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As the number of overall clinic visits has been on the increase these years, there is also a trend toward increase in the number of Emergency Room (ER) visits in Taiwan. With the never-stop working hours in nature, ERs unavoidably turn to be the busiest sections among the hospitals, and the challenge on the quality of care comes immediately. Therefore, to establish quality related indicators to monitor and improve performance in ER is considered to be very important issue. A total of 13,592 patients visited ER of a community hospital in north Taiwan during May 2004 to April 2005. Among them, 127 came back to ER within 24 hours after first visit, the 0-24h ER revisit rate was 0.934%. In terms of work shift, most patients revisited ER during night shift (16.00-24.00); in terms of department, patients visiting internal medicine had the highest revisit rate (1.13%); in terms of season, the highest revisit rate occurred during May to August. When reasons of revisit were analyzed, inadequate symptom relief ranked first (63.78%), and new problem placed second (17.32%). Among patients who complained inadequate symptoms improvement, acute gastroenteritis or upper respiratory tract infection accounted for the major diagnosis. After revisiting ER, home rest was mostly frequently recommended (74.8%), but a significant part of patients were advised to be admitted (23.62%). This study showed disease problem was the top reason for ER revisit, however, for those with most serious conditions, doctor problem accounted for the major factor. About one-fourth of patients (23.62%) needed hospital admission, furthermore, the admission rate came up to 62.5% among those whose revisits were due to doctor factors. According to the literature if doctors in ER can do more such as make a complete physical and neurological examination, check white blood cells、electrolyte levels、EKG、blood sugar、chest X-ray and make routine urine analysis, the revisit rate and inappropriate diagnosis will improve. Also, as long as appropriate education and instruction are provided to the patients, the revisit rate shall be reduced and aftercare will be easier, too.
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