Bouncebacks The Case of a 10-Year-Old Male with Eye Pain Bouncebacks 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 avail- able at www.amazon.com and www.acep.org. Ryan Longstreth, MD, FACEP and Michael B. Weinstock, MD T his article is the third in a series in which we will sequentially answer the following questions: I. What is the incidence of bouncebacks? II. What is the incidence of bounceback ad- missions? III. What is the inci- dence of death in patients recently discharged from the ED? IV. What percent of om bouncebacks occur s.c ge ma / r I because of medical ble Sta errors? on a B rt © V. How can we use this information to im- prove patient safety? This month, we will discuss Question IV: What percent of bouncebacks occur because of medical errors? A 2006 case control study performed by Nunez et al compared 250 unscheduled ED returns over a four- month period with 250 similar visits in which patients did not return to the ED. The authors discovered a prognostic error in 20% of the ED returns, a diagnostic error in 20%, and a follow-up error in 26% in the un- w w w. j u c m . c o m scheduled returns. Other than these medical errors, dysp- nea and advanced age were the two most common factors associated with an un- scheduled return visit. Another study looking at this is- sue was published in 1990 in the Annals of Emergency Medi- cine by Pierce et al. During the three-month study period, there were 17,214 new visits to their ED with 569 unscheduled returns (defined as ED return within 48 hours), equating to a bounceback rate of just over 3%. The researchers con- cluded that over 18% were due to physician-related factors (e.g., misdiagnosis, treatment error, inappropriate discharge on initial visit, radiol- ogy over-reads, or lack of outpa- tient analgesics when indicated). Finally, we revisit a recent study by Sklar et al pub- lished in the Annals of Emergency Medicine in 2007. This study analyzed unanticipated death in patients dis- charged home from the ED. Out of the 387,334 visits considered from 1994-2004, 117 patients died within 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 | M a r c h 2 0 0 8 23