Abstract for: Capacity Impact of Revisits on ER Services

ED (Emergency Department) crowding is a widespread phenomenon which jeopardizes the well-being of patients seeking acute medical care. ED revisits account for a sizable usage of ED capacity. Understanding the systemic causes and effects of revisits upon ED capacity is important. We use a comprehensive ED dataset to first explore revisits from and empirical standpoint. We intend to build an SD model to further explore the dynamics. Our data show that an average patient will go to the ER between 3 and 3.5 times per year. Revisits account for about 40% of cases treated. Such percentage remains stable for different urgency types, case dispositions, work shifts, and diagnostic areas. Creation of SD model is in progress. We attempt to identify feedback mechanisms, such as incomplete initial care, as drivers of ED revisits. However, a thorough review of the data does not reveal substantial endogenous mechanisms that drive congestion, suggesting that the locus of its origins is elsewhere and not necessarily within the ER itself.