Frequent emergency attenders: is there a better way?

2011 ◽  
Vol 35 (4) ◽  
pp. 462 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Upali W. Jayasinghe ◽  
Mark F. Harris
Keyword(s):  
Emergency Department ◽  
Community Mental Health Services ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Hospital Data ◽  
Service Usage ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Repeat Prescriptions

Background. Understanding the reasons for frequent re-attendances will assist in developing solutions to hospital overcrowding. This study aimed to identify the factors associated with frequent re-attendances in a regional hospital thereby highlighting possible solutions to the problem. Methods. A retrospective analysis was performed on emergency department data from 2008. Frequent re-attenders were defined as those with four or more presentations in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on re-presentations using multivariate analysis. Results. A total of 8% of the total patients presenting to emergency re-attended four or more times in the year. Frequent re-attenders were older, presented with an unplanned returned visit and had a diagnosis of neurosis, chronic obstructive pulmonary disease (COPD), convulsions, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures and less likely to present in summer. Frequent re-attendances were unrelated to sex, time of presentation or country of birth. Conclusions. Diversion of patients with minor conditions to alternative services; referral of COPD patients to follow-up respiratory services and patients with neurosis to community mental health services would reduce emergency utilisation. Improving access to and resourcing of alternative non-hospital services should be investigated to reduce emergency overcrowding. What is known about the topic? Frequent re-attendances at emergency contribute to emergency overcrowding and are a problem worldwide. Generally, frequent re-attendances have been associated with disadvantage. Identifying patient factors that predict re-attendances will assist in developing strategies to prevent their occurrence. The reasons for re-attendances may vary depending on access to other services and the role of the hospital. What does this paper add? This paper adds to the field by demonstrating how routinely collected hospital data can be used to determine patient characteristics important in frequent re-attendances. The factors associated with frequently re-attending patients include older age, type of condition, unplanned return visit and season. What are the implications for practitioners? This paper has implications for both administrators and clinicians. The diversion of attending patients with neurosis, COPD, dyspnoea or repeat prescriptions, follow-up examinations or dressings and sutures to alternative affordable and accessible services would reduce overcrowding in the emergency department.

scholarly journals Patient characteristics and healthcare utilisation among Danish patients with chronic conditions: a nationwide cohort study in general practice and hospitals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anders Damgaard Møller Schlünsen ◽  
David Høyrup Christiansen ◽  
Ulrich Fredberg ◽  
Peter Vedsted
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
General Practice ◽  
Chronic Conditions ◽  
Healthcare Utilisation ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Healthcare Resources ◽  
Obstructive Pulmonary Disease ◽  
Hospital Outpatient

Abstract Background The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up. Methods On 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression. Results Across all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources. Conclusions Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.

P415330-Day readmission after hospitalization for heart failure in china

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Li ◽  
X K Bai ◽  
L H Zhang ◽  
F A Masoudi ◽  
J A Spertus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Odds Ratio ◽  
Patient Characteristics ◽  
Transitions Of Care ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Face To Face ◽  
C Statistic

Abstract Background Hospital readmission after heart failure (HF) is common, costly, and potentially preventable. Current patterns of 30-day readmission rates after HF discharge and patient characteristics associated with these readmissions in China are unknown. Purpose To calculate the rates and timing of all-cause readmissions within 30-day after HF hospitalization and to identify patient characteristics associated with readmissions. Methods We included consecutive patients who were hospitalized primarily for HF and discharged alive from 52 geographically diverse hospitals in China followed for 30 days after discharge. Patients were invited for face-to-face interviews to collect information about any readmission. If a patient was unwilling or unable to attend, information was obtained by telephone contact with the patient, his or her relatives, or physicians. We fit mixed models with a logit link function accounting for patient clustering by hospital to identify patient factors associated with 30-day readmission. To estimate the variability in hospital-level, we calculated the median odds ratio (OR) from the fully adjusted hierarchical model, which represents the average likelihood of a statistically identical patient readmitted at one random hospital versus another. Results Among 4649 eligible patients, 4542 (97.7%) had 30-day follow-up. the median (IQR) age was 67 (57, 75) years; 62.5% were men. The length of index hospital stay was 9 (7, 13) days. Readmissions for any cause within 30 days of discharge occurred in 562 patients (12.4%), of which 30.1% occurred within 7 days of discharge and 58.9% 15 days. Half of readmission diagnosis within 30 days were HF (283, 50.4%). Prior HF (OR 1.3, 95% CI 1.09–1.55), valvular heart disease (OR 1.64, 95% CI 1.26–2.1), chronic obstructive pulmonary disease (OR 1.35, 95% CI 1.05–1.73), diabetes (OR 1.44, 95% CI 1.19–1.74) and longer length of index hospitalization stay (HR 1.02, 95% CI 1.01–1.03 per day) were associated with higher risks of 30-day readmission. The C-statistic was 0.615. The median odds ratio was 1.32 (1.05–1.48). Conclusion In China, one in eight patients hospitalized for HF are readmitted within 30-days, with the majority occurring within 2 weeks of discharge. Both patient characteristics and variability across hospitals accounted for the variability in readmissions, suggesting an important opportunity for improving the transitions of care in HF.

