Bouncebacks
The Case of a 33-Year-Old
Male with Abdominal Pain
Bouncebacks, in which we recount scenarios of actual patients who were evaluated in and discharged
from an emergency department or urgent care facility and then “bounced back” for further treatment,
appears semimonthly in JUCM.
Case presentations on each patient, along with case-by-case risk management commentary by Gre-
gory L. Henry, past president of The American College of Emergency Physicians, and discussions by
other nationally recognized experts are detailed in the book Bouncebacks! Emergency Department
Cases: ED returns (2006, Anadem Publishing, www.anadem.com).
Ryan Longstreth, MD, FACEP and Michael B. Weinstock, MD
ver the next few installments of this
series, we will be discussing
“bounceback” studies, and
answering the following ques-
tions, in sequence:
Ⅲ What is the incidence of
bouncebacks? Ⅲ What is the incidence
of bounceback admis-
sions? Ⅲ What is the incidence
of deaths in patients
recently discharged
from the ED?
m Ⅲ What percent of
.co es
ag I / m
bouncebacks occur be-
ler tab
cause of medical errors?
nS t ar o
B ©
Ⅲ How can we use this in-
formation to improve
patient safety?
Our feeling is that if we can
use these data to identify high-
risk patients, we can assure that our ur-
gent care evaluation was appropriate.
If we can identify patients who are more likely to
bounce back, we can revisit their evaluation before
they leave the urgent care center.
O w w w. j u c m . c o m
Question I: What is the incidence of
bouncebacks? Several studies have attempted to an-
swer this question, using 72 hours as a
bounceback “window” and produc-
ing strikingly similar results.
Though the data were gathered
from emergency departments,
they may also be applied to
the urgent care setting.
Ⅲ 1998, Annals of Emergency
Medicine: Gordon, et al pub-
lished a study of 52,553 ED
visits during a 12-month
period and found a return
rate of 2.7%.
Ⅲ 1992, Archives of Emer-
gency Medicine: Wilkins
and Beckett’s audit of
5,811 ED visits found 102
unscheduled returns, a rate
of 1.9%.
Ⅲ 1991, Archives of Emergency
Medicine: O’Dwyer and Bodiwala
published a study encompassing more than
8,000 ED visits; they found a bounceback rate
of 2.9%.
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