Predictors of Unscheduled Return-to-EMS Cases within 72 Hours: A Retrospective Case–Control Study from Saudi Arabia

Introduction: Unscheduled return visits to the Emergency Department within 72 hours are widely used as a quality indicator for Emergency Medical Services (EMS). Timely identification of the predictors of a patient’s return and addressing them during the first EMS encounter could minimize the potential of the patient’s return by triggering attentive, extended, alternate, and focused care before discharging the patient home. Methods: A retrospective case–control study of return-to-EMS cases was conducted at XXXX using data of patients above the age of 15 who visited EMS during the period from October 2022 to March 2023. Data was extracted from both the RLDatix and the Epic systems. The study group included a total of 338 patients who returned to EMS within 72 hours, while the control group included a total of 247 patients who visited the EMS only once. A computerized stratified random sampling was used to select the control group cases. Nineteen predictors, including demographics, clinical presentations, diagnoses, comorbidities, and utilization measures, were assessed. Results: Patients older than 45 years had a higher incidence of return to EMS within 72 hours (55%) than similar patients who only visited EMS once (42%). Meanwhile, the proportion of cases with triage levels II and III were higher for patients who returned within 72 hours (6% and 82%, respectively) than for those cases who visited once (2% and 56%, respectively). Patients who returned within 72 hours had a higher average number of abnormal test results compared with the control group cases (2.49 vs. 0.68, p < 0.0001). In addition, shifts overlap during the first EMS visit was more common in the study group (32%) than in the control group (13%). Conclusion: This study reveals distinct factors that are significantly associated with higher potential for adult EMS cases returning within 72 hours. In specific, patients older than 45 years, cases that were triaged at levels II and III, cases exhibiting more subacute noncritical abnormal blood test results across various body systems, and those displaying subacute noncritical abnormal echocardiogram results had elevated odds of returning to EMS.