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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, November 26, 2015

Retornos ("Bouncebacks")

emDocs - November 25, 2015 - Authors: Gadhok K and Fairbrother H
Edited by: Koyfman A and Long B
Emergency Department (ED) bouncebacks are a serious concern in patient safety. A bounceback is when a discharged patient returns to the ED for care within a short period of time. The typical Emergency Medicine (EM) physician working 1,728 hours per year for 30 years seeing 2.5 patients per hour will see about 130,000 patients in their career. An EM physician will send home about 44 patients in their career who will die within 7 days of ED discharge.1 Bouncebacks can create terrible outcomes for the patients and their family and can also emotionally devastate the physicians and nurses that took care of that patient. With the ever-increasing number of patients being seen in the ED, it is important to know how to safely discharge a patient to minimize the risk of unexpected bounceback...
What we know: Bouncebacks are bad for patient outcome and care and are a medicolegal concern in the ED. There are many studies demonstrating that we send home a small minority of patients who die within one week of discharge.
Goal: We must try to identify patients high risk for bounceback, particularly those with high morbidity and mortality.
What can we do: We can be diligent through QI programs, reviewing the charts of patients who bounceback in 2-3 days. Some studies have shown an increase in the bounceback rate in Medicare and Medicaid patients, and certainly patients who leave AMA and those who LWBS are at high risk. Patients with chronic renal and cardiac disease are also at risk.
In the end, a simple approach is to trust your gut (while thinking harder on patients known to be high risk). If you think you will worry about the patient after they are discharged, start over, review the case, consider the worst-case scenario, and document your medical reasoning thoroughly. Remember to re-assess vital signs prior to discharge, and pay special attention to patients with persistent tachycardia."