LAUSR

There is an increasing recognition in health care that our historical approach to safety and improvement has limitations,1 and the shame and blame approach continues to slowly be replaced by more positive (and effective) educational methodologies.2 At the system level, the apparition of learning health organizations demonstrates a much more growthfocused health care system that is responsive to the needs of its constituency— patients, providers, staff, and community. This transformation has made its way to the field of emergency medicine, with an increasing focus on quality improvement methodologies and patient safety initiatives.3,4 One remnant of our historical paradigm is encapsulated in the term “bouncebacks,” known to induce fear in the heart of any emergency department (ED) provider when their peers approach them with the dreaded “Remember this patient you saw...?!” I propose we abolish this term and replace it with the more appropriate term “return visits,” herein describing how it will foster a culture of safety where providers are enabled to identify adverse events and suboptimal outcomes for improvement. The term “bounceback” has historically referred to patients who were seen and discharged from the ED and who subsequently come back for another assessment for a condition that is (at least loosely) related to their initial visit, typically within a few days.5 “Bouncebacks” are widely known as being markers of quality and safety of care.6 There are four ways in which this term is problematic: