scholarly journals P149: Benign headache management in Alberta emergency departments: a chart review study to explore gaps in practice

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S118
Author(s):  
J. Gouda ◽  
N. Runham ◽  
L. Krebs ◽  
S. Couperthwaite ◽  
B. Rowe
Keyword(s):  
Emergency Departments ◽  
Chart Review ◽  
Medication Management ◽  
Pain Scale ◽  
Geographic Region ◽  
Care Physician ◽  
Left Without Being Seen ◽  
Personal Transportation ◽  
Study Sites ◽  
Tension Management

Introduction: Variation in medication management and image ordering for HA presentation to emergency departments (ED) has been documented. This study examined benign HA (i.e., migraine, cluster, tension) management in order to identify the consistency and appropriateness of HA management in EDs in Alberta. Methods: Patients were identified by primary discharge diagnosis in the National Ambulatory Care Reporting System using ICD-10-CA codes for benign HA (G43, G44, R51). Patients presenting to study sites from January 1, 2017 to September 30, 2017 were eligible for inclusion, provided they were adults (≥18 years), were not transferred from another institution or directly admitted to a service, and had an active HA at presentation. One hundred eligible patients were randomly selected for chart review. Data were extracted on standardized forms. Preliminary data on 50 patients (n = 150) from three Edmonton study sites is presented. Results: Most patients arrived to the ED via personal transportation (93%) and were assigned a Canadian Triage and Acuity Scale (CTAS) score of 3 (71%). The majority of patients were female (75%); mean age was 45 years (standard deviation: 18). Triage pain score was not documented for 21%. When documented, pain scores were most frequently between 4 and 7 (49%). Nearly 10% of patients left without being seen. For those who were assessed, physicians most frequently used ketorolac and metoclopramide as first or second line treatments or as a combination treatment. Consults were infrequent (14%). Nearly half of the patients (47%). had computed tomography (CT) in the ED. Pain re-assessment was completed for 69% of patients. Most patients were discharged from the ED (88%) and given some form of discharge instruction (78%). The most common instructions were to return to ED as needed (45%) and follow-up with their primary care physician (28%). Across all patients, 13% returned to the ED with headache within 30 days. Conclusion: Physicians treat patients with benign headaches appropriately and hospitalization is infrequent; however, one in eight patients relapse. Missing pain scale documentation reveals a potential problem for ED clinicians in assessing management effectiveness and ensuring patients leave the ED following pain relief. Half of the patients received a CT scan, highlighting the urgent need for an intervention to address CT overuse for patients with benign HA within this geographic region.

scholarly journals Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038415
Author(s):  
Jennifer Johnston ◽  
Jo Longman ◽  
Dan Ewald ◽  
Jonathan King ◽  
Sumon Das ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Medication Management ◽  
Community Dwelling ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Study Sites

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

Physical therapy in the emergency department: surveying primary care practitioners' perceptions and recommendations

2020 ◽  
Vol 26 (8) ◽  
pp. 1-12
Author(s):  
Stacy J Fisher
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Physician Assistants ◽  
Geographic Region ◽  
Full Time ◽  
Chi Square ◽  
The Usa ◽  
Primary Care Practitioners ◽  
The Impact

Background/aims Little is known regarding the impact that physiotherapists can have on patients in the emergency department. A study was carried out to explore attitudes of physicians, physician assistants and nurse practitioners in emergency departments about physiotherapists being staffed full-time to assist with patient care. It also aimed to investigate whether physiotherapists should be staffed in emergency departments, what they are capable of doing in an emergency department and identify areas where physiotherapists are most useful in emergency departments in the USA. Methods This sequential mixed method study examined the perceptions and recommendations of emergency medicine practitioners regarding physiotherapists' services in the emergency department. Phase one analysed geographical data. Phase two analysed qualitative components of the survey. Frequencies were analysed and either Fisher's exact or Chi-square tests used to analyse the findings. Participants included physician assistants, nurse practitioners and physicians in emergency departments in the USA. Results A statistically significant association was shown between the geographic region and whether or not physiotherapists were staffed within the emergency departments in states outside the western region. Additionally, 97% of qualified participants reported positive experiences working with physiotherapists regularly. Conclusions Physiotherapists should be used for the specialisation and knowledge they have. More education is needed in emergency departments around the USA to understand what a physiotherapist can offer and how this reduces unnecessary hospital admission. Physiotherapists working in the emergency department can ultimately reduce costs for hospitals.

