Not gonna lie, as an ER doc, there’s just something that nags at me when I hear the word bounceback. If a colleague saw the patient and they’re back super soon, the usual question is, “But why didn’t this patient follow up with their [probably difficult to access, if not non-existent] primary care or other specialist?” If I saw the patient previously, the question is often, “Oh crap, what did I miss?”
Supples, et al. ran a study to try and figure out what was associated with bouncebacks. It’s a bit of a shorter paper and my notes are also pretty sparse; I’d love to see more hospital and EMS systems run a similar study for generalization.
Supples, et al. 2023. Descriptive analysis of emergency medical services 72-hour repeat patient encounters in a single, urban agency. AJEM, 65, p113-117.
https://www.sciencedirect.com/science/article/pii/S0735675722007689
This paper tried to look at risk factors that would trigger an EMS bounceback, defined as someone who essentially called EMS twice in 72 hr.
Of note, this study ran from Jan to Dec 2021, which included some prime pandemic time, where many ER’s across the United States saw markedly lower patient volumes compared to previous years due to stay-at-home orders, fear of the covid-19 pandemic and infectious disease spread, etc.
The most frequent EMS diagnoses for initial encounters were mental health, atraumatic back, abdominal pain, respiratory, EtOH use.
Most frequent subsequent encounter EMS diagnoses were mental health, EtOH, atraumatic pain, abdominal pain, and respiratory. This would make sense to me, as intoxication, pain that is particularly disabling or distressing, abdominal pain (perhaps with nausea that prevents someone who eating and drinking and caring for themselves), and respiratory (hard to do anything when you can’t breathe) make sense for someone calling EMS for care. Hard to transport oneself to a hospital in these conditions!
Pts who had EMS called but refused transport, or were transported to an ER and discharged, or left AMA from the ER, had higher rates of EMS bounceback as well. In my own experience as an ER doc, I can unfortunately attest to many situations where this was repeatedly the case and is easily believable for a variety of reasons, including culturally, educationally, financially, familial, etc.
Interestingly, “No complaints or injury/illness noted” accounted for 6% of calls. I’m uncertain if this meant a patient who had too many chief complaints to list on an EMS runsheet, or if these were the sort of people who used EMS as a “taxi service” to get closer to a hospital and left, or what-have-you.
The Kung Fu Rubik's Cube 