Patient Anxiety Causes Returns to ER

WASHINGTON — If a patient returns to the emergency room only a few days after their initial visit, it’s generally due to a lack of trust in other parts of the health care system and because he or she is anxious about their symptoms.

That’s what authors of a study published on Sept. 2 in Annals of Emergency Medicine, a peer-reviewed scientific journal, concluded. The article, “Return Visits to the Emergency Department: The Patient Perspective,” discusses findings of 60 in-person interviews with patients who returned to the emergency department within nine days of discharge.

“When asked why they did not follow up as an outpatient, patients reported feeling that their symptoms were too severe to wait until their scheduled appointment or being instructed to return to the ER by the outpatient provider they contacted,” said lead study author Dr. Kristin Rising, who works at the Department of Emergency Medicine at Thomas Jefferson University in Philadelphia, in a statement.

If a patient returned to the emergency department, their decision was driven largely by fear and uncertainty regarding their medical conditions, as well as a lack of trust in the system to be responsive to their needs, according to the article. Other prominent themes related to patients’ limited use of outpatient care included problems accessing care due to lack of insurance, dissatisfaction with a primary care physician and lack of trust in their primary physician.

Patients didn’t report that post-discharge problems stemmed from discharge instructions or transportation issues. However, many patients reported that their current illness created problems getting around at home. Forty percent of the patients who returned were admitted to the hospital during the return visit. These patients were most likely experiencing a deterioration of what was a chronic or pre-existing condition (such as asthma).

The majority of patients — 70 percent — had a primary care physician. When asked why they didn’t go to an outpatient clinic after their ER experience, patients said that clinics lack the necessary resources to complete the work-up or treatment and to sufficiently address their symptoms. Patients also reported delays in diagnosis associated with outpatient testing and inconvenience related to having multiple appointments on different days.

“The medical community must learn to meet our patients when and where they need us,” Rising added in a statement. “Sometimes, they may just need reassurance, especially when there is no clear explanation for what is causing their symptoms. Going forward, technology may play a role in facilitating connectedness with care teams to help patients stay healthy.”