scholarly journals LO13: Eye care in the emergency department: what proportion of patients presenting to the emergency department with isolated eye related complaints could alternatively be seen by an optometrist?

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S11-S11
Author(s):  
K. Phillips ◽  
L. Thorpe ◽  
G. Innes
Keyword(s):  
Emergency Department ◽  
Descriptive Analysis ◽  
Drug Effects ◽  
Visual Disturbance ◽  
Scope Of Practice ◽  
Administrative Database ◽  
Operative Complications ◽  
Neurologic Abnormality ◽  
Ed Visits ◽  
One Year

Introduction: Approximately 2-3 percent of emergency department (ED) visits are due to eye-related complaints, adding to the ED workload. Many of these could be seen instead by an optometrist who specializes in the examination, diagnosis and treatment of eye-related disorders. We sought to determine the proportion of ED patients with isolated eye-related complaints that could be managed by an optometrist. Methods: We performed an administrative database study and descriptive analysis of all patients presenting to Calgary EDs with eye-related complaints during a one-year period. We determined optometry eligibility by reviewing discharge diagnoses and assessing whether that condition was within the Alberta Association of Optometrys (AAO) defined scope of practice. Patients were considered ineligible if their condition was related to bites, stings, thermal burns, assault, MVA or operative complications; if they required hospitalization or referral to a non-eye specialist (e.g. neurology); if they had associated headache, dizziness, syncope, hypertension, neurologic abnormality (e.g. diplopia); if they had facial cellulitis, orbital infections, adverse drug effects, or if they underwent observation in the ED because of concerns about a cardiac or neurological condition. Results: In 2015, 7686 patients were seen in Calgarys 5 EDs with eye related complaints. Of these, 76.2% were optometry-eligible and 75% of optometry-eligible patients arrived during day or evening hours (0800-2100). The most common presenting complaints were visual disturbance (24.8%), redness (22.1%), and pain or photophobia (16.4%). Optometry-eligible patients waited an average of 110 min and had an ED LOS of 149 min. Conclusion: Approximately 3 in every 4 patients seen in the ED for eye related complaints could alternatively be seen by an optometrist. Further research is required to establish the feasibility of diversion to an optometrist from the ED for eye-related complaints.

scholarly journals P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
E. Losier ◽  
A. McCollum ◽  
P. Jarrett ◽  
R. McCloskey ◽  
P. Nicholson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Assisted Living ◽  
Demographic Data ◽  
Care Home ◽  
Functional Decline ◽  
Retrospective Chart Review ◽  
Community Services ◽  
Level 3 ◽  
Ed Visits ◽  
One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

scholarly journals Cartography of Emergency Department Visits for Asthma – Targeting High-Morbidity Populations

2004 ◽  
Vol 11 (6) ◽  
pp. 427-433 ◽  
Author(s):  
Pierre Lajoie ◽  
Andrée Laberge ◽  
Germain Lebel ◽  
Louis-Philippe Boulet ◽  
Marie Demers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Administrative Database ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Age Group ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Patients ◽  
South Central ◽  
Ed Visits

BACKGROUND:Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.METHODS:All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age- and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters.RESULTS:There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.CONCLUSION:The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.

The role of chronic disease in the costs of potentially preventable emergency department use during treatment: A regional study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6505-6505 ◽  
Author(s):  
Laura Elizabeth Panattoni ◽  
Catherine R. Fedorenko ◽  
Karma L. Kreizenbeck ◽  
Stuart Greenlee ◽  
Julia Rose Walker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Disease ◽  
Chronic Conditions ◽  
Healthcare Research ◽  
Future Research ◽  
Regional Study ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
One Year

6505 Background: The Centers for Medicare and Medicaid Services (CMS) released a quality metric for potentially preventable chemotherapy-associated emergency department (ED) use, effective in 2020. This metric excludes diagnoses with emerging evidence for outpatient management, such as proactive symptom management (PSM) and those for ambulatory care sensitive chronic conditions. Little is known about the intersection between potentially preventable ED visits due to cancer vs. other chronic disease. This study characterized the number and costs of ED visits during treatment. Methods: Western Washington cancer registry records from 2011- 2015 were linked with claims from two commercial insurers. Patients with newly diagnosed solid tumors undergoing initial treatment with chemotherapy or radiation were eligible. ED use was tracked one year post treatment initiation. ED diagnosis codes for fields 1-10 from the CMS metric and the PSM literature were labeled “Potentially Preventable” (Pp). Codes from the Agency for Healthcare Research and Quality’s Prevention Quality Indicators (PQI) for Chronic Conditions were labeled “Potentially Preventable-Chronic Disease” (PpChronic). Costs were adjusted to $2016. Results: Of the 7,053 eligible patients, 2,543 (36.1%) visited the ED (median # visits [IQR]: 1 [1-2]). The most commonly listed codes included Pain (1,054 visits) and Dyspnea (279 visits) for Pp, Hypertension-PQI (652 visits) and COPD-PQI (206 visits) for PpChronic, and Diabetes (247 visits) and Hyperlipidemia (181 visits) for the other codes. Spending on ED visits including both potentially preventable cancer and chronic disease diagnoses totalled $706,552 (20% of ED costs). Conclusions: One fifth of ED costs potentially resulted from simultaneous poor cancer symptom and chronic disease management. Future research should explore the role of chronic illness in categorizing which ED visits are potentially preventable during cancer treatment. [Table: see text]