scholarly journals Frequency of emergency department visits and hospitalizations due to chronic obstructive pulmonary disease exacerbations in patients included in two models of care

Biomédica ◽  
2019 ◽  
Vol 39 (4) ◽  
pp. 748-758
Author(s):  
Abraham Alí ◽  
Luis Fernando Giraldo-Cadavid ◽  
Elizabeth Karpf ◽  
Luz Adriana Quintero ◽  
Carlos Eduardo Aguirre ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Emergency Department ◽  
Incidence Rate ◽  
Models Of Care ◽  
Emergency Department Visits ◽  
Chronic Obstructive ◽  
Emergency Visits ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) have a huge impact on lung function, quality of life and mortality of patients. Emergency Department visits and hospitalizations due to exacerbations cause a significant economic burden on the health system.Objective: To describe the differences in the number of emergency visits and hospitalizations due to exacerbations of COPD among patients included in two models of care of the same institution.Materials and methods: A historical cohort study in which COPD patients who are users of two models of care were included: COPD integrated care program (CICP) and general consultation of pulmonology (GCP). The first model, unlike the second one, offers additional educational activities, 24/7 telephone service, and priority consultations. The number of emergency visits and hospitalizations due to COPD exacerbations in patients who had completed at least one year of follow-up was evaluated. The multivariable Poisson regression model was used for calculating the incidence rate (IR) and the incidence rate ratio (IRR) with an adjustment for confounding factors.Results: We included 316 COPD patients (166 from the CICP and 150 from the GCP). During the year of follow-up, the CICP patients had 50% fewer emergency visits and hospitalizations than patients from the GCP (IRR=0.50, 95%CI: 0.29-0.87, p=0.014). Conclusions: COPD patients in the CICP had fewer emergency visits and hospitalizations due to exacerbations. Prospective clinical studies are required to confirm the results and to evaluate the factors that contribute to the differences.

Unplanned return visits to emergency in a regional hospital

2012 ◽  
Vol 36 (3) ◽  
pp. 336 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Upali W. Jayasinghe ◽  
Mark F. Harris
Keyword(s):  
Emergency Department ◽  
Patient Characteristics ◽  
Regional Hospital ◽  
Hospital Data ◽  
Service Usage ◽  
Return Visit ◽  
Visit Rate ◽  
Return Visits ◽  
Emergency Department Patients ◽  
Patient Service

Objective. The aim of this study was to determine the patient characteristics associated with unplanned return visits, using routinely collected hospital data, to assist in developing strategies to reduce their occurrence. Methods. Emergency department data from a regional hospital were analysed using univariate and multivariate methods to determine the influence of clinical, service usage and demographic patient characteristics on unplanned return visits. Results. Around 80% of the 16 000 patients attending emergency presented on only one occasion in a year. Five per cent of patients presented with an unplanned return visit. Older patients, those with minor and low urgency conditions and with non-psychotic mental health conditions, those presenting during winter and after hours were significantly more likely to present as unplanned return visits. Conclusion. Although patient characteristics associated with unplanned return visits have been identified, the reasons underpinning the unplanned return visit rate, such as patient service preference and attitudes, need to be more fully investigated. What is known about the topic? Patients who present as unplanned return visits are older and have a range of chronic and acute conditions. Some unplanned return visits occur because of limited access to other non-hospital service. What does this paper add? This paper adds to the field by providing information from a regional hospital in NSW Australia on the patient characteristics associated with unplanned return visits. It provides a basis for differentiating between other groups of frequent emergency department patients. However, the reasons behind the unplanned return visit rate need to be more fully investigated. What are the implications for practitioners? The implications of the findings of this study for policy makers, administrators and clinicians are that access to alternative services for the conditions associated with unplanned return visits need to be further investigated in the context of the role for emergency department services.

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