Bouncebacks The Case of a 17-Year-Old Male with Fever and Headache 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 nationally recognized experts are detailed in the book Bouncebacks! Emergency Department Cases: ED returns (2006, Anadem Publishing, www.anadem.com).] Also available at www.amazon.com and www.acep.org. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP T his article is the third in a series in which we will sequentially answering the following ques- tions: I. What is the incidence of bouncebacks? II. What is the inci- dence of bounce- back admissions? III. What is the inci- dence of deaths in patients recently discharged from the ED? om IV. What percent of s.c ge ma / r I bouncebacks occur ble Sta because of medical on a B rt © errors? V. How can we use this information to im- prove patient safety? This month, we will discuss Ques- tion III: What is the incidence of deaths in patients recently discharged from the ED? In May 2007, Sklar et al performed a very interesting study concerning deaths that occurred within seven days of ED discharge. A similar study had been done in w w w. j u c m . c o m 1994 by Kefer et al, looking at medical ex- aminer cases. Sklar’s study, however, is more likely to have captured all unanticipated deaths because it was performed at the Univer- sity of New Mexico Health Sciences Center, an urban tertiary care cen- ter and the University of New Mexico’s only medical school and Level I trauma center. The Sklar study was a retro- spective cohort of ED patients who were discharged to home. Ten-year data review of 387,334 ED visits identified 117 patients who died within seven days of being discharged from the ED, equating to a death rate of 30/100,000. Of the 117 patients, 50% (58 total patients) died of complica- tions related to the initial visit; 60% of those 58 patients died due to a possible medical error (35 of the total 117 patients). Frequent initial complaints included CNS symptoms (i.e., seizure, headache, dizziness), abdominal pain, 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 | J a n u a r y 2 0 0 8 21