scholarly journals Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study

2021 ◽  
Vol 5 (1) ◽  
pp. e001188
Author(s):  
Monakshi Sawhney ◽  
Elizabeth G VanDenKerkhof ◽  
David H Goldstein ◽  
Xuejiao Wei ◽  
Genevieve Pare ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Ambulatory Surgery ◽  
Day Surgery ◽  
Population Based ◽  
Administrative Database ◽  
Same Day Discharge ◽  
Ed Visits

IntroductionPaediatric ambulatory surgery (same day surgery and planned same day discharge) is more frequently being performed more in Canada and around the world; however, after surgery children may return to hospital, either through the emergency department (ED) or through a hospital admission (HA). The aim of this study was to determine the patient characteristics associated with ED visits and HA in the 3 days following paediatric ambulatory surgery.MethodsThis population-based retrospective cohort study used de-identified health administrative database housed at ICES and included residents of Ontario, younger than 18 years of age, who underwent ambulatory surgery between 2014 and 2018. Patients were not involved in the design of this study. The proportion of ED visit and HA were calculated for the total cohort, and the type of surgery. The ORs and 95% CIs were calculated for each outcome using logistic regression.Results83 468 children underwent select ambulatory surgeries. 2588 (3.1%) had an ED visit and 608 (0.7%) had a HA in the 3 days following surgery. The most common reasons for ED visits included pain (17.2%) and haemorrhage (10.5%). Reasons for HA included haemorrhage (24.8%), dehydration (21.9%), and pain (9.1%).ConclusionsOur findings suggest that pain, bleeding and dehydration symptoms are associated with a return visit to the hospital. Implementing approaches to prevent, identify and manage these symptoms may be helpful in reducing ED visits or hospital admissions.

scholarly journals STANDING update: A retrospective analysis in the Emergency Department one year after its validation

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Alice Ceccofiglio ◽  
Rudi Pecci ◽  
Giulia Peruzzi ◽  
Giulia Rivasi ◽  
Martina Rafanelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Analysis ◽  
Fast Track ◽  
Spontaneous Nystagmus ◽  
Head Impulse Test ◽  
Multidisciplinary Assessment ◽  
Effective Application ◽  
Training Courses ◽  
Ed Visits ◽  
One Year

A structured four-step bedside algorithm, named SponTAneous Nystagmus, Direction, head Impulse test, standiNG (STANDING), has been proposed to differentiate central from peripheral acute vestibulopathy in the Emergency Department (ED). We aimed to evaluate the effective application of STANDING in the management of vertigo in the ED and to define its role in deciding the patient’s pathway after discharge. We retrospectively analysed data from 131 consecutive patients (65% female, mean age 56) undergoing ED visits for a vertigo complaint between April and May 2016. Our study showed that the STANDING algorithm is underused, being performed only in the 18% of patients. The positivity of the STANDING did not influence the choice of the following pathway (e.g. outpatient fast track or discharge). Moreover, a small percentage of patients had a non-audiological diagnosis (mainly presyncope), for which no defined pathways were yet foreseen. Our study emphasized the need for continuous updating with appropriate training courses and the importance of a multidisciplinary assessment of vertigo in the ED.

scholarly journals P131: Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S122 ◽  
Author(s):  
J.W. Yan ◽  
K. Gushulak ◽  
M. Columbus ◽  
K. Van Aarsen ◽  
A. Hamelin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Emergency Department ◽  
Protective Factors ◽  
Diabetic Ketoacidosis ◽  
Initial Presentation ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State ◽  
Ed Visits ◽  
One Year

Introduction: Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. Methods: We conducted a one-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days. Results: There were 833 ED visits for hyperglycemia in the one-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age &lt;25 years (OR 2.6, 95% CI 1.5-4.7), glucose &gt;20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate &gt;110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit. Conclusion: This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.

