Literature Review on Early Return Visits to the Emergency Department for Assessing Healthcare Quality and Safety

Early return visits to the emergency department (ED) may be due to adverse event occurring during the first visit. We reviewed 24 publications to focus on return visits as sentinel event to detect preventable errors and adverse events in the ED. Most of returns are not related to lapses in care but to patient factors, disease progression or post-ED factors. Only 15% of early return visits are related to adverse events, but these patients often return with severe conditions and must be hospitalized. Their risk factors are age, comorbidities, poor insurance coverage, and severe conditions at the first visit. Early return visits should not be used as indicator of quality of care because most of return visits are not related to quality issues, but as a screening tool to detect deficits in care. Review of screened records characterizes adverse events for identifying preventable errors and improve healthcare.