The following is a summary of “Descriptive analysis of emergency medical services 72-hour repeat patient encounters in a single, Urban Agency,” published in the March 2023 issue of Emergency Medicine by Supples, et al.

Bouncebacks, sometimes known as unexpected return trips to the emergency department within 72 hours after release, have been used as a care quality metric. Researchers speculated that certain racial and psychological characteristics could be linked to Emergency Medical Services (EMS) 72-h bouncebacks.

They kept records on the demographics (name, date of birth, race, and gender), the primary impression, the disposition, and the vital signs for all patient visits with an EMS provider within a 12-month period at a sizable metropolitan EMS agency. A patient with multiple EMS encounters within 72 hours was considered a bounceback if their first, last, and date of birth all matched. Using median (interquartile range), Wilcoxon Rank Sum test for age and frequency (percent), and chi-square test for gender, race, and run disposition, we performed descriptive statistics for patients who did and did not have a subsequent bounceback. They described the frequency and proportion of initial impressions EMS professionals make for patients who experience a bounceback.

A total of 98,043 contacts between January 1 and December 31, 2021, were examined. The median patient age was 50 years (IQR 32-65); 49.4% of patients were female (46,147), and 50.7% were White (47,376). A bounceback occurred in 3,951 encounters, and compared to encounters without bouncebacks, they were more likely to involve male patients (58.7% versus 50.2%, P < 0.001) and to not be transferred (22.3% versus 15.5%, P < 0.001). According to a multivariable logistic regression model, the odds of bounceback were lower for female patients [OR 0.64 (95% CI 0.61-0.68)], Asian and Latino patients compared to White patients [OR 0.33 (95% CI 0.21-0.53) and 0.42 (95% CI 0.34-0.51)], respectively. There was no statistically significant difference between Black and White patients, and the odds of bounceback were higher for non-transported patients [OR 1.25 (95% CI 1.16–1.34)]. Mental health was the most prevalent EMS first impression for both the first and subsequent interactions [576 (14.7%) and 944 (17.0%), respectively]. In 67 (1.2%) of the cases, cardiac arrest or death was the overriding impression for subsequent encounters.

The one-year study of a busy urban EMS organization found that bouncebacks were frequent. The majority of patients who bounced back were male and not moved. Experiences with bounceback were most frequently associated with mental health. In 1% of bounceback cases, a cardiac arrest happened outside of a hospital. To fully comprehend the impact on patient-centered outcomes, more research was required.

Reference: sciencedirect.com/science/article/pii/S0735675722007689