Anxiety, provider mistrust send patients back to ER

Emergency department (ED) patients who return within a few days of discharge are usually anxious about their symptoms and lack trust in their care, according to a new study published in the Annals of Emergency Medicine.

Researchers, led by Kristin Rising, M.D., of the Department of Emergency Medicine at Philadelphia's Thomas Jefferson University, conducted 60 in-person interviews with patients who returned to the ED within nine days of discharge about why they had returned.

The most common reason for return was uncertainty about the condition they were originally treated for, according to the study. Subjects did not report significant problems with post-discharge instructions or transportation. Four in 10 of the returning patients were admitted upon their return; these patients were most likely to experience a deterioration of a pre-existing or chronic condition, according to the study.

When Rising and her team asked the patients why they returned to the ED rather than visiting an outpatient clinic for follow-up treatment, the most common reason was concern over insufficient resources at clinics, as well as the waits associated with outpatient testing and multiple appointments on different days. Seventy percent of patients had a primary care physician, according to the study.

"The medical community must learn to meet our patients when and where they need us," Rising said in a statement. "Sometimes, they may just need reassurance, especially when there is no clear explanation for what is causing their symptoms. Going forward, technology may play a role in facilitating connectedness with care teams to help patients stay healthy."

Some healthcare providers take steps to reduce non-emergency ED use, such as Maryland's Access Health pilot program, which targets patients who frequently use the emergency room for primary or specialty care. The program provides participants with community resources that they can use to manage their conditions rather than continually returning to the ED, FierceHealthcare previously reported.

To learn more:
- here's the study abstract
- read the statement