Direct Admission from the Emergency Department to a Subacute Care Ward: An Alternative to Acute Hospitalization

2020 ◽  
Vol 21 (9) ◽  
pp. 1346-1348
Author(s):  
Seng Hock Ang ◽  
Barbara Helen Rosario ◽  
Ko Yen Ivan Ngeow ◽  
Xin Yu Koh ◽  
Seruwati Abdul Hamid ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Hospitalization ◽  
Subacute Care ◽  
Direct Admission ◽  
Care Ward

Improving the Safety of an Emergency Department-Based Direct Admission Process at a Children's Hospital

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tess Huy ◽  
Lia Lowrie ◽  
Robert Flood ◽  
Rebecca Chambers ◽  
Nancy Weiss ◽  
...  
Keyword(s):  
Emergency Department ◽  
Admission Process ◽  
Children's Hospital ◽  
Direct Admission ◽  
Children’S Hospital

“They Shouldn’t Be Coming to the ED, Should They?”: A Descriptive Service Evaluation of Why Patients With Palliative Care Needs Present to the Emergency Department

2017 ◽  
Vol 34 (10) ◽  
pp. 984-990 ◽  
Author(s):  
Emilie Green ◽  
Sarah Ward ◽  
Will Brierley ◽  
Ben Riley ◽  
Henna Sattar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
A Priori ◽  
Service Evaluation ◽  
Palliative Care Team ◽  
Care Team ◽  
Care Needs ◽  
Direct Admission ◽  
Palliative Care Needs ◽  
Single Center Observational Study

Background: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. Methods: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period. Demographic and clinical data were collected from electronic health records. Results: A total of 105 patients made 112 presentations to the ED. The 2 most common presenting complaints were shortness of breath (35%) and pain (28%). Eighty-three percent of presentations required care in the ED according to a priori defined criteria. They either underwent urgent investigation or received immediate interventions that could not be delivered in another setting, were referred by a health-care professional, or were admitted. Conclusions: Findings challenge the misconception that patients known to a palliative care team should be cared for outside the ED. The importance and necessity of the ED for patients in their last years of life has been highlighted, specifically in terms of managing acute, unpredictable crises. Future service provision should not be based solely on a patient’s presenting complaint. Further qualitative research exploring patient perspective is required in order to explore the decision-making process that leads patients with palliative care needs to the ED.

scholarly journals Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: A Swedish multicenter register study

2017 ◽  
Vol 2 (2) ◽  
pp. 178-186 ◽  
Author(s):  
David Darehed ◽  
Bo Norrving ◽  
Birgitta Stegmayr ◽  
Karin Zingmark ◽  
Mathias C. Blom
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Register Study ◽  
Bed Occupancy ◽  
Hospital Beds ◽  
Hospital Bed ◽  
Direct Admission

Introduction It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome. Patients and methods This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011–2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission. Results A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978–0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6–5.5) for direct admission to a stroke unit versus the reference hospital. Discussion and conclusion We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

scholarly journals 372 A Comparison of Emergency Department and Direct Admission Care of Oncologic Patients With Febrile Neutropenia

2014 ◽  
Vol 64 (4) ◽  
pp. S132-S133
Author(s):  
D. Owolabi ◽  
R. Rowland ◽  
R. Miller ◽  
L. King ◽  
M. McGraw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Febrile Neutropenia ◽  
Oncologic Patients ◽  
Direct Admission

scholarly journals Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario

2020 ◽  
Vol 153 (4) ◽  
pp. 224-231
Author(s):  
Mohamed Gazarin ◽  
Brian Devin ◽  
Darren Tse ◽  
Emily Mulligan ◽  
Mary Naciuk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Multidisciplinary Approach ◽  
Effective Means ◽  
Outcome Evaluation ◽  
Emergency Department Visits ◽  
Rural Hospital ◽  
Added Value ◽  
Cross Sectional ◽  
Subacute Care ◽  
Phone Calls

Background: Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. Methods: We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital’s medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. Results: Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. Conclusions: This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.

Policy, Resources and Practice: A Palliative Care Ward

1989 ◽  
Vol 5 (2) ◽  
pp. 6-9 ◽  
Author(s):  
Paul D. Henteleff
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
Terminally Ill Patients ◽  
Direct Admission ◽  
Dying At Home ◽  
Care Ward ◽  
At Home ◽  
Policies And Practices

Palliative Care, like any other service, must operate with policies, practices and resources. The St. Boniface Hospital Program undertook to reduce the insecurities of dying at home by assuring direct admission of terminally ill patients to the Palliative Care Unit. The operation of the unit was simulated with a computer to define rules for controlling bed utilization. The simulated description of the program also enabled projection of bed needs to accommodate changing demand and guided redefinition of policies and practices to adjust to changes. Over a ten year period the program was able to double program size with fixed resources.

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