A missed specialist consultation was associated with a much higher rate of hospital admission when adults returned to the same emergency department within 72 hours, according to a retrospective study at Afyonkarahisar Health Sciences University in Türkiye. Among 1,505 return visits, 38.1% of patients with a missed consultation were admitted, compared with 8.0% of those without one.
The researchers defined a missed consultation opportunity as no specialty consultation during the first emergency visit followed by a formal consultation from that same specialty after the patient returned within 72 hours. The finding is an association, not evidence that the missed consultation caused the admission.
Most returns were linked to the illness itself
The study identified 81,390 adult emergency-department visits from April 1, 2024, to April 30, 2025. Of these, 1,505 met the criteria for a return to the same department within 72 hours, producing a 1.85% return rate.
Disease-related causes accounted for 75.5% of the returns, or 1,136 visits. Patient-related causes accounted for 22.2%, or 334 visits, while physician-related causes accounted for 2.3%, or 35 visits. Overall, 369 returns, or 24.5%, were classified as potentially preventable.
At the return visit, 77.4% of patients were discharged. Hospital admission occurred in 12.2% of cases, including 10.1% admitted to a ward and 2.1% admitted to intensive care.
Missed specialist input appeared in 14% of returns
Missed consultation opportunities were recorded in 210 of the 1,505 returns, or 14.0%. Most of these cases, 158 or 75.2%, were classified as disease-related. Patient-related causes made up 16.7%, and physician-related causes made up 8.1%.
The association remained after the researchers adjusted for age, sex, the urgency level assigned at the first visit, and how soon the patient returned. The study reported an adjusted odds ratio of 6.84, a measure comparing admission odds after accounting for those factors, with a 95% confidence interval from 4.70 to 9.95.
Older age and higher initial triage acuity were also independently associated with admission. Patients aged 65 or older had an adjusted odds ratio of 2.32, while higher triage acuity had an adjusted odds ratio of 4.47. The model's ability to distinguish admission from non-admission was reported as good, with a c-statistic of 0.84. A sensitivity analysis produced an adjusted odds ratio of 6.38, with a 95% confidence interval from 4.36 to 9.33.
A signal for review, not a prescription
The authors describe missed consultation as a possible marker of diagnostic complexity rather than a proven cause of admission. That distinction matters because most missed-consultation cases were classified as disease-related, rather than physician-related.
Because the research was retrospective, it cannot show that the missed consultation caused the admission. The result describes an association in documented adult returns to the same emergency department, not proof that changing consultation decisions would reduce later admissions.
The researchers used an automated hospital information-system and electronic-record search, and two emergency physicians independently reviewed the returns with a standardized form. They also independently classified causes using predefined criteria, with a reported agreement statistic of 0.81. The study received institutional ethics approval, and consent was waived because the records were de-identified.
The findings point to missed consultation as a possible quality-review signal for diagnostic complexity in emergency care, rather than a proven explanation for every admission.
Paper data and sources
Original title: Missed specialty consultation and hospital admission in 72-hour emergency department return visits.
Authors: Ertekin A, Soyugūzel M, Rakip U
Journal/Repository: Annals of Saudi medicine
Status: Peer-reviewed
First online: 2026-10-01
DOI: 10.5144/0256-4947.2026.339
Original paper · Full text