Early emergency department representations

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The present study aims to describe early ED representation rates and identify the causes for this commonly seen problem.


This was a retrospective chart review of all patients that represented within 72 h of discharge from a tertiary level ED in Sydney, Australia, over a 2 month period between 1 May 2010 and 30 June 2010. Presentations were categorised according to their diagnosis and cause for representation. Each representation was then classified as being avoidable or unavoidable.


There were 10 141 presentations to the ED during the study period, with 497 patients (4.9%, 95% confidence interval [CI] 4.5–5.3) representing within 72 h of discharge. Disease-related causes of representation were seen in 55.1% (95% CI 50.7–59.5), with 39% (95% CI 34.8–43.4) of these caused by disease progression and 12.3% (95% CI 9.6–15.5) for scheduled review. Patient-related causes were seen in 32.2% (95% CI 28.2–36.4) of representations with 20.9% (95% CI 17.6–24.7) of these for patients who did not wait or left against medical advice. Physician-related causes were seen in 3.2% (95% CI 2.0–5.2) of representations. Furthermore, 23.7% (95% CI 20.2–27.7) of patients who represented to the ED required hospital admission. A total of 37.0% (95% CI 32.9–41.4) of representations were assessed as being preventable.


Early ED representations are a common problem. The majority of preventable representations are patient related, and interventions to target these areas might be of benefit in reducing this problem.

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