Bouncebacks The Case of a 46-Year-Old Man with Neck and Upper Back 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 Gregory L. Henry, past president of The American College of Emergency Physicians, and discussions by other na- tionally recognized experts are detailed in the book Bouncebacks! Emergency Department Cases: ED returns (2006, Anadem Publishing, www.anadem.com). Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP T his article is the second in a series that will sequentially answer the following questions: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients re- cently discharged from the ED? What percent of bounce- backs occur because of medical errors? m How can we use this in- .co es ag I / m formation to improve pa- ler tab tient safety? nS t ar o B © In the September issue of JUCM, we discussed several studies which found the in- cidence of ED bouncebacks is 3%; of the 115 million ED visits per year in the U.S., approximately 3.3 million patients will “bounce back” to the ED within 72 hours. This month, we turn our attention to Question II: What is the incidence of bounceback admissions? w w w. j u c m . c o m The most comprehensive recent study of bounceback admissions (Martin-Gill, et al, Am J Emerg Med) spanned a two- year period with 104,584 new patients seen and discharged; 609 patients (0.58%) were admitted within 72 hours of their initial ED visit. Other studies have reached similar conclusions. Martin-Gill found the fol- lowing groups more likely to be admitted on ED return: Ⅲ Age >65 (three times more likely to require admission than patients <30 years of age) Patient with the follow- ing diagnoses: Ⅲ mental disorder Ⅲ GU system disorder/ UTI and urinary calculus Ⅲ alcohol-related disorder Ⅲ abdominal pain Ⅲ chest pain The direct answer to the question of bounceback ad- missions—0.6%—equates to roughly 660,000 patients per year. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | N o v e m b e r 2 0 0 7 21