scholarly journals Management of Discharged Emergency Department Patients with a Primary Diagnosis of Hypertension: A Multicentre Study

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 523-531 ◽  
Author(s):  
Dennis D. Cho ◽  
Peter C. Austin ◽  
Clare L. Atzema
Keyword(s):  
Emergency Department ◽  
Primary Outcome Measure ◽  
Primary Diagnosis ◽  
Emergency Physicians ◽  
Physician Characteristics ◽  
Included Patient ◽  
Follow Up Care ◽  
Emergency Department Patients ◽  
Certification Type

AbstractIntroductionMany patients are seen in the emergency department (ED) for hypertension, and the numbers will likely increase in the future. Given limited evidence to guide the management of such patients, the practice of one’s peers provides a de facto standard.MethodsA survey was distributed to emergency physicians during academic rounds at three community and four tertiary EDs. The primary outcome measure was the proportion of participants who had a blood pressure (BP) threshold at which they would offer a new antihypertensive prescription to patients they were sending home from the ED. Secondary outcomes included patient- and provider-level factors associated with initiating an antihypertensive based on clinical vignettes of a 69-year-old man with two levels of hypertension (160/100 vs 200/110 mm Hg), as well as the recommended number of days after which to follow up with a primary care provider following ED discharge.ResultsAll 81 surveys were completed (100%). Half (51.9%; 95% CI 40.5-63.1) of participants indicated that they had a systolic BP threshold for initiating an antihypertensive, and 55.6% (95% CI 44.1-66.6) had a diastolic threshold: mean systolic threshold was 199 mm Hg (SD 19) while diastolic was 111 mm Hg (SD 8). A higher BP (OR 12.9; 95% CI 7.5-22.2) and more patient comorbidities (OR 3.0; 95% CI 2.1-4.3) were associated with offering an antihypertensive prescription, while physician years of practice, certification type, and hospital type were not. Participants recommended follow-up care within a median 7.0 and 3.0 days for the patient with lower and higher BP levels, respectively.ConclusionsHalf of surveyed emergency physicians report having a BP threshold to start an antihypertensive; BP levels and number of patient comorbidities were associated with a modification of the decision, while physician characteristics were not. Most physicians recommended follow-up care within seven days of ED discharge.

scholarly journals Adherence of older emergency department patients to community-based specialized geriatric services

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 659-666
Author(s):  
Zachary MacDonald ◽  
Ian G. Stiell ◽  
Ioanna Genovezos ◽  
Debra Eagles
Keyword(s):  
Emergency Department ◽  
Patient Adherence ◽  
Cognitively Impaired ◽  
Study Participation ◽  
Convenience Sample ◽  
Home Based ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Future Work

ABSTRACTObjectivesOur objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance.MethodsWe conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used.ResultsWe enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%).ConclusionAdherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.

scholarly journals LO77: Compliance of older emergency department patients to community-based specialized geriatric services

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S54-S55
Author(s):  
Z. MacDonald ◽  
D. Eagles ◽  
I.G. Stiell
Keyword(s):  
Emergency Department ◽  
Medication Management ◽  
Compliance Rate ◽  
Functional Decline ◽  
Community Based ◽  
Convenience Sample ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Future Work

Introduction: The Geriatric Emergency Management (GEM) model has been developed to facilitate identification of older patients that are at higher risk of functional decline, repeat Emergency Department (ED) visits and future hospitalization. Those identified at risk, are referred for more in-depth evaluation and management in community-based specialized geriatric services. Our objective was to: 1) determine the compliance rate to outpatient evaluation following ED recommendation; and 2) identify barriers and facilitators to attendance. Methods: We conducted a prospective cohort study at two sites of an academic, tertiary level hospital ED between July and December 2016. We enrolled a convenience sample of ED patients, 65 years and older who were seen by a GEM nurse, referred to outpatient specialized geriatric services and consented to study participation. The GEM nurses conducted targeted geriatric assessments, identifying those who would benefit from further community management. We conducted a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used. Results: A total of 101 patients were prospectively enrolled, with 30.4% of eligible participants declining outpatient referral. Enrolled subjects had a mean age of 83.3 years, 58.4% female and 62.0% cognitively impaired. Reasons for referral to specialized geriatric services included: mobility (86.1%), cognition (57.4%), pain (38.6%), mood (34.7%), medication management (33.6%) and nutrition (30.7%). Outpatient referrals were to: geriatric day hospital (51.5%), geriatric outreach (22.7%), falls clinic (11.8%) and geriatric psychiatry (9.9%). Compliance with follow-up within 6 weeks was 64.4%. Barriers to attendance included: patient did not feel specialized geriatric services was needed (52.6%); admitted to hospital (10.5%); reported not called for appointment (15.8%); forgot appointment (5.3%) and transportation (5.3%). Family support with scheduling and transportation to appointments, reported by 68.6%, was the most common enabler to compliance. Conclusion: Over one third of older ED patients referred by GEM for further specialized geriatric services are non-compliant with their community-based evaluation, while one in four older ED patients decline referral to these evaluations while in the ED. Future work should focus on interventions that promote increased referral acceptance and address barriers to attendance.

Services for emergency department patients experiencing early pregnancy complications: A survey of Ontario hospitals

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 653-658 ◽  
Author(s):  
Robin Glicksman ◽  
Shelley L McLeod ◽  
Jackie Thomas ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Primary Objective ◽  
Early Pregnancy Loss ◽  
Online Questionnaire ◽  
Follow Up Care ◽  
Emergency Department Patients

ABSTRACTObjectivesWomen experiencing complications of early pregnancy frequently seek care in the emergency department (ED), because most have not yet established care with an obstetrical provider. The primary objective of this study was to explore the services available (ED management, ultrasound access, and follow-up care) for ED patients experiencing early pregnancy loss or threatened early pregnancy loss in Ontario hospitals.MethodsThe emergency medicine chiefs of 71 Ontario hospital EDs with an annual census of more than 30,000 ED patient visits in 2017 were invited to complete a 30-item, online questionnaire using modified Dillman methodology.ResultsRespondents from 63 EDs across Ontario completed the survey (response rate 88.7%). Of the EDs surveyed, 34 (54.0%) reported that they did not have access to early pregnancy clinic services for women who presented to the ED with early pregnancy complications that were safe to discharge home. At these hospitals, it was found that patients were followed up in 14 (41.2%) EDs for the same complications, including pregnancy of unknown location and threatened abortion. Respondents also stated that a radiologist-interpreted ultrasound was available to only 22 (34.9%) of hospital sites for 24 hours, 7 days per week for women with early pregnancy complications.ConclusionsThe results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy. The lack of clinical resources and specialized personnel in Ontario hospital EDs makes supporting these women longitudinally unrealistic, exposing them to undue risk and complications.

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.

Follow-up Care After an Emergency Department Visit for Asthma in a Pediatric Military Population: Clinical Interventions and Outcomes

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 674A
Author(s):  
Michael Smiley ◽  
Nick Sicignano ◽  
Elizabeth Allen ◽  
Rees Lee ◽  
Deena Chisolm
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Military Population ◽  
Clinical Interventions ◽  
Follow Up Care

scholarly journals Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

2014 ◽  
Vol 15 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Getaw Worku Hassen ◽  
Albert Hwang ◽  
Lydia Liyun Liu ◽  
Felicia Mualim ◽  
Toshiro Sembo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intravenous Contrast ◽  
Emergency Department Patients
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