Research Article|Articles in Press

Unscheduled emergency department presentations with diabetes: Identifying high risk characteristics

Published:December 16, 2022DOI:



      Unscheduled emergency department (ED) presentation by patients with diabetes has seldom been examined. This study aimed to determine the frequency and associated characteristics of presentations in this population.


      Using a prospective cross-sectional design, data were collected from patients with diabetes presenting and/or admitted to a tertiary metropolitan hospital in New South Wales, Australia (December 2016-September 2017). A screening interview including brief measures of cognitive and executive function, and clinical details from healthcare records were utilised; details around unscheduled presentations within 90 days were extracted. Independent associations with ED presentation were determined.


      Unscheduled ED presentations were common; 35.4% had at least one within 90 days, and for 20.1% this occurred within 28 days. The screening tool contributed little towards identifying risk of unscheduled presentation. Those attending any community or outpatient follow-up appointment within the first 28 (OR 0.42, 95% CI 0.23–0.76; p = 0.004) or 90 days (OR 0.25; 0.13–0.47; p < 0.001) from the index presentation were less likely to present within that same period.


      Findings indicated the magnitude of unscheduled ED presentation, care complexity and the value of targeted and timely follow-up. Alternative service support may help maintain and improve diabetes self-management and will require effectiveness and cost-effectiveness evaluation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Australasian Emergency Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. International Diabetes Federation, IDF diabetes atlas. Tenth edition. Available at 〈〉. Accessed 16th February 2022.

        • Sun H.
        • et al.
        IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045.
        Diabetes Res Clin Pr. 2022; 183109119
      2. Diabetes Australia, Diabetes in Australia, Available at: 〈〉, accessed 16th February 2022.

        • Calder L.
        • Pozgay A.
        • Riff S.
        Adverse events in patients with return emergency department visits.
        BMJ Qual Saf. 2015; 24: 142-148
        • Duseja R.
        • Bardach N.
        • Lin G.
        Revisit rates and associated costs after an emergency department encounter: a multistate analysis.
        Ann Intern Med. 2015; 162: 750-756
        • Robinson K.
        • Lam B.
        Early emergency department representations.
        Emerg Med Australas. 2013; 25: 140-146
        • Gatt M.L.
        • Cassar M.
        • Buttigieg S.C.
        A review of literature on risk prediction tools for hospital readmissions in older adults.
        J Health Organ Manag Print. 2022; 14: 14
        • Van der Linden M.
        • Lindeboom R.
        • De Haan R.
        Unscheduled return visits to a Dutch inner-city emergency department.
        Int J Emerg Med. 2014; 7: 1-8
        • Gale J.
        • et al.
        Unplanned representatio to hospital by patients with diabetes: development and pilot feasibility testing of a screening tool.
        Conte Nurse. 2022; (p. Online ahead of print - DOI:)
        • Rubin D.J.
        • Shah A.A.
        Predicting and preventing acute care Re-utilization by patients with diabetes.
        Curr Diabetes Rep. 2021; 21: 34
        • McKay B.
        • et al.
        Predicting 30 - Day outcomes in emergency department patients discharged with COVID-19.
        Am J Emerg Med. 2021; 50: 513-517
        • Akbari A.
        • et al.
        Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis.
        Am J Emerg Med. 2022; 52: 166-173
        • Subramaniam A.
        • et al.
        Systematic review and meta-analysis of the characteristics and outcomes of readmitted COVID-19 survivors.
        Intern Med J. 2021; 51: 1773-1780
        • Myers A.K.
        • et al.
        Laboratory and Pharmaceutical Data Associated With Hospital Readmission in Persons With Diabetic Foot Ulcers.
        Inquiry. 2021; 58 (p. 469580211060779)
        • Carter P.
        • et al.
        Readmission outcomes of sliding scale insulin compared to basal-bolus insulin prescribed at discharge in an insulin-naive patient population.
        J Pharm Pract. 2021; 34: 780-785
        • Sokoreli I.
        • et al.
        Prognostic value of psychosocial factors for first and recurrent hospitalizations and mortality in heart failure patients: insights from the OPERA-HF study.
        Eur J Heart Fail. 2018; 20: 689-696
        • Rubin D.J.
        • et al.
        Development and validation of a novel tool to predict hospital readmission risk among patients with diabetes.
        Endocr Pr. 2016; 22: 1204-1215
        • Jade Gek Sang S.
        • et al.
        Predictors of 30-day unplanned hospital readmission among adult patients with diabetes mellitus: a systematic review with meta-analysis.
        BMJ Open Diabetes Res Care. 2020; 8
        • Yan J.
        • et al.
        Do Adult Patients With Type 1 or 2 Diabetes Who Present to the Emergency Department With Hyperglycemia Have Improved Outcomes if They Have Access to Specialized Diabetes Care?.
        Can J Diabetes. 2021; 45: 59-63
        • Yan J.
        • et al.
        Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus.
        Int J Emerg Med. 2017; 10: 23
        • Agrell B.
        • Dehljn O.
        The clock-drawing test.
        Age Ageing. 1998; 27: 309-403
        • Ismail Z.
        • Rajji T.
        • Shulman K.
        Brief cognitive screening instruments: an update.
        Int J Geriatr Psychiatry. 2010; 25: 111-120
        • Freedman M.
        • et al.
        Clock drawing: a neuropsychological analysis.
        Oxford University Press, New York2003
        • Hubbard E.
        • et al.
        Clock drawing performance in cognitively normal elderly.
        Arch Clin Neuro. 2008; 23: 295-327
        • Nasreddine Z.
        • et al.
        The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Leslie F.
        • et al.
        Frontier executive screen: a brief executive battery to differentiate frontotemporal dementia and Alzheimer’s disease.
        J Neurosurg Psych. 2016; 87: 831-835
        • DeDe G.
        • et al.
        Construct validity and reliability of working memory tasks for people with aphasia.
        Aphasiology. 2014; 28: 692-712
        • James S.
        • et al.
        Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review.
        BMC Res Notes. 2014; 7: 1-11
        • Caughey G.E.
        • et al.
        Understanding 30-day re-admission after hospitalisation of older patients for diabetes: identifying those at greatest risk.
        Med J Aust. 2017; 206: 170-175
        • Azzopardi K.
        • et al.
        Hidden dangers revealed by misdiagnosed diabetic neuropathy: a comparison of simple clinical tests for the screening of vibration perception threshold at primary care level.
        Prim Care Diabetes. 2018; 12: 111-115
        • Yan J.
        • et al.
        Experience of emergency department patients after a visit for hyperglycaemia: implications for communication and factors affecting adherence postdischarge.
        Emerg Med J. 2022; 39: 132-138
        • James S.
        • et al.
        A discussion of healthcare support for adolescents and young adults with long-term conditions: current policy and practice and future opportunities.
        Int J Nurs Pr. 2020; e12882
        • Farrell K.
        • Holmes-Walker D.
        Mobile phone support is associated with reduced ketoacidosis in young adults.
        Diabet Med. 2011; : 1001-1004