Background: Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality\nindicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been\nconsidered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs\nabove 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in\nparticular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate.\nMethods: This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were\nselected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to\n2013 were collected from the study hospitals� information systems. These included: ED visit date, day of week,\nmonth, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th\npercentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was\nunplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression\nwere respectively applied to study the crude and adjusted association between the unplanned 3-day ED reattendance\nrate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM).\nResults: The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old\n(SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %)\nin hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates,\nthe unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily\naverage BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was first explored in this\nstudy. Thursday had the lowest re-attendance rate, while Sunday has the highest re-attendance rate. The patients who\nvisited at ED on the dates with higher BOR were more likely to re-attend the ED within 3 days for hospitals A and B.\nThere was no significant association between BOR and ED re-attendance rate in hospital C.\nConclusions: A study using time series data has been conducted to explore the factors associated with the\nunplanned 3-day ED re-attendance rate. Strong day-of-week effect was first reported. The association between\nBOR and the ED re-attendance rate varied with hospital.
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