Adherence to national paediatric bronchiolitis management guidelines and impact on emergency department resource utilization

2020 ◽  
Author(s):  
Kate Maki ◽  
Hawmid Azizi ◽  
Prabhjas Hans ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Prodromal Symptom ◽  
Retrospective Case ◽  
Management Guidelines ◽  
System Utilization ◽  
Index Visit ◽  
Return Visits ◽  
Physical Exam Finding ◽  
Study Participants ◽  
Control Study

Abstract Objective To evaluate the association between the use of nonrecommended pharmacology (salbutamol and corticosteroids) per national bronchiolitis guidelines, either during the index visit or at discharge, and system utilization measures (frequency of return visits [RTED] and on paediatric emergency department [PED] length of stay [LOS]). Study Design We conducted a retrospective case control study of 185 infants (≤12 months old) who presented to the PED between December 2014 and April 2017 and discharged home with a clinical diagnosis of bronchiolitis. Inclusion criteria included ≥ 1 viral prodromal symptom and ≥ 1 physical exam finding of respiratory distress. Cases were defined as infants who had ≥ 1 RTED within 7 days of their index visit and controls were matched for age and acuity but without RTED. Logistic regression analysis and multivariable linear regression were used to assess the odds of RTED and PED LOS associated with nonadherence to pharmaceutical recommendations per AAP and CPS bronchiolitis guidelines. Results Use of nonrecommended pharmacology per national bronchiolitis guidelines was documented among 39% of the 185 study participants. Adjusting for acuity of index visit, age, severe tachypnea, oxygen desaturation, and dehydration, use of nonrecommended pharmacology was not associated with RTED (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.47 to 2.03). Use of salbutamol and corticosteroids, however, were each independently associated with increased PED LOS (58.3 minutes [P=0.01] and 116.7 minutes [P<0.001], respectively). Conclusion Nonadherence to the pharmaceutical recommendations of national bronchiolitis guidelines was not associated with RTED but salbutamol and corticosteroid use increased PED LOS.

scholarly journals Characteristics and determinants of high-risk unscheduled return visits to the emergency department

2019 ◽  
Vol 37 (2) ◽  
pp. 79-84 ◽  
Author(s):  
Eveline A Hiti ◽  
Hani Tamim ◽  
Maha Makki ◽  
Mirabelle Geha ◽  
Rima Kaddoura ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Digestive System ◽  
Case Control Study ◽  
Final Analysis ◽  
Quality Metric ◽  
Ed Visits ◽  
Return Visits ◽  
Control Study

BackgroundHigh-risk unscheduled return visits (HRURVs), defined as return visits within 72 hours that require admission or die in the emergency department (ED) on representation, are a key quality metric in the ED. The objective of this study was to determine the incidence and describe the characteristics and predictors of HRURVs to the ED.MethodsCase–control study, conducted between 1 November 2014 and 31 October 2015. Cases included all HRURVs over the age of 18 that presented to the ED. Controls were selected from patients who were discharged from the ED during the study period and did not return in the next 72 hours. Controls were matched to cases based on gender, age (±5 years) and date of presentation.ResultsOut of 38 886 ED visits during the study period, 271 are HRURVs, giving an incidence of HRURV of 0.70% (95% CI 0.62% to 0.78%). Our final analysis includes 270 HRURV cases and 270 controls, with an in-ED mortality rate of 0.7%, intensive care unit admission of 11.1% and need for surgical intervention of 22.2%. After adjusting for other factors, HRURV cases are more likely to be discharged with a diagnosis related to digestive system or infectious disease (OR 1.64, 95% CI 1.02 to 2.65 and OR 2.81, 95% CI 1.05 to 7.51, respectively). Furthermore, presentation to the ED during off-hours is a significant predictor of HRURV (OR 1.64, 95% CI 1.11 to 2.43) as is the presence of a handover during the patient visit (OR 1.68, 95% CI 1.02 to 2.75).ConclusionHRURV is an important key quality outcome metric that reflects a subgroup of ED patients with specific characteristics and predictors. Efforts to reduce this HRURV rate should focus on interventions targeting patients discharged with digestive system, kidney and urinary tract and infectious diseases diagnosis as well as exploring the role of handover tools in reducing HRURVs.