scholarly journals Hospitalist and primary care physician perspectives on medication management of chronic conditions for hospitalized patients

2014 ◽  
Vol 9 (5) ◽  
pp. 303-309 ◽  
Author(s):  
Anthony C. Breu ◽  
Joshua Allen-Dicker ◽  
Stephanie Mueller ◽  
Kerri Palamara ◽  
Keiki Hinami ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Chronic Conditions ◽  
Medication Management ◽  
Care Physician ◽  
Hospitalized Patients ◽  
Physician Perspectives

Do Symptoms Matter When Considering Patients for Phase I Clinical Trials? A Pilot Study of Older Adults With Advanced Cancer

2011 ◽  
Vol 28 (7) ◽  
pp. 463-466 ◽  
Author(s):  
Jennifer M. Healy ◽  
Taral Patel ◽  
Shuko Lee ◽  
Sandra Sanchez-Reilly
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Phase I ◽  
Advanced Cancer ◽  
Poor Prognosis ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Experimental Treatment ◽  
Pain Scale ◽  
Phase I Clinical Trials

Background: Older adults (OA) with advanced cancer (AC) undergoing phase I clinical trials (PICT) have poor prognosis. There are no studies which describe symptoms experienced by OA. Methods: Retrospective chart review of PICT participants >60 years. OA were compared by age (>65 vs 60-65) and by number of symptoms (>3 vs ≤3). Results: N = 56. Mean age = 67.09; 48.21% female. Median life-expectancy = 5 months (interquartile range = 2-9 months); 80.36% had pain; of those 64% without pain scale. Most did not have interdisciplinary professionals or hospice referrals. Older adults with >3 symptoms had more admissions (37.5% vs 14.29%; P = .0335), complications (46.43% vs 16.07%; P = .0026), and greater decline in functional status (24 participants >3 symptoms vs 8; P = .0173). There were no significant differences comparing OA by age. Conclusions: Older adults enrolled in PICT with more symptoms may sacrifice QOL for experimental treatment.

scholarly journals Potential Antipsychotic Side Effects and Adverse Events of Assisted Living Residents With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 706-707
Author(s):  
Anna Beeber ◽  
Sheryl Zimmerman ◽  
Christopher Wretman ◽  
Stephanie Miller ◽  
Kush Patel ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Assisted Living ◽  
Chart Review ◽  
Medication Management ◽  
Psychological Effects ◽  
Potential Side Effect ◽  
Us States ◽  
Psychoactive Medications ◽  
Antipsychotic Side Effects

Abstract This presentation provides the findings from a descriptive study examining the potential adverse events and side effects of antipsychotic medications prescribed to assisted living (AL) residents with dementia drawn from interviews with family members and chart review on 238 AL residents, from 91 AL communities in seven US states. We found that 85% of family reported that medication had been administered for agitation or aggression, 93% of the sample experienced at least one potential side effect, and 19% experienced five or more. The most common potential side effects were neurologic/psychological effects (89% of residents), and somnolence during the day (81%). Six percent of the sample experienced at least one potential adverse event. This work implies a need for caution when prescribing antipsychotics to older adults with dementia in AL. Medication management efforts should extend to monitoring AL residents for potential side effects and adverse events from specific psychoactive medications.

scholarly journals Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments

CJEM ◽  
2013 ◽  
Vol 15 (03) ◽  
pp. 141-160 ◽  
Author(s):  
Bjug Borgundvaag ◽  
Wil Ng ◽  
Brian Rowe ◽  
Kevin Katz ◽  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Emergency Departments ◽  
The United States ◽  
Chart Audit ◽  
Methicillin Resistant ◽  
History Of ◽  
Canadian Provinces ◽  
Study Sites ◽  
Hospital Emergency Departments

ABSTRACTBackground:Community-associated methicillin-resistantStaphylococcus aureus(MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.Methods:Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grewS. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.Results:Of the 1,353S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptibleS. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.Interpretation:MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.

Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments

2016 ◽  
Vol 31 (6) ◽  
pp. 675-679 ◽  
Author(s):  
Olindi Wijesekera ◽  
Amanda Reed ◽  
Parker S. Chastain ◽  
Shauna Biggs ◽  
Elizabeth G. Clark ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Emergency Medical Services ◽  
Emergency Departments ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Medical Services ◽  
Publication Type ◽  
Patient Demographics ◽  
Emergency Medical ◽  
Chief Complaints

AbstractIntroductionWithout a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) utilization in four Indian emergency departments. Prehosp Disaster Med. 2016;31(6):675–679.

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