Patients Evaluated and Discharged From the Waiting Room Do Not Have a Higher Rate of 72-Hour Returns - A Retrospective Observational Study.

Abstract

Objectives: To evaluate the rate of return visits to the emergency department (ED) within 72 hours of discharge for patients evaluated in the waiting room. ED crowding challenges throughput, and we hypothesized that some patients may be suitable for the completion of evaluation without rooming.

Methods: This was a single-center retrospective analysis of a tertiary hospital ED. The primary outcome was 72-hour returns following discharge from the ED, stratified by location of initial physician evaluation and discharge: waiting room only, waiting room followed by treatment space, and treatment space only. Categorical data were compared using a chi-squared test and continuous data using a one-way analysis of variance with Bonferroni correction. The primary outcome was analyzed using a chi-squared test adjusting for age, biologic sex, Emergency Severity Index, primary language, time of day, and day of the week using logistic regression.

Results: There was a statistically significant overall difference in return visits within 72 hours of discharge based on the ED location where the evaluation occurred (P < .05; 5.0% in the waiting room only, 4.4% in the waiting room followed by treatment space, and 4.9% in the treatment space only). However, when comparing groups individually, there was a significantly lower rate of 72-hour return only for patients seen in the waiting room followed by a treatment space compared with treatment space only (P = .032). The patients evaluated and discharged from the waiting room tended to be younger, more likely to be male, with lower acuity Emergency Severity Index scores, and typically seen during an evening shift compared with the patients who were evaluated in a treatment space during their visit.

Conclusion: There was no significant increase in the rate of return for those patients seen primarily in the waiting room or for those where the initial work up started in the waiting room compared with those who were placed in a treatment space prior to a physician evaluation.