Decreasing Emergency Department Visits for Children with Epilepsy

2021 ◽  
pp. 10.1212/CPJ.0000000000001109
Author(s):  
Anup D. Patel ◽  
Andrea Debs ◽  
Debbie Terry ◽  
William Parker ◽  
Mary Burch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Children And Adolescents ◽  
Multidisciplinary Team ◽  
Outcome Measure ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
One Year ◽  
Patients With Epilepsy

AbstractObjectiveEpilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy.MethodsIn 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible Our aim statement was to decrease the number of ED visits, per 1000 established epilepsy patients, from 13.03 to 11.6, by December 2019 and sustain for one year.ResultsWe successfully decreased ED visits for seizure related care in patients with epilepsy from 13.03% to 10.2% per 1000 patients which resulted in a centerline shift.ConclusionUsing QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.

scholarly journals A Promising Step in Fighting the Opioid Epidemic, Care Plan Implementation for those Presenting to the Emergency Department

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
F. Fiesseler ◽  
R. Riggs ◽  
D. Salo ◽  
D. Feldman ◽  
R. Shih
Keyword(s):  
Emergency Department ◽  
Care Plan ◽  
Rank Test ◽  
Opioid Epidemic ◽  
Plan Implementation ◽  
Care Plans ◽  
Opioid Administration ◽  
Ed Visits ◽  
One Year

Background: The opioid epidemic has both financial implications and ethical confounders affecting emergency departments across the country. Additionally, patients presenting to the emergency department (ED) seeking opioid administration and prescriptions can be both disruptive and time intensive. Objective: To determine long-term effectiveness of ED care plans designed to improve medical care for ED opioid-seeking patients with chronic painful conditions. Methods: A retrospective, cohort observational study. Location: a suburban teaching hospital with an annual census of 90,000 patients. The number of ED visits were tallied one year prior (control), and for five consecutive years following initiation. The primary outcome was the number of yearly ED visits in subjects meeting criteria. Statistics: Two-tailed Wilcoxon signed-rank test with significance of p<0.05, two tailed. Results: One hundred and twenty patients were enrolled. Twelve were excluded, leaving 108 patients for analysis. Mean yearly ED visits prior to care plan initiation were 7.6 (95% CI 11.9-3.3). Following care plan initiation, mean visits were: one year, 2.3 (95% CI 4.3-0.3); two years, 1.3 (95% CI 2.7-0.0); three years, 1.1(95 % CI 3.1-0.0); four years, 0.8 (95% CI 2.1-0.0); five years, 0.6 (95% CI 1.7-0.0). The five-year total mean reduction in visits was 7.0 (95% CI 8.1- 6.2) (p=0.0001). Conclusions: ED care plans are an effective long-term method to reduce visits in patients with chronic painful conditions who present seeking opioid treatment.

scholarly journals P028: Implementation of an emergency department outpatient deep venous thrombosis treatment guideline: a quality improvement initiative

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S87-S88
Author(s):  
L. Costello ◽  
M. McGowan ◽  
V. Dounaevskai ◽  
A.H. Cheng
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Treatment Guideline ◽  
Quality Improvement Initiative ◽  
Warfarin Group ◽  
Ed Visits ◽  
One Year

Introduction: Deep venous thrombosis (DVT) is a common diagnosis in the Emergency Department (ED). Despite evidence that Rivaroxaban is non-inferior to the low molecular weight heparin (LMWH) bridge to Warfarin approach for anticoagulation, there is still variability in physician practice. A collaborative ED-Hematology quality improvement initiative, that included a treatment guideline and increased access to a thrombosis clinic, was introduced to guide anticoagulation. Methods: A retrospective chart review of ED patients with DVT one-year pre (April 1, 2013-March 31, 2014) and one-year post (April 1, 2014-March 31, 2015) implementation of an outpatient DVT treatment guideline was conducted. Primary outcomes were percentage of patients discharged from the ED on Rivaroxaban or LMWH/Warfarin. Secondary outcomes included mean ED length of stay (ED LOS), mean number of return ED visits per patient and percentage of thrombosis clinic referrals. Balance measures included percentage of return ED visits with pulmonary embolism (PE) within one month and percentage of return ED visits with bleeding (major bleeding or clinically relevant non-major bleeding) due to anticoagulation use. Clinical and administrative data was extracted with 15% independently reviewed for inter-rater reliability. Results: 95 patients met inclusion criteria (52 patients pre and 43 post guideline implementation). The prescribing of Rivaroxaban increased from 9.6% (5/52) to 62.7% (27/43). Mean ED LOS for the Rivaroxaban group was 7.5 hours (95% CI, 5.8-9.2) versus 10.0 hours in the Warfarin group (95% CI, 8.5-11.4) [p=0.04]. The mean return ED visits for the Rivaroxaban group was 0.2 (95% CI, 0-0.3) versus 3.9 in the Warfarin group (95% CI, 3.2-4.6) [p<0.001]. The thrombosis clinic referrals increased from 29.5% (13/44) to 86.0% (37/43). There was one PE diagnosed in the Warfarin group within one month of treatment and zero in the Rivaroxaban group. There were 7.9% (5/63) return visits for bleeding in the warfarin group and 3.1% (1/32) in the Rivaroxaban group. Conclusion: By implementing an outpatient DVT treatment guideline at our academic center, we increased the prescribing of Rivaroxaban. This significantly decreased both the ED LOS and return ED visits in the Rivaroxaban group. There was also a threefold increase in referrals to a thrombosis clinic. This was all achieved without increasing patient harm.