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 Pharmacist-Managed Antimicrobial Stewardship Program for Patients Discharged From the Emergency Department

2011 ◽  
Vol 25 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Stephanie N. Baker ◽  
Nicole M. Acquisto ◽  
Elizabeth Dodds Ashley ◽  
Rollin J. Fairbanks ◽  
Suzanne E. Beamish ◽  
...  
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Antimicrobial Stewardship ◽  
Positive Culture ◽  
Inpatient Setting ◽  
Antimicrobial Stewardship Program ◽  
Retrospective Case ◽  
Stewardship Program ◽  
Control Study

Positive outcomes of antimicrobial stewardship programs in the inpatient setting are well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case–control study of patients discharged from the emergency department (ED) with subsequent positive cultures conducted to determine whether integrating antimicrobial stewardship responsibilities into practice of the emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of antimicrobial therapy. Pre- and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Positive cultures were identified in 177 patients, 104 and 73 in pre- and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1-15) and 2 days (range 0-4) in the post-implementation group ( P = .0001). There were 74 (71.2%) and 36 (49.3%) positive cultures that required notification in the pre- and post-implementation groups, respectively, and the median time to patient or PCP notification was 3 days (range 1-9) and 2 days (range 0-4) in the 2 groups ( P = .01). No difference was seen in the appropriateness of therapy. In conclusion, EPh involvement reduced time to positive culture review and time to patient or PCP notification when indicated.

Medical Assessment Units and the older patient: a retrospective case-control study

2012 ◽  
Vol 36 (3) ◽  
pp. 331 ◽  
Author(s):  
Bin S. Ong ◽  
Huong Van Nguyen ◽  
Mohammad Ilyas ◽  
Irene Boyatzis ◽  
Vincent J. J. Ngian
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Case Control Study ◽  
Case Control ◽  
Hospital Length Of Stay ◽  
Model Of Care ◽  
Medical Assessment ◽  
Retrospective Case ◽  
Assessment Unit ◽  
Control Study

Objective. To evaluate the effect of a Medical Assessment Unit (MAU) on older patients. Methods. Retrospective case-control study of patients 65 years and above admitted to the MAU (study group) and the general medical wards (control group) in Bankstown-Lidcombe Hospital from 1 October 2008 to 31 March 2009 with four most common Diagnosis-Related Groups (DRG) (‘falls and gait disorder’, ‘chronic obstructive pulmonary disease (COPD)’, ‘other major respiratory diseases and ‘cellulitis’). Main outcome measures. Length of stay (LOS) in Emergency Department (ED) and in the hospital, mortality, readmissions within 1 month, and discharge destination. Results. Eighty-nine patients were studied; 47 in the MAU group and 42 in the non-MAU group. The MAU cohort was significantly older (84.1 ± 7.9 years v. 80.4 ± 7.8 years, respectively, P = 0.03); and had shorter ED LOS (4.9 ± 3.0 h v. 6.5 ± 2.8 h, P = 0.012). Overall hospital LOS did not differ except for patients with ‘cellulitis’, (5.7 ± 4.9 days for MAU cohort v. 14.8 ± 6.8 days for non-MAU cohort, P = 0.022). There was no significant difference in mortality, readmission rate or discharge destination. Conclusions. The MAU can be an effective service model for older patients. More research is required to confirm this and to define the key elements that are essential for its effectiveness. What is known about the topic? The Medical Assessment Unit is a model of care that has been developed in response to increasing Emergency Department presentations and rising demand on hospital beds. There has been some evidence that this model of care improves efficiency by reducing Emergency Department length of stay and overall hospital length of stay, but little published data targeting the Aged Care population group, who account for a high proportion of Emergency Department admissions. What does this paper add? This paper is a case-control study and provides additional evidence on the benefit of the Medical Assessment Unit model in the elderly population, specifically the benefits in the reduction of Emergency Department length of stay and overall hospital length of stay. This paper also assists in identifying key elements essential for the success of the Medical Assessment Unit model. What are the implications for practitioners? With increasing demand on healthcare, practitioners need to continually redesign how they deliver healthcare to maximise cost efficiency and effectiveness. We believe the Medical Assessment Unit is an effective new model of care. However, more research is required to further refine this model and also identify target patient groups who can most benefit from this model of care.

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 Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2748-2756
Author(s):  
Sophia Sheikh ◽  
Ashley Booth-Norse ◽  
Carmen Smotherman ◽  
Colleen Kalynych ◽  
Katryne Lukens-Bull ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Health Literacy ◽  
Adult Literacy ◽  
Middle Aged ◽  
Index Visit ◽  
Predictive Variables ◽  
Pain Scores ◽  
Academic Center ◽  
Return Visits

Abstract Objective The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients &gt; 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. Methods Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. Results The majority of the 130 enrolled patients &gt; 55 years of age returned for pain (57%), were African American (78%), were younger (55–64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8–0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3–7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0–1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. Conclusions The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.

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