scholarly journals LO003: Outpatient referrals from the emergency department - a retrospective review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S31-S31
Author(s):  
N. Prudhomme ◽  
S. White ◽  
E.S. Kwok
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Waiting Times ◽  
Time Intervals ◽  
Inpatient Hospitalization ◽  
Current State ◽  
Ed Visits ◽  
A Current

Introduction: While a majority of patients presenting to the emergency department (ED) are discharged home without need for inpatient hospitalization, many require outpatient follow-up. Currently, outpatient referrals from our ED are made via a complex and error-prone series of manual steps which have the potential to be unreliable and negatively impact quality of care. We sought to perform a current state analysis of our outpatient referral processes across the hospital’s specialties. Methods: We conducted a retrospective health records review at a tertiary academic centre (>160,000 ED visits/year) from January 1 to January 7, 2015. All consecutive outpatient consultation requests triggered by an ED physician were identified and included for chart review. All cases were subsequently followed up to 11 months. A single reviewer extracted data on demographics, actual referral attendance rates, incomplete referrals, return ED visits, and time intervals. The top 3 and bottom 3 performing services were identified for further analysis of their outpatient referral mechanisms and processes. We present descriptive statistics. Results: A total of 251 outpatient referrals to a broad range of specialty services were identified during the study period. 216 (86.1%) of patients attended the intended appointment, while 35 (13.9%) of referrals were incomplete at 11 months post index ED visit. The overall median time to successful outpatient follow-up appointments was 8.5 days [IQR=3.8-24.2]. 8 (3.2%) patients had a return ED visit for a related complaint prior to being seen at their outpatient appointment. The top 3 performers were Ophthalmology [Median=1.0 day, IQR=0.0-1.0, Incomplete=2.8%], Plastic Surgery [Median=5.0 days, IQR=2.8-6.0, Incomplete=7.7%], and Orthopedics [Median=8.0 days, IQR=7.0-10.0, Incomplete=0.0%]. The bottom 3 performers were Dermatology [Median=52days, IQR=41.5-92.5, Incomplete=25.0%], Neurology [Median=40.0 days, IQR= 2.5-43.5, Incomplete=56.3%], and Urology [Median=14.0 days, IQR=10.5-48.0, Incomplete=33.3%]. Conclusion: We found a tremendous range of variability in both the waiting times and actual reliability of outpatient referral processes from the ED. Future phases of this project will focus on examining specific processes of the top and bottom performing specialties in order to improve and standardize all outpatient referrals.

scholarly journals A Health Records Review of Outpatient Referrals from the Emergency Department

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Nicholas Prudhomme ◽  
Edmund S. H. Kwok ◽  
Laura Olejnik ◽  
Shannon White ◽  
Venkatesh Thiruganasambandamoorthy
Keyword(s):  
Emergency Department ◽  
Waiting Times ◽  
Health Records ◽  
Ottawa Hospital ◽  
Outpatient Consultation ◽  
Adult Outpatient ◽  
Ed Visits ◽  
Lost To Follow Up ◽  
Qualitative Mapping

Objectives. Many patients discharged home from the emergency department (ED) require urgent outpatient consultation with a specialty service. We sought to identify the best- and worst-performing services with regard to time to outpatient consultation, the proportion of patients lost to follow-up, the rate of related return ED visits prior to consultation, and common strategies used by our top-performing clinics. Methods. We conducted a health records review of The Ottawa Hospital ED visits during four 1-week periods. All consecutive adult outpatient consultation requests were included for chart review and were followed up to 12 months. Outcome measures included demographics, referral attendance rates, incomplete referrals, return ED visits, and time intervals. Services with at least 15 consultation requests were included for data analysis and qualitative mapping of their referral processes. Results. Of the 963 patients who met inclusion criteria, 803 (83.4%) attended their appointment, while 160 (16.6%) were lost to follow-up. The overall median time to successful consultation was 9 days (IQR = 2–27). 92 (9.6%) patients returned to the ED with a related complaint. The top-performing clinics included ophthalmology, orthopedics, and thrombosis (median = 1, 8, 1 days; incomplete consultation = 3%, 4%, 6%; return ED visits = 0%, 6%, 2% respectively). The bottom-performing clinics included otorhinolaryngology, neurology, and gynecology (median = 47, 39, 27 days; incomplete consultation = 50%, 41%, 37%; return ED visits = 11%, 15%, 26%, respectively). Processes incorporated by top-performing clinics included reserving appointment slots for emergency referrals, structured referral forms, and centralized booking. Conclusions. We found a substantial variability in both the waiting times and reliability of outpatient referrals from the ED. Top-performing clinics incorporate common referral processes.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment

