A recent study described 60 persons who returned to an emergency department (ED) within 9 days after being discharged from it. (The study, “Return Visits to the Emergency Department: the Patient Perspective,” was published online on September 2, 2014, in Annals of Emergency Medicine.)

In most cases, that subsequent ED visit was a quest for follow-up care for the condition that had originally brought the person to the ED. Most of these patients did report having a primary-care provider they could have consulted instead.

According to the lead author of that study, Kristin Rising, MD, MS, director of acute care transitions in the Department of Emergency Medicine at Thomas Jefferson University in Philadelphia, the most frequent explanation participants gave for choosing the ED over primary care was that outpatient clinics lack the necessary resources to complete the workup and treatment and to sufficiently address patient symptoms. 

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The Clinical Advisor asked Dr. Rising how primary-care nurse practitioners and physician assistants could keep their patients from making return trips to the ED in search of care they should be receiving from these clinicians. Here is her response: 

Our findings highlight two main points: First, patients have preferences regarding how they receive medical workups that we should incorporate into our care-delivery system. 

Second, we must establish open lines of communication with patients to facilitate ongoing dialogues rather than the episodic approach to care patients currently experience. 

For primary-care practitioners, this means developing a system in which they can care for patients when and where patients want care. Peoples’ lives are unpredictable, and the expectation that patients will wait hours to days for their provider to be available to see them for an acute-care need is unreasonable. Unless patients are provided with alternatives for receiving expedited evaluation and treatment when and where they want, they will continue to return to the emergency department. 

In the future, technology may play a role in helping to facilitate connectedness with primary-care teams to help patients stay healthy and out of the hospital. (192-5) 

Kristin Rising, MD, MS, is the director of acute care transitions in the Department of Emergency Medicine at Thomas Jefferson University in Philadelphia.

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