Managing Sickle Cell Anemia: Use of Hospital, Emergency Department and Observation Unit Care over One Year.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3135-3135
Author(s):  
Judith A. O’Brien ◽  
Clare Pitoniak-Morse ◽  
Alex Ward
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Average Cost ◽  
Observation Unit ◽  
Principal Diagnosis ◽  
Hospital Stays ◽  
Ed Visits ◽  
The Mean ◽  
One Year

Abstract Sickle cell anemia (SCA) affects roughly 1 in 500 African Americans in the U.S., and there are approximately 72,000 known cases. Management consists primarily of treating symptoms and complications as there is no cure for SCA at present. Pain medications, transfusions, fluids and antibiotics are common treatments. Although these therapies could be administered potentially in routine outpatient settings, clinical and other circumstances may drive a patient to seek or receive care in other locations. This analysis examined use of non-routine locations of care defined as inpatient hospital care, Emergency Department (ED), and Observation Unit (OU) during one year by patients with SCA and the related costs. Using 2001–2002 Massachusetts statewide hospital, ED and OU data, a cohort of patients with SCA using these locations was identified by unique identifiers and an ICD-9 principal diagnosis code of SCA (282.60–282.69). Cases were limited to principal diagnosis to avoid inclusion of encounters that were primarily for complications, injuries or other conditions. A profile was established for each patient over the course of one year starting with the first stay or visit (index encounter) at any hospital, ED or OU in Massachusetts in 2001. From that index encounter, each hospital, ED or OU contact for SCA was tracked across the three locations for twelve months for that patient. Cost estimates, reported in 2004 US$, are limited to direct medical costs and include accommodations, ancillary and physician services. Fee schedules from 2004 were used for physician costs. Charges were adjusted by a 0.55 cost-to-charge ratio and appropriate medical inflation indices. A cohort of 436 patients with SCA was identified (females = 53%). The mean age was 20 years (median: 21.5) with 40% under age 17. A combined total of 2,258 hospital stays, ED visits and OU stays for SCA management were used by these patients during one year (mean non-routine encounters per patient = 5, range: 1–107). Hospital stays accounted for 50% of all encounters; 44% were ED visits and 6% were OU stays. SCA with crisis (ICD-9 code 282.62) was coded as the principal diagnosis in 90% of all encounters. Roughly half (49%) of the patients used more than one of these locations during the year. Distribution by location was: 30% inpatient hospital only [mean stays (range): 2 (1–23)]; 19% ED only [mean visits:2 (1–11)]; 2% OU only [mean stays:1 (1–3)]; 34% hospital and ED [mean combined encounters: 8, (2–107)]; 5% hospital and OU [mean combined: 5 (2–15)]; 3% ED and OU [mean combined: 4 (2–7)] and 7% used all three locations [mean combined:14, (3–49)].The mean hospital length of stay (LOS) was 5 days at an average cost of $6,830 per stay. The mean ED visit was 7.5 hours; average cost of $775 per visit. The mean OU LOS was 26 hours; average cost of $1,908 per stay. Medicaid was the responsible payer for most patients. The cumulative cost for hospital, OU stays and ED visits for this 436 patient cohort for one year was roughly $9.3 million (mean $21,300/pt) and this is a conservative estimate, as it does not include management costs for outpatient care or SCA-related complications. The results of this analysis show that these patients utilized non-routine sites of care frequently. Apart from the clinical consequences, these encounters represent a substantial personal and economic burden. Whether these care locations were used solely for clinical reasons, or were used due to lack of access to, or non-compliance with, care in the outpatient setting cannot be determined. This should be explored further.

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