Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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Factors associated with unexpected revisit to an emergency medical center

예고되지 않은 응급의료센터 재방문에 영향을 미치는 요인 분석

  • Lim, Mi-Sun (Department of Medical Record, Seoul National University Hospital, Graduate School of Public Health, Yonsei University) ;
  • Kang, Hye-Young (Department of Medical Record, Seoul National University Hospital, Graduate School of Public Health, Yonsei University) ;
  • Sub, Gil-Joon (Department of Emergency Medicine, Seoul National University Hospital) ;
  • Hong, Joon-Hyun (Department of Health Administration, College of Health Sciences, Yonsei University)
  • 임미선 (서울대학교 병원 의무기록과, 연세대학교 보건대학원) ;
  • 강혜영 (서울대학교 병원 의무기록과, 연세대학교 보건대학원) ;
  • 서길준 (서울대학교 의과대학 응급의학과) ;
  • 홍준현 (연세대학교 보건과학대학 보건행정학과)
  • Published : 2005.06.30
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Abstract

The objectives of this study were to identify factors associated with unexpected revisit to an emergency medical center (EMC) located in Seoul and to examine reasons for revisit. During March, June, September and December, 2002, a total of 168 patients had unexpected revisits to the EMC within 48 hours of a previous discharge. As a 1:1 matched control, we included 136 patients who: discharged from the EMC during the same time period: did not return to the EMC; had the same diagnosis and age(${\pm}5$) with the case. In this study, factors associated with unexpected revisits were defined as characteristics of a previous discharge, which were classified into three: sociodemographic, EMC visit-related, and discharge management factors. Reasons for revisit were categorized into disease, physician, patients, and system-related factors. Data were collected by medical chart review with assistance from clinicians of the EMC. Logistic regression results showed that patients who headed home after discharge without follow-up schedule had a 27.6 times higher risk of revisiting EMC than those who were hospitalized following EMC visit. Patients discharged on his own will had a 5.9 times higher risk of revisiting than those discharged following physician's advice. Patients requiring continual observation at the time of discharge were more likely to revisit by 8.7 times than those discharged with improved condition. About 69.13% of the revisits were due to disease-related factors, followed by 13.90% due to patient-related factors, 8.64% due to system-related factors, and 8.34% due to physician-related factors. It appears that the most significant factors influencing revisits are discharge management factors such as patient's condition at discharge, whether the discharge was accorded with physician's advice, and whether returning home without follow-up schedule. Therefore, appropriate discharge management is necessary to prevent EMC revisit.

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