Reduction of inappropriate revisits to the emergency department 72 hours after being discharged by 'Discharge explanation report'

Park, Ha Young; Sim, Min Seob; Song, Hyoung Gon; Song, Keun Jeong

Journal of Korean Society Quality Assurance Health Care 2006;12(1): 114.
Published online May 30, 2006.

'퇴원설명문'에 의한 72시간내 부적절한 응급센터 재방문의 감소

박하영, 심민섭, 송형곤, 송근정

성균관대학교 의과대학 삼성서울병원 응급의학과

Reduction of inappropriate revisits to the emergency department 72 hours after being discharged by 'Discharge explanation report'

Ha Young Park, Min Seob Sim, Hyoung Gon Song, Keun Jeong Song

Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine

Abstract

Background
Patients who were discharged from the emergency department(ED) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in 2002.
Methods
This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in 2003. An emergency physician completed 'discharge explanation report' and explained it to patients in 2004.
Results
In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in 2003. Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in 2004. Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED.

Key words Revisit;Emergency department;Quality assurance;