scholarly journals Return visits to the pediatric emergency department: A multicentre retrospective cohort study

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 578-585 ◽  
Author(s):  
Colin B. Meyer-Macaulay ◽  
Mimi Truong ◽  
Garth D. Meckler ◽  
Quynh H. Doan
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Significant Proportion ◽  
Pediatric Emergency ◽  
Index Visit ◽  
Return Visits

AbstractObjectiveReturn visits to the emergency department (RTED) for the same clinical complaint occur in 2.7% to 8.1% of children presenting to pediatric emergency departments (PEDs). Most studies examining RTEDs have focused solely on PEDs and do not capture children returning to other local emergency departments (EDs). Our objective was to measure the frequency and characterize the directional pattern of RTED to any of 18 EDs serving a large geographic area for children initially evaluated at a PED.MethodsWe conducted a retrospective cohort study of all visits to a referral centre PED between August 2012 and August 2013. We compared demographic variables between children with and without an RTED, measures of flow and disposition outcomes between the initial (index) visit and RTED, and between RTED to the original PED versus to other EDs in the community.ResultsAmong all PED visits, 7.6% had an RTED within 7 days, of which 13% were to a facility other than the original PED. Children with an RTED had higher acuity and longer length of stay on their index visit. They were also more likely to be admitted on a subsequent visit than the overall PED population. RTED to the original PED had a longer waiting time (WT), length of stay, and more frequently resulted in hospitalization than RTED to a general ED.ConclusionsA significant proportion of RTED occur at a site other than where the original ED visit occurred. Examining RTED to and from only PEDs underestimates its burden on emergency health services.

scholarly journals Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients – A Retrospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0135066 ◽  
Author(s):  
Steffie H. A. Brouns ◽  
Patricia M. Stassen ◽  
Suze L. E. Lambooij ◽  
Jeanne Dieleman ◽  
Irene T. P. Vanderfeesten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Organisational Factors

scholarly journals Association of patient-to-emergency department staff ratio with the incidence of cardiac arrest: A retrospective cohort study

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Occupancy Rate ◽  
Number Of Patients ◽  
Ed Overcrowding

Background: Emergency department (ED) overcrowding and overuse are global healthcare problems. Despite that substantial pieces of literature have explored quality parameters to monitor the patients’ safety and quality of care in the ED, to the best of our knowledge, no reasonable patient-to-ED staff ratios were established. Objectives: This study aimed to find the association between unexpected emergency department cardiac arrest (EDCA) and the patient-to-ED staff ratio. Methods: A retrospective cohort study was conducted in a medical center in Taiwan. Non-trauma patients (age > 18) who visited the ED from January 1, 2016 to November 30, 2018 were included. The total number of patients in ED, number of patients waiting for boarding, length of stay over 48 hours, and physician/nurse number in ED were collected and analyzed. The primary outcome was the association of each parameter with the incidence of EDCA. Results: A total of 508 patients were included. The total number of patients in ED ( > 361, RR: 1.54; 95% CI {1.239-1.917}), ED occupancy rate (> 280, RR: 1.54; 95% CI {1.245-1.898}), ED bed occupancy rate (> 184, RR: 1.63; 95% CI {1.308-2.034}), number of patients waiting for boarding (> 134, RR: 1.45; 95% CI {1.164-1.805}), number of patients in ED with length of stay over 48 hours (> 36, RR: 1.27; 95% CI {1.029-1.558}) and patient-to-nurse ratio (> 8.5, adjusted RR: 1.33; 95% CI {1.054-1.672}) had significant associations with higher incidence of EDCA. However, the patient-to-physician ratio was not associated with EDCA incidence. Discussions: Regarding loading parameters, the patient-to-nurse ratio is more representative than the patient-to-physician ratio as regards association with higher EDCA incidence. Conclusions: A higher patient-to-nurse ratio (> 8.5) was associated with an increment in the incidence of EDCA. Our findings provide a basis for setting different thresholds for different ED settings to adjust ED staff and develop individually tailored approaches corresponding to the level of ED overcrowding.

scholarly journals Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rasha D. Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract Background Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to December 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into < 2 and ≥ 2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p = 0.18). Among patients < 2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p = 0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p = 0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p = 0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged < 2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

scholarly journals Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

scholarly journals Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

scholarly journals Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Research Network ◽  
Minor Head Trauma

Abstract Background Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% to 16.5% post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% to 11.4% (p=0.02). There was no significant decrease in CT rates in patients ≥2 years. There was no increase in bounce-backs numbers, nor in admission rates or positive CT findings among bounce-backs. Conclusions PECARN rules implementation reduced CT rates, most significantly among patients <2 years at low risk for ciTBI. The implementation did not increase the number of missed ciTBI.

scholarly journals Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

2019 ◽  
Author(s):  
Leonard Mermel ◽  
Sarah L. Weatherall ◽  
Alison B. Chambers
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia.Methods Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables.Results 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4°F) at triage. Triage temperatures were 100.5°F (95% CI 99.9-101.2°F) and 99.0°F (95% CI 98.4-99.6°F) in the hemodialysis and non-hemodialysis cohorts, respectively (p<0.001). Triage temperature in patients with and without diabetes mellitus was 99.2°F (95% CI 98.4-99.9°F) and 100.4°F (95% CI 99.7-101.0°F), respectively (p=0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19).Conclusions Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

scholarly journals Impact of patient isolation on emergency department length of stay: A retrospective cohort study using the Registry for Emergency Care

2020 ◽  
Vol 32 (6) ◽  
pp. 1034-1039
Author(s):  
Gerard M O'Reilly ◽  
Rob D Mitchell ◽  
Biswadev Mitra ◽  
Michael P Noonan ◽  
Ryan Hiller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Emergency Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Patient Isolation
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