Degree of Worry and unscheduled returns to the emergency department within 30 days: An observational study

Resumé

Abstract (Dansk)

Baggrund: Ikke-planlagte genhenvendelser (IPG) til akutmodtagelser (AKM) er ofte anvendt som kvalitetsmarkør, men det er debatteret hvilke patientrelaterede variabler der kan forudsige disse. Dette studie har undersøgt om Degree of Worry (DOW), en ny patient reported outcome, er associeret til IPG ved ankomst til AKM.

Formål: At undersøge associationen mellem DOW ved ankomst til AKM og 30 dages IPG.

Metode: I et observationelt studie blev 1945 patienter screenet, hvoraf 845 samtykkede og blev inkluderet. Dataindsamlingen blev udført på Hvidovre Hospital, Region Hovedstaden. Eksklusionskriterier var manglende samtykke, <18 år, ikke-dansk talende, højeste triage niveau, fysisk eller mentalt hæmmede, påvirkning af alkohol eller euforiserende stoffer eller ortopædkirurgiske skader. Patienter blev bedt om at vurdere deres DOW ved ankomst til AKM og 30 dages followup up blev lavet via patienternes journaler. Det primære outcome var association mellem en høj DOW (7-10) og 30 dages IPG. Dette blev testet ved tre separate logistiske regressioner, 1) crude, 2) semi-justeret for triage niveau, køn, alder og kronisk sygdom, 3) justeret for self-rated health, triage niveau, køn, alder og kronisk sygdom.

Resultat: Associationen mellem IPG og DOW var 1) crude OR (odds ratio) 1.04 (95% CI: 0.74-1.46) for 30-day URV, 2) semi-justeret, OR 0.98 (95% CI: 0.68-1.41), and 3) justeret inklusiv SRH, OR 0.92 (95% CI: 0.63-1.33).

Konklusion: Vore analyser viste ingen signifikant association mellem DOW og 30 dages IPG, i alle tre analyser, hvilket kan skyldes timingen af DOW spørgsmålet, manglende power eller en reel manglende association.

Abstract (Engelsk)

Background: Unscheduled return visits (URVs) to emergency departments (EDs) are widely used as an indicator of quality of care. However, it is debated which patient related variables accurately predict URVs. This study aimed to investigate if Degree of Worry (DOW), a novel patient reported outcome, at arrival is associated with ED URVs. The objective of this study was to investigate the association between DOW and 30-day URV to the ED.

Aims: To investigate the association between a novel patient reported outcome measure at Emergency department (ED) arrival with 30-day Unscheduled Return Visits (URV).

Methods: An observational study, 1945 patients were screened. 845 were eligible for inclusion and provided informed consent. Setting was the ED at Copenhagen University Hospital, Hvidovre, Capital Region of Denmark. Exclusion criteria were lack of consent, <18 years of age, non-Danish speaking, highest triage level, physically or mentally impairment, affected by drugs or alcohol, or orthopedic injuries. Patients were asked to rate their DOW on arrival to the ED and 30-day URV was determined by follow up in medical records. Primary outcome was the association between high DOW (DOW 7-10) and 30-day URV. This was tested with three logistic regression analyses, 1) crude, 2) semi-adjusted for triage level, sex, age, and chronic disease, 3) adjusted for self-rated health, triage level, sex, age, and chronic disease.

Results: The association between URV and DOW was 1) crude, OR (odds ratio) 1.04 (95% CI: 0.74-1.46) for 30-day URV, 2) semi-adjusted, OR 0.98 (95% CI: 0.68-1.41), and 3) fully adjusted including SRH, OR 0.92 (95% CI: 0.63-1.33).

Conclusion: Our analysis showed no significant association between DOW at ED-arrival and 30-day URV in all three analyses.