There and back again: The tale of bounce-back admissions in emergency care

Aim: Unscheduled return visits to the emergency department (ED), or “bounce-backs” are widely used as indicators of care quality. These revisits may signal deficiencies in initial assessment, premature discharge, or inadequate discharge planning. This study aimed to evaluate the demographic and clinical characteristics, revisit intervals, and in-hospital outcomes of patients who returned to the ED within 72 hours of discharge.

Materials and Methods: A retrospective observational study was conducted at a tertiary training and research hospital. Adult patients (≥18 years) who returned to the ED within 72 hours with the same or similar complaints were included. Data collected included triage levels, presenting complaints, diagnostic investigations, and clinical outcomes at both visits. Patients hospitalized after return were compared with non-hospitalized counterparts. Subgroup analyses examined ward admissions, ICU admissions, and mortality. Statistical analyses used chi-square and independent t-tests (p<0.05).

Results: Among the 640 patients who returned to the emergency department, the mean age was 43.1±17.8 years, with a balanced gender distribution. Most revisits occurred within 24 to 48 hours of discharge. The overall hospitalization rate was 7.3%, ICU admission rate was 1.4%, and in-hospital mortality was 0.8%. Red triage level on revisit was significantly associated with ICU admission and mortality (p<0.001). Gastrointestinal/genitourinary and cardiovascular complaints were more frequently observed among hospitalized patients (p=0.008 and p=0.004, respectively). The rates of consultation, laboratory testing, and imaging were significantly higher in the hospitalized group (all p<0.001). No significant difference in hospitalization rates was observed across revisit intervals (p=0.863).

Conclusion: Bounce-back visits within 72 hours highlight critical gaps in emergency care. Higher triage acuity, specific complaints, and increased diagnostic interventions were linked to worse outcomes. Early revisits offer an opportunity to improve discharge processes, follow-up planning, and care continuity.