ArticleAnnals of Saudi medicine
Missed specialty consultation and hospital admission in 72-hour emergency department return visits.
Article in Annals of Saudi medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
backgroundUnscheduled 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.
objectivesThis 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.
designRetrospective cohort study. SETTINGS: Single-center, tertiary care university hospital emergency department.
methodsThis 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 measuresPatient 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.
resultsThe 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];
conclusionsOne 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.
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