scholarly journals P041: Does the involvement of learners in emergency department patient assessments result in an increased rate of short-term return visits?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S77-S78
Author(s):  
C. Elliott ◽  
K. Chen ◽  
T. Fitzpatrick
Keyword(s):  
Medical Students ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Short Term ◽  
Return Visit ◽  
Patient Assessments ◽  
Ed Visits ◽  
Return Visits ◽  
Level Of Training ◽  
One Year

Introduction: Learners, ether medical students or residents, often provide the initial assessment of patients visiting the Emergency Department (ED). Their involvement in ED patient care has been shown to increase length of stay, time to disposition decision, utilization of imaging and admission rates. It is unclear, however, if learners have an impact on the rate of short-term unscheduled return visits. The objective of this study was to determine if the involvement of learners in ED visits increases the rate of short-term unscheduled return visits. Methods: This study was a retrospective analysis of ED visit data at a single tertiary care center over a one-year period. Short-term unscheduled return visits (return visits) were defined as ED visits presenting within 72 hours of discharge from an initial non-admit ED visit and resulting in an admission to an inpatient unit on the second visit. The primary outcome was the rate of return visits for each staff physician, with and without learners involved during the initial visit. The secondary outcome assessed the interaction of level of training (medical student year 3, 4, resident year 1, 2, etc.) on return visit rates. For the primary outcome, statistical analysis was with a Wilcoxon Matched Pairs test; staff alone vs with learners. A Kruskal-Wallis test was used to compare learner level of training. Results: Return visits accounted for 1858 (1.09%) of all visits (N = 172494) to this tertiary care ED over the one-year study period. Return visits were statistically more likely when learners were involved in the initial ED visit (1.16%, CI 0.12), compared to initial visits seen by staff physicians alone (0.88%, CI 0.09) (p < 0.0001). Return rates were statistically higher for PGY2 (1.67% CI 0.35) and PGY3 (1.66% CI 0.28) residents compared to staff physicians alone (p < 0.0001). There was no difference in return visit rates between staff physicians and third year medical students (1.07% CI 0.27), fourth year medical students (1.21% CI 0.37), PGY1 (1.42% CI 0.22), PGY4 (1.23% CI 0.54) or PGY5 (1.33% CI 0.49) residents. Conclusion: This study demonstrated that the involvement of learners in ED patient assessments increased the rate of short-term unscheduled return visits. Moreover, return visit rates were highest for PGY2 and PGY3 residents. Further work is needed to understand the factors that contribute to this phenomenon.

scholarly journals P126: Utilization and outcomes of children presenting to an emergency department by ambulance

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S110-S110
Author(s):  
Z. Cantor ◽  
M. Aglipay ◽  
A. Plint
Keyword(s):  
Primary Outcome ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Patient Discharge ◽  
Primary Objective ◽  
Critically Ill Children ◽  
Secondary Outcome ◽  
Self Presentation ◽  
Discharge Disposition ◽  
Ed Visits

Introduction: Children account for a low proportion of paramedic transports. Evidence suggests that many pediatric transports are of low acuity, but there are few studies comparing these patients to those that self-present to the ED. Our primary objective was to determine if illness severity was associated with presentation by ambulance among pediatric patients. Methods: We undertook a single centre, retrospective cohort study at a tertiary care pediatric centre. All patients presenting to the ED in 2015 by any route other than air ambulance were eligible. Patients were divided into two groups based on the route of presentation – ambulance or self-presentation. The primary outcome was disposition decision; the secondary outcome was CTAS level. To determine whether patient discharge disposition or CTAS was associated with the method of arrival, we conducted generalized estimating equations (GEE) to account for correlation within patients with multiple ED visits. Results: Of the 69,092 visits, 69,034 were eligible and analyzed. Of those, 4478 (6.5%) arrived by ambulance, while 64,556 (93.5) self-presented. Those arriving by ambulance had a median age of 10 years [IQR: 2-5 years] vs. 4 years [IQR: 1.75-10 years] in the self-presenting group and were 52.6% male (vs. 52.8%). Two percent of the ambulance cohort were admitted to the ICU (vs. 0.2%), and 16.6% were admitted to the ward (vs. 5%). Patients presenting by ambulance had higher CTAS scores – 5.3% CTAS 1 (vs. 0.3%), 16.4% CTAS 2 (vs. 7.0%), 61.2% CTAS 3 (vs. 45.8%), and 17.1% CTAS 4-5 (vs. 46.9%). The odds of arriving by ambulance were 10.2 x higher for patients admitted to the ICU (OR = 10.2, 95%CI: 7.9 to 13.3) vs. those discharged home. The odds of arriving by ambulance were 64.2 x (OR = 64.2, 95% CI: 48.6 to 84.7) higher for patients CTAS 1 patients vs. CTAS 5 patients. The top 3 complaints among ambulance patients were neurological (22.5%), respiratory (22.7%), and orthopaedic (11.3%). Among self-presenting patients, the top three were general/minor (20.4%), respiratory (16.4%), and gastrointestinal (14.3%). Conclusion: Children presenting to the ED via ambulance are at higher risk for admission to the ward and critical care unit. It is important that paramedics have sufficient training to ensure adequate skills to manage critically ill children. Given the low proportion but higher severity of illness of pediatric transports, further research and consideration must be given to how best to enable paramedics in the management of children.

