Unscheduled Return Visits to the Emergency Department: Case of University Hospital Center in Tunisia

Abstract

Introduction: The re-consultation after short period of initial visit is an indicator of health care’s quality offered in the first consultation. They increase health expenditures and reflect a wrong medical care process. Aims: The aims of this work are to determine the rate of reconsultations in Farhat Hached‘s Emergency service, Sousse, Tunisia and analyze the demographic characteristics of these patients in short terms, medical history, their chief complaint in initial consultations and disease progression. Materials and Methods: We conducted a prospective descriptive study realized in the polyvalent emergency service of university hospital Farhat Hached over a period of 6 months, starting from January the 1st 2015 to  June  2015, covering patients reconsulting in an interval of 7 days. Results: Almost 200 patients needed a second consultation in the 07 next days. The period between 2 consultations in emergency department was 2.66(SD= 1.28) days. The median age of re-consultants was 48 (IQR=17) years old with extremes going from 16 to 84 years. We noticed a predominance of female gender. The most frequent complaints during the first and the second consultations were digestive. The prescribed treatments after first consultations were dominated by antibiotics (39%) and painkillers (34.5%). 49.5% of patients who needed second visit went back home after reconsultations while 50.5% of them needed hospitalization. We have noticed a diagnostic relation established between the two consultations among 140 patients (70%), an aggravation among 65 of them (32%) and 3 deaths (1.5%). Conclusion: We propose to include second and third health care institution as well as the private sector in order to generalize this study’s findings and make it multi-centric.