Annals of Saudi medicine · 2026
Missed specialty consultation and hospital admission in 72-hour emergency department return visits.
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Ertekin Ayse, Soyugūzel Mehmet, Rakip Usame
Аннотация
BACKGROUND: Unscheduled 72-hour emergency department (ED) return visits are key quality indicators; however, aggregate return rates alone may mask modifiable clinical vulnerabilities. In high-performing EDs with low baseline return rates, the extent of preventable revisits and the impact of missed index-visit specialty consultations remain poorly defined.
OBJECTIVES: This study aimed to classify return causes using standardized criteria, determine the proportion of potentially preventable return visits, and evaluate whether missed specialty consultations at the index visit are independently associated with hospital admission.
DESIGN: Retrospective cohort study.
SETTINGS: Single-center, tertiary care university hospital emergency department.
METHODS: This study evaluated all ED return visits occurring within 72 hours between April 1, 2024 and April 30, 2025. Two emergency physicians independently classified causes using predefined criteria (κ=0.81). The primary outcome was hospital admission at return, analyzed via multivariable logistic regression.
MAIN OUTCOME MEASURES: Patient demographics (age, sex), triage zone at both visits, presenting complaints, final diagnoses, specialty consultation status, and disposition. Triage was zone-based: green (low acuity), yellow (moderate acuity), and red (high acuity).
SAMPLE SIZE: 1505 unplanned return visits among 81390 adult ED visits.
RESULTS: The 72-hour return rate was 1.85%. While most returns were disease-related (75.5%, n=1136), 24.5% (n=369) were potentially preventable. Missed consultation opportunities occurred in 14.0% of cases (n=210), with 75.2% (n=158) of these appearing in disease-related returns. Admission rates were significantly higher in the missed-consultation group (38.1% [80/210] vs. 8.0% [103/1295]; P<.001). After adjustment for disease severity (index-visit triage acuity and age), missed consultation showed the strongest association with hospital admission in the multivariable model (adjusted OR 6.84, 95% CI 4.70-9.95), followed by higher index-visit triage acuity (adjusted OR 4.47) and age ≥65 years (adjusted OR 2.32); the model showed good discrimination (c-statistic 0.84).
CONCLUSIONS: One in four return ED visits was potentially preventable. Missed index-visit specialty consultations were independently associated with markedly higher admission risks and may warrant evaluation as quality improvement targets.
LIMITATIONS: Retrospective, single-center design; the missed-consultation definition is not externally validated and is subject to information and hindsight bias; residual confounding cannot be excluded, precluding causal inference.
OBJECTIVES: This study aimed to classify return causes using standardized criteria, determine the proportion of potentially preventable return visits, and evaluate whether missed specialty consultations at the index visit are independently associated with hospital admission.
DESIGN: Retrospective cohort study.
SETTINGS: Single-center, tertiary care university hospital emergency department.
METHODS: This study evaluated all ED return visits occurring within 72 hours between April 1, 2024 and April 30, 2025. Two emergency physicians independently classified causes using predefined criteria (κ=0.81). The primary outcome was hospital admission at return, analyzed via multivariable logistic regression.
MAIN OUTCOME MEASURES: Patient demographics (age, sex), triage zone at both visits, presenting complaints, final diagnoses, specialty consultation status, and disposition. Triage was zone-based: green (low acuity), yellow (moderate acuity), and red (high acuity).
SAMPLE SIZE: 1505 unplanned return visits among 81390 adult ED visits.
RESULTS: The 72-hour return rate was 1.85%. While most returns were disease-related (75.5%, n=1136), 24.5% (n=369) were potentially preventable. Missed consultation opportunities occurred in 14.0% of cases (n=210), with 75.2% (n=158) of these appearing in disease-related returns. Admission rates were significantly higher in the missed-consultation group (38.1% [80/210] vs. 8.0% [103/1295]; P<.001). After adjustment for disease severity (index-visit triage acuity and age), missed consultation showed the strongest association with hospital admission in the multivariable model (adjusted OR 6.84, 95% CI 4.70-9.95), followed by higher index-visit triage acuity (adjusted OR 4.47) and age ≥65 years (adjusted OR 2.32); the model showed good discrimination (c-statistic 0.84).
CONCLUSIONS: One in four return ED visits was potentially preventable. Missed index-visit specialty consultations were independently associated with markedly higher admission risks and may warrant evaluation as quality improvement targets.
LIMITATIONS: Retrospective, single-center design; the missed-consultation definition is not externally validated and is subject to information and hindsight bias; residual confounding cannot be excluded, precluding causal inference.