Implementation and evaluation of a pharmacy-driven transitions of care program for patients discharged from the emergency department

2018 ◽  
Vol 2 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Mary C. Lacy ◽  
Ginelle A. Bryant ◽  
Morgan S. Herring ◽  
Carrie F. Koenigsfeld ◽  
Nicholas P. Lehman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Care Program ◽  
Transitions Of Care

Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration

2021 ◽  
pp. 1357633X2110248
Author(s):  
Charlie M Wray ◽  
Myla Junge ◽  
Salomeh Keyhani ◽  
Janeen E Smith
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Care Program ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Emergency Department Care ◽  
Referral Rates ◽  
Care Assessment ◽  
The Impact ◽  
Care Evaluation

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

Transitions of Care for the Geriatric Patient in the Emergency Department

2013 ◽  
Vol 29 (1) ◽  
pp. 49-69 ◽  
Author(s):  
Chad Kessler ◽  
Meredith C. Williams ◽  
John N. Moustoukas ◽  
Cleo Pappas
Keyword(s):  
Emergency Department ◽  
Geriatric Patient ◽  
Transitions Of Care

Abstract WP384: Redesigning the Information Highway - Using Video to Improve Nurse Satisfaction with Patients’ Transitions from the Emergency Department to the Neuroscience Unit

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Melissa Richardson ◽  
Omid Salehi ◽  
Kevin Hinkelman ◽  
Clarke Tyan ◽  
Teresa Young ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Project ◽  
Transitions Of Care ◽  
Nurse Satisfaction ◽  
Nursing Satisfaction ◽  
Hand Off ◽  
Neurological Exam ◽  
Pertinent Information ◽  
Strongly Agree ◽  
The Sacrifice

Background: An effective hand-off process promotes transfer of critical information during transitions of care, thus decreasing the risk of adverse events. For patients with neurological symptoms, exchanging information over the phone may not provide the complete clinical picture of the patient and may contribute to the receiving nurse under appreciating early neurological changes. However, having the nurse leave a busy emergency department (ED) to perform bedside hand-off on the neuroscience unit (NSU) is often not realistic. Purpose: To improve nursing satisfaction with the hand-off process between the ED and the NSU, comparing video and phone report. Methods: The population consisted of stroke patients admitted from the ED to the NSU over a three month period. The intervention was offering a computer with video for the ED nurse to share pertinent information and perform a neurological exam, a process which allowed the receiving nurse to ask questions and interact with the patient. Nurses who used the video hand-off (n=24) were surveyed at the end of the pilot project to measure their satisfaction. Results: Overall, the nurses were more satisfied using video. (Figure). The increase in percentage of nurses answering “Strongly Agree”/ “Agree” were noted in these areas: 71%-85% for relevance of information, 68%-81% for efficiency, 54%-58% for staff relationships, 33%-63% for patient engagement, and 42%-75% for reducing risk for error. Conclusions: The use of video during transition of care provides an option for hospitals to employ an interactive handoff between departments without the sacrifice of time. Nursing should further explore the benefits of video technology during transitions of care, particularly inter-departmental transfers for special populations.

Tracking the Rise of Geriatric Emergency Departments in the United States

2018 ◽  
Vol 39 (8) ◽  
pp. 871-879 ◽  
Author(s):  
John G. Schumacher ◽  
Jon Mark Hirshon ◽  
Phillip Magidson ◽  
Marilyn Chrisman ◽  
Terisita Hogan
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Emergency Departments ◽  
The United States ◽  
Transitions Of Care ◽  
Emergency Department Care ◽  
Equipment And Supplies ◽  
Care Services ◽  
Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

107 Improving Transitions of Care for Patients Initiated on Buprenorphine from the Emergency Department

2020 ◽  
Vol 76 (4) ◽  
pp. S42
Author(s):  
C. Fockele ◽  
L. Whiteside ◽  
H. Duber ◽  
B. Finegood ◽  
S. Morse
Keyword(s):  
Emergency Department ◽  
Transitions Of Care

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

scholarly journals Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

2020 ◽  
Vol 9 (8) ◽  
pp. 2644
Author(s):  
Mariaenrica Tinè ◽  
Erica Bazzan ◽  
Umberto Semenzato ◽  
Davide Biondini ◽  
Elisabetta Cocconcelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Final Diagnosis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Copd Patients

Background: Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. Aims: To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. Methods: Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. Results: At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW’s in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. Conclusions: HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.

Low-Income Senior Housing Residents’ Emergency Department Use and Care Transition Problems

2017 ◽  
Vol 31 (6) ◽  
pp. 610-616 ◽  
Author(s):  
Antoinette B. Coe ◽  
Leticia R. Moczygemba ◽  
Kelechi C. Ogbonna ◽  
Pamela L. Parsons ◽  
Patricia W. Slattum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Personal Health Record ◽  
Primary Care Providers ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Care Providers ◽  
Senior Housing ◽  
Follow Up Care

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

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