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Introduction <p>Teaching hospitals are vital for training future physicians, yet there is concern that the presence of learners may increase unscheduled emergency department (ED) return visits. Previous studies of this phenomenon are limited to a sample of EDs in a region. Our study aimed to address this gap using a comprehensive regional dataset and multiple academic years of routinely collected electronic medical record data<b>.</b> Our objective was to determine whether ED patients seen by supervised learners had higher rates of unscheduled return visits within 72&#xa0;hours compared to those seen by attending physicians alone. Secondary outcomes were return visits resulting in hospital admission and the impact of learner training level.</p> Methods <p>We conducted a cohort study of over 1 million ED discharges across nine linked hospitals in a large Canadian health region between July 1, 2015, and June 30, 2018. The primary outcome was the rate of unscheduled return visits within 72&#xa0;hours. Secondary outcomes included return visits with hospital admission and critical care admission. Logistic regression models were adjusted for patient demographics, acuity, and site characteristics.</p> Results <p>Among 1,033,026 patient visits, 7.4% returned within 72&#xa0;hours. There was no statistically significant difference in unscheduled return visits between supervised learners and attending physicians alone (adjusted RR 0.98, 95% CI 0.96–1.00, <i>p</i> = 0.054). Return visit admissions were slightly higher among patients seen by learners (adjusted RR 1.06, 95% CI 1.01–1.13), primarily those seen by medical students and off-service residents. Emergency medicine residents in mid-training had lower return visit rates than attendings.</p> Conclusions <p>Patients seen by supervised learners in a regional ED network did not have increased rates of unscheduled return visits. Further research is warranted to explore factors underlying return visit admissions in learner-involved care.</p>

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Are patients seen by a supervised learner more likely to return to the Emergency Department? A regional multi-centre cohort study of electronic health records

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Isabelle N. Colmers-Gray,
  • Leandro Solis Aguilar,
  • Brian R. Holroyd,
  • Brandy A. Stauffer

摘要

Introduction

Teaching hospitals are vital for training future physicians, yet there is concern that the presence of learners may increase unscheduled emergency department (ED) return visits. Previous studies of this phenomenon are limited to a sample of EDs in a region. Our study aimed to address this gap using a comprehensive regional dataset and multiple academic years of routinely collected electronic medical record data. Our objective was to determine whether ED patients seen by supervised learners had higher rates of unscheduled return visits within 72 hours compared to those seen by attending physicians alone. Secondary outcomes were return visits resulting in hospital admission and the impact of learner training level.

Methods

We conducted a cohort study of over 1 million ED discharges across nine linked hospitals in a large Canadian health region between July 1, 2015, and June 30, 2018. The primary outcome was the rate of unscheduled return visits within 72 hours. Secondary outcomes included return visits with hospital admission and critical care admission. Logistic regression models were adjusted for patient demographics, acuity, and site characteristics.

Results

Among 1,033,026 patient visits, 7.4% returned within 72 hours. There was no statistically significant difference in unscheduled return visits between supervised learners and attending physicians alone (adjusted RR 0.98, 95% CI 0.96–1.00, p = 0.054). Return visit admissions were slightly higher among patients seen by learners (adjusted RR 1.06, 95% CI 1.01–1.13), primarily those seen by medical students and off-service residents. Emergency medicine residents in mid-training had lower return visit rates than attendings.

Conclusions

Patients seen by supervised learners in a regional ED network did not have increased rates of unscheduled return visits. Further research is warranted to explore factors underlying return visit admissions in learner-involved care.