One in nine patients discharged from hospital emergency departments (EDs) after an initial evaluation for kidney stones will face a repeat visit. In a study to be published in an upcoming issue of Academic Emergency Medicine, authors identified multiple factors that correlate with repeat ED visits for kidney stones, which are becoming more common.

In their retrospective study, author Charles Scales, MD, a Duke urologic surgeon, and colleagues analyzed data collected over 2 years from every ED visit in California. Using administrative information generated from more than 128,000 initial visits for a kidney stone, they were able to identify associations between patient-level characteristics, area health care resources, care processes, and the risk of a repeat ED visit.

For example, patients who return to the ED often have uncontrolled pain, severe vomiting leading to dehydration, or infections that coincide with kidney stones. And repeat visits were more likely to occur in areas where there are fewer urologists—an indication that access to specialized treatment might help prevent returns to the ED.

“We also found that patients who had Medicaid or Medicare coverage were more likely than those who were privately insured to return to the ED,” Scales says. “This finding suggests that obtaining access to care may involve more than simply having insurance coverage.”

The researchers also examined whether the care patients received was associated with the risk of a revisit to the ED. Patients who received lab testing to assess for systemic infection were less likely to return.

“Although it requires further investigation, this finding suggests that the quality of care at that first visit may influence the risk of a second ED visit,” Scales says. To improve care, he notes, “One solution may be better coordination between primary care and urology to treat patients so they do not have to seek care in a high-expense, high-acuity setting like the ED.”

In addition to Scales, study authors included Li Lin from Duke and Christopher S. Saigal, Carol J. Bennett, Mark S. Litwin, Ninez A. Ponce, and Carol M. Mangione from the University of California, Los Angeles.