scholarly journals P068: Predictors of admission in unscheduled return visits to the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S81-S81
Author(s):  
J. Hayward ◽  
R. Hagtvedt ◽  
W. Ma ◽  
M. Vester ◽  
A. Gauri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Performance Indicator ◽  
Multivariable Analysis ◽  
Distinct Subgroup ◽  
Return Visit ◽  
Index Visit ◽  
System Data ◽  
Return Visits ◽  
One Year ◽  
Ed Crowding

Introduction: The 72-hr unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in Emergency Medicine. Patients with unscheduled return visits and admission to hospital (URVA) may represent a distinct subgroup of URVs compared to unscheduled return visits with no admission (URVNA). Methods: A retrospective cohort study of all 72-hr URVs in adults across nine EDs in the Edmonton Zone (EZ) over a one-year period (Jan 1 2015 Dec 31 2015) was performed using ED information system data. URVA and URVNA populations were compared and a multivariable analysis identified predictors of URVA. Results: Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, OR 3.6), fewer annual ED visits (<4 visits, OR 2.0), higher disease acuity (CTAS 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a large referral hospital (OR 1.4), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit was also a risk factor (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion: We demonstrate that URVA patients comprise a distinct subgroup of 72-hr URVs across an entire health region. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.

scholarly journals P016: Utilization and outcomes of children presenting to an emergency department by ambulance

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S68-S69
Author(s):  
Z. Cantor ◽  
M. Aglipay ◽  
A. Plint
Keyword(s):  
Primary Outcome ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Patient Discharge ◽  
Primary Objective ◽  
Critically Ill Children ◽  
Secondary Outcome ◽  
Self Presentation ◽  
Discharge Disposition ◽  
Ed Visits

Introduction: Children account for a low proportion of paramedic transports. Evidence suggests that many pediatric transports are of low acuity, but there are few studies comparing these patients to those that self-present to the ED. Our primary objective was to determine if illness severity was associated with presentation by ambulance among pediatric patients. Methods: We undertook a single centre, retrospective cohort study at a tertiary care pediatric centre. All patients presenting to the ED in 2015 by any route other than air ambulance were eligible. Patients were divided into 2 groups based on the route of presentation – ambulance or self-presentation. The primary outcome was disposition decision; the secondary outcome was CTAS level. To determine whether patient discharge disposition or CTAS was associated with method of arrival, we conducted generalized estimating equations (GEE) to account for correlation within patients with multiple ED visits. Results: Of the 69,092 visits, 69,034 were eligible and analyzed. Of those, 4478 arrived by ambulance, while 64,556 self-presented. Those arriving by ambulance had a median age of 10 years [IQR: 2-5 years] vs. 4 years [IQR: 1.75-10 years] in the self-presenting group, and were 52.6% male (vs. 52.8%). Two percent of the ambulance cohort were admitted to the ICU (vs. 0.2%), and 16.6% were admitted to the ward (vs. 5%). Patients presenting by ambulance had higher CTAS scores – 5.3% CTAS 1 (vs. 0.3%), 16.4% CTAS 2 (vs. 7.0% ), 61.2% CTAS 3 (vs. 45.8%), and 17.1% CTAS 4-5 (vs. 46.9%). The odds of arriving by ambulance were 10.2 x higher for patients admitted to the ICU (OR = 10.2, 95%CI: 7.9 to 13.3) vs. those discharged home. The odds of arriving by ambulance was 64.2 x (OR = 64.2, 95% CI: 48.6 to 84.7) higher for patients CTAS 1 patients vs. CTAS 5 patients. The top 3 complaints among ambulance patients were respiratory (22.7%), orthopedic (14.7%), and general/minor (10.3%). Among self-presenting patients, the top three were general/minor (22.5%), respiratory (18.0%), and gastrointestinal (15.7%). Conclusion: Children presenting to the ED via ambulance are at higher risk for admission to the ward and critical care unit. It is important that EMS staff responsible for transporting children be well trained in managing critically ill children. Given the low proportion of pediatric transports, consideration must be given to how best to train EMS services in managing these children.

scholarly journals P120: Characteristics and outcomes of patients with neurologic complaints who have an unscheduled return visit to the emergency department within 72 hours

