Frequencies and reasons for unplanned emergency department return visits by older adults: a cohort study.

BACKGROUND: As unplanned Emergency Department (ED) return visits (URVs) are associated with adverse health outcomes in older adults, many EDs have initiated post-discharge interventions to reduce URVs. Unfortunately, most interventions fail to reduce URVs, including telephone follow-up after ED discharge, investigated in a recent trial. To understand why these interventions were not effective, we analyzed patient and ED visit characteristics and reasons for URVs within 30 days for patients aged ≥ 70 years. METHODS: Data was used from a randomized controlled trial, investigating whether telephone follow-up after ED discharge reduced URVs compared to a satisfaction survey call. Only observational data from control group patients were used. Patient and index ED visit characteristics were compared between patients with and without URVs. Two independent researchers determined the reasons for URVs and categorized them into: patient-related, illness-related, new complaints and other reasons. Associations were examined between the number of URVs per patient and the categories of reasons for URVs. RESULTS: Of the 1659 patients, 222 (13.4%) had at least one URV within 30 days. Male sex, ED visit in the 30 days before the index ED visit, triage category "urgent", longer length of ED stay, urinary tract problems, and dyspnea were associated with URVs. Of the 222 patients with an URV, 31 (14%) returned for patient-related reasons, 95 (43%) for illness-related reasons, 76 (34%) for a new complaint and 20 (9%) for other reasons. URVs of patients who returned ≥ 3 times were mostly illness-related (72%). CONCLUSION: As the majority of patients had an URV for illness-related reasons or new complaints, these data fuel the discussion as to whether URVs can or should be prevented. TRIAL REGISTRATION: For this cohort study, we used data from a randomized controlled trial (RCT). This trial was pre-registered in the Netherlands Trial Register with number NTR6815 on the 7th of November 2017.

Respiratory Distress Following Cleft Palate Repair in Children With Robin Sequence.

Objective The aim of this study is to assess prevalence, severity, and duration of respiratory distress following palatoplasty in children with Robin sequence and to evaluate perioperative management. Design Retrospective chart review study. Data were collected for patients who were born between 2009 and 2012 and underwent palatoplasty in the Sophia Children's Hospital-Erasmus Medical Center. Results Of the 75 patients with cleft palate, 30 with Robin sequence and a control group of 45 cleft without Robin sequence underwent palatoplasty. Prior to closure, 26 of 30 patients with Robin sequence had been treated by prone positioning, and four needed additional treatment. The mean age at closure was 12.4 months for patients with Robin sequence and 10.9 months for patients without Robin sequence (P = .05). On the basis of the results of preoperative polysomnography with palatal plate, closure was postponed in two patients with Robin sequence. In the Robin sequence group, eight of the 30 patients developed postoperative respiratory distress within 48 hours and one patient, after 7 days; whereas none within the non-Robin sequence group developed respiratory distress. In all nine cases of Robin sequence the obstructive problems resolved within a few days, with four children requiring a temporary nasopharyngeal tube (NPT). There were no significant differences between preoperative polysomnography results of the nine patients with Robin sequence who developed postoperative respiratory distress compared with those patients with Robin sequence who did not. Conclusion Despite delayed closure compared with children without Robin sequence, 30% of the children with Robin sequence developed respiratory distress following palatoplasty, which resolved within a few days. This study emphasizes the need for close perioperative monitoring of patients with Robin sequence who undergo palatoplasty.