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.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

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 Specialized fast track: a sustainable model to improve emergency department patient flow

2015 ◽  
Vol 4 (5) ◽  
pp. 40
Author(s):  
Emilpaolo Manno ◽  
Marco Pesce ◽  
Umberto Stralla ◽  
Federico Festa ◽  
Silvio Geninatti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Fast Track ◽  
Patient Flow ◽  
Wait Time ◽  
Emergency Department Patient ◽  
Care Needs ◽  
Time Length ◽  
Hospital Units ◽  
Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

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 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 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.

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