methods: Observational, correlational, and cross-sectional study. Consecutive patients seeking care from a tertiarylevel 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.

Conclusion: 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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与急诊科复诊相关的护理复杂性因素。
目的分析急诊科(ED)患者中护理复杂性因素(CCFs)的发生率,并分析这些因素与 30 天急诊科再次就诊的关系:观察性、相关性和横断面研究。研究对象包括在一家三级医院急诊科就诊的连续患者,为期 6 个月。研究的主要变量是30天内再次到急诊室就诊的患者,以及26个CCFs,分为5个领域:心理情感、精神认知、社会文化、发育和合并症/并发症。数据来自医院记录,用于描述性和推论性统计分析:研究共涉及 15 556 例患者。有12 811份病历(82.4%)记录了CCF,1088名直接从急诊室出院的患者(11.9%)在30天内再次就诊。存在更多 CCF 与 30 天内再次就诊有关(几率比 1.26;95% CI,1.11-1.43;P .05)。与再次就诊明显相关的CCF是大小便失禁、血液动力学不稳定、出血风险、焦虑、高龄、焦虑和恐惧、认知障碍和文盲:结论:在寻求急诊室护理的患者中,CCF 的发病率很高。在发病后 30 天内再次就诊的患者中,CCF 的发病率更高。及早识别这类患者将有助于对风险进行分层,并制定预防策略以降低再次就诊的发生率。
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A pioneering Spanish book on psychiatric emergencies from 1928, by César Juarros. Rapunzel syndrome in the emergency department. Complexity of care in the emergency department: Shall we treat the whole person to prevent revisits? Considerations regarding the use of the sex/gender variable in research: moving towards good practice. Progenders decalogue. We must be doing something right.
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