2002 ◽  
Vol 111 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Hamid R. Djalilian ◽  
Sharon L. Smith ◽  
Timothy A. King ◽  
Samuel C. Levine
Keyword(s):  
Quality Of Life ◽  
Complication Rate ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Life Assessment ◽  
Test Results

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.

scholarly journals Emotions in leaders’ enactment of professional agency

2019 ◽  
Vol 31 (2) ◽  
pp. 143-165 ◽  
Author(s):  
Päivi Hökkä ◽  
Katja Vähäsantanen ◽  
Susanna Paloniemi ◽  
Sanna Herranen ◽  
Anneli Eteläpelto
Keyword(s):  
Qualitative Content Analysis ◽  
Leadership Coaching ◽  
Content Type ◽  
Current State ◽  
Before And After ◽  
State Of Affairs ◽  
Practical Implications ◽  
A Current

Purpose Although there has been an increase in workplace studies on professional agency, few of these have examined the role of emotions in the enactment of agency at work. To date, professional agency has been mainly conceptualised as a goal-oriented, rational activity aimed at influencing a current state of affairs. Challenged by this, this study aims to elaborate the nature and quality of emotions and how they might be connected to the enactment of professional agency. Design/methodology/approach Data are collected in the context of a leadership coaching programme that aimed to promote the leaders’ professional agency over the course of a year. The participants (11 middle-management leaders working in university and hospital contexts) were interviewed before and after the programme, and the data were analysed using qualitative content analysis. Findings Findings showed that emotions played an important role in the leaders’ enactment of professional agency, as it pertained to their work and to their professional identity. The study suggests that enacting professional agency is by no means a matter of purely rational actions. Practical implications The study suggests that emotional agency can be learned and enhanced through group-based interventions reflecting on and processing one’s own professional roles and work. Originality/value As a theoretical conclusion, the study argues that professional agency should be reconceptualised in such a way as to acknowledge the importance of emotions (one’s own and those of one’s fellow workers) in practising agency within organisational contexts.

scholarly journals Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study

2015 ◽  
Vol 8 (1) ◽  
pp. 143 ◽  
Author(s):  
Saeed Amina ◽  
Ahmad Barrati ◽  
Jamil Sadeghifar ◽  
Marzeyh Sharifi ◽  
Zahra Toulideh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Time ◽  
Waiting Times ◽  
Hospital Data ◽  
Governance System ◽  
Cross Sectional ◽  
Average Waiting Time ◽  
Study Population

<p><strong>BACKGROUND</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>AIMS:</strong> Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran.</p> <p><strong>MATERIAL</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>METHODS:</strong> This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t.<strong> </strong>test and ANOVA.</p> <p><strong>RESULTS:</strong> The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant<strong> </strong>correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed.</p> <p><strong>CONCLUSION:</strong> According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.</p>

scholarly journals Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Morgan Black ◽  
Valene Singh ◽  
Vladimir Belostotsky ◽  
Madan Roy ◽  
Deborah Yamamura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Chart Review ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Process Mapping ◽  
Number Of Children ◽  
Positive Urine ◽  
Tract Infections

Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children’s hospital’s ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting.

Review article: Quality of follow-up care for anaphylaxis in the emergency department

2015 ◽  
Vol 27 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Fiona J Burnell ◽  
Gerben Keijzers ◽  
Pete Smith
Keyword(s):  
Emergency Department ◽  
Review Article ◽  
Follow Up Care ◽  
Article Quality
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