The problem of hospitalizations during return visits to the hospital emergency department, their impact on the quality to healthcare services and the ways to manage them

Doctoral dissertation investigates the frequency, reasons, evaluate outcomes and economic effect of return visits (RV) to the emergency department (ED) with hospitalization within 30 days time frame and develops a prognostic tool facilitating, during the index visit, to predict the risk of return visit with hospitalization within 30 days. Analysis measures the number of patients who had a return visit during selected timeframe. The analysis of the reasons discusses the influence of patient‘s gender, age, number of consultations and medical services, triage category, number of laboratory, diagnostic and computed tomography examinations performed, time spent in the ED, diagnosis-related groups category for return visits with hospitalization. When analyzing the costs related to the treatment, the difference between reimbursement for patients who arrived once and those who arrived twice is assessed. Qualitative benchmarking examines the determinants of RV to Emergency Department. The study revealed that the most important factors causing the RV are the number of laboratory tests and the time spent ED during index visit, the diagnosis- related DRG category; poorer disease outcomes, longer length of stay in hospital, higer costs have been found in this patient group; a predictive tool was developed and introduced to identify the patients at risk for RV in the ED during the index visit