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BMC Public Health
Published in: BMC Public Health 1/2007

Open Access 01-12-2007 | Research article

Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery

Authors: Gaye Moore, Marie Gerdtz, Elizabeth Manias, Graham Hepworth, Andrew Dent

Published in: BMC Public Health | Issue 1/2007

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Abstract

Background

People who have complex health care needs frequently access emergency departments for treatment of acute illness and injury. In particular, evidence suggests that those who are homeless, or suffer mental illness, or have a history of substance misuse, are often repeat users of emergency departments. The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations. Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital.

Methods

A retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital. Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a random effect.

Results

From 64,147 presentations to the emergency department the re-presentation rate was 18.0% (n = 11,559) of visits and 14.4% (5,894/40,942) of all patients. Median time to re-presentation was 6 days, with more than half occurring within one week of discharge (60.8%; n = 6,873), and more than three-quarters within two weeks (80.9%; n = 9,151). The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation (adjusted OR 3.09; 95% CI, 2.83 to 3.36). Similarly, the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not (adjusted OR 1.73; 95% CI, 1.63 to 1.84), patients who left part-way through treatment compared to those who completed treatment and were discharged home (adjusted OR 1.64; 95% CI, 1.36 to 1.99), and those discharged to a residential-care facility compared to those who were discharged home (adjusted OR 1.46: 95% CI, 1.03 to 2.06).

Conclusion

Emergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter. Housing status and being a recipient of a government pension are the most significant risk factors. Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group.
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Metadata
Title
Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery
Authors
Gaye Moore
Marie Gerdtz
Elizabeth Manias
Graham Hepworth
Andrew Dent
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2007
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-7-320

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