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S107
Author(s):  
A. Schouten ◽  
A. Gauri ◽  
M. Bullard
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Admission Rate ◽  
Quality And Safety ◽  
University Of Alberta ◽  
Return Visit ◽  
Ed Visits ◽  
Return Visits ◽  
Ischemic Attack ◽  
The University

Introduction: Patients with neurologic presenting complaints comprised 12.5% of total University of Alberta Emergency Department (ED) visits in 2017. This group of patients has high rates of EMS utilization, admission, and ED resources including diagnostic imaging and consult services. We sought to analyze the characteristics and outcomes of the patients with neurologic complaints who have an unscheduled return visit (URV) to the ED within 72 hours to identify opportunities for improvement in quality and safety of patient care. Methods: Data was extracted from the Emergency Department Information System (EDIS) and National Ambulatory Care System databases to select adult patients presenting to the University of Alberta hospital in 2017 with neurologic complaints as defined by the Canadian Triage and Acuity Scale (CTAS). We additionally selected for return visits to Edmonton Zone EDs within 72 hours. Using standard descriptive statistics, we examined demographic and clinical characteristics of patients with 72-hour URV. Results: Of 8,770 total visits, 674 (7.69%) had a 72-hour URV to an Edmonton zone ED. The URV rate was 9.0% in patients seen by a physician and discharged with approval and 23.4-33.3% in patients who left against medical advice (LAMA), prior to completion of treatment (LPCT), or without being seen by a physician (LWBS). The mean age of URV patients was 45.6 years, 56.5% were male, with a mean ED length of stay of 7.37 hours. The top 5 diagnoses for URV patients were headache, migraine, alcohol related disorders, concussion, and transient ischemic attack. 14.7% of URV patients were admitted, 13.5% LWBS, 1.6% LAMA, 1.6% LPCT, and 66.1% were discharged. Conclusion: The majority of neurologic complaint patients with URV within 72 hours are those who LAMA, LPTC, or LWBS at index visit. The admission rate for URV patients (14.7%) is lower than for the index ED visit (55%), however these patients have high LWBS rates. Identifying strategies to limit the LWBS rate for these patients would reduce return visits and improve the quality and safety of patient care.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad
Keyword(s):  
Saphenous Vein ◽  
Short Term ◽  
Foam Sclerotherapy ◽  
Results Of Treatment ◽  
Ulcer Healing Rate ◽  
Complete Obliteration ◽  
Ceap Classification ◽  
One Year ◽  
The One

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.

A Clinical Study and Management of Inguino-scrotal Swellings In Children

2018 ◽  
Vol 2 (S1) ◽  
pp. e000125
Author(s):  
Khyati Vaja ◽  
Mukesh Suvera
Keyword(s):  
Inguinal Hernia ◽  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Undescended Testis ◽  
Length Of Hospital Stay ◽  
Indirect Inguinal Hernia ◽  
Short Term ◽  
One Year ◽  
Groin Hernias ◽  
Inguinal Hernia In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely. Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome. Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results. Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

Sustained normoglycemia in newly diagnosed type I diabetic subjects. Short-term effects and one-year follow-up

Diabetes ◽  
1984 ◽  
Vol 33 (10) ◽  
pp. 995-1001 ◽  
Author(s):  
K. Perlman ◽  
R. M. Ehrlich ◽  
R. M. Filler ◽  
A. M. Albisser
Keyword(s):  
Type I ◽  
Newly Diagnosed ◽  
Short Term ◽  
One Year ◽  
Short Term Effects

scholarly journals Price adjustments on the Johannesburg Stock Exchange for unexpected and dramatic news events: An empirical analysis

1989 ◽  
Vol 20 (3) ◽  
pp. 119-128 ◽  
Author(s):  
N. Bhana
Keyword(s):  
Empirical Analysis ◽  
Stock Exchange ◽  
Abnormal Returns ◽  
Short Term ◽  
Johannesburg Stock Exchange ◽  
Price Adjustments ◽  
Weak Evidence ◽  
News Events ◽  
One Year

The objective of this study is to determine whether companies listed on the Johannesburg Stock Exchange overreacted to unexpected favourable and unfavourable company-specific news events during the period 1970 - 1984. The JSE appears to be inefficient in reacting to the announcement of unfavourable news; economically significant abnormal returns up to one year following the event are observed. The JSE does not appear to overreact to news of a favourable nature, there is only weak evidence of short-term overreaction. The selling pressure caused by panic selling could depress prices well below levels justified by the unfavourable news. The magnitude of the overreaction to unfavourable news is sufficient to enable astute investors to outperform the market by taking positions in these securities. Knowledge of the pattern of market overreaction can also be of value to investors for transactions that are to take place anyway.

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