scholarly journals Undiagnosed Diabetes in Patients Admitted to a Clinical Decision Unit from the Emergency Department: A Retrospective Review

Cureus ◽  
2018 ◽  
Author(s):  
Jessica Sop ◽  
Mark Gustafson ◽  
Clyde Rorrer ◽  
Alfred Tager ◽  
Frank H Annie
Keyword(s):  
Emergency Department ◽  
Retrospective Review ◽  
Clinical Decision ◽  
Undiagnosed Diabetes ◽  
Decision Unit ◽  
Clinical Decision Unit

Symptom-triggered therapy for assessment and management of alcohol withdrawal syndrome in the emergency department short-stay clinical decision unit

2018 ◽  
pp. emermed-2017-206997 ◽  
Author(s):  
Muhammad Fahmi Ismail ◽  
Kieran Doherty ◽  
Paula Bradshaw ◽  
Iomhar O’Sullivan ◽  
Eugene M Cassidy
Keyword(s):  
Emergency Department ◽  
Cumulative Dose ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Clinical Decision ◽  
Short Stay ◽  
Decision Unit ◽  
Clinical Decision Unit ◽  
Oral Diazepam

IntroductionWe previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.MethodsIn this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.Results5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1–48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1–168).ConclusionSTT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.

scholarly journals LO27: System outcomes associated with an emergency department clinical decision unit

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S36-S37
Author(s):  
D. Karacabeyli ◽  
D.K. Park ◽  
G. Meckler ◽  
Q. Doan
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Positive Impact ◽  
Clinical Decision ◽  
Initial Assessment ◽  
Discharge Process ◽  
Decision Unit ◽  
Natural Progression ◽  
Progression Of Disease ◽  
Clinical Decision Unit

Introduction: A clinical decision unit (CDU) is an area within the emergency department (ED) that allows for protocol-driven treatment & observation of patients who may not require hospital admission, but are not ready for discharge after initial assessment & treatment. A CDU was established at BC Children’s Hospital in 2014 as a means to optimize hospital resource utilization. Preliminary administrative data review revealed a return to ED (RTED) rate of 15% following a CDU stay, 2-3 times the RTED rate reported in the literature. Whether this is the expected cost of reducing hospital admissions remains unclear. Research exploring the underlying reasons for RTED following a CDU stay is limited. Objectives: Following a CDU stay, to describe 1) disposition outcome distribution; 2) underlying reasons for RTED; and 3) the proportion of potentially preventable RTED. Methods: Retrospective cohort study of all ED visits with a CDU stay from Jan 1, 2015 to Dec 31, 2015. Health records data was extracted & entered into standardized online forms by trained research assistants, then blindly reviewed by two investigators to determine a) the most probable cause of each RTED & b) the number of RTED that were clinically unnecessary. Results: Of the 1696 index CDU visits, 1503 (89%) were discharged home. However, 139 (9%) had ≥1 associated RTED. Among these, 48 (35%) were deemed clinically unnecessary (89% agreement, Kappa=0.79) & therefore potentially preventable. The most common reason (88%) for unnecessary RTED was mismatch between expected natural progression of disease (not requiring further medical assessment or treatment) & families’ understanding of disease symptom range & duration. In 90% of these cases, anticipatory guidance regarding natural progression of disease was not communicated to parents upon discharge. Among the remaining 1364 (91%) that did not return, 750 had an initial visit total ED length of stay of >8 hours, thus were considered averted hospitalizations attributable to the CDU. Conclusion: The CDU has had a positive impact on patient & system outcomes through the prevention of several inpatient admissions. However, we observed a relatively large proportion of RTED, 35% of which were clinically unnecessary & 27% of which had inadequate discharge instructions. This highlights opportunities to further optimize the effectiveness of the CDU through quality improvement initiatives focusing on the ED discharge process.

scholarly journals System outcomes associated with a pediatric emergency department clinical decision unit

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 195-198
Author(s):  
Derin Karacabeyli ◽  
Garth D Meckler ◽  
David K Park ◽  
Quynh Doan
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Clinical Decision ◽  
Pediatric Emergency ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Pediatric Emergency Department ◽  
Short Stay ◽  
Decision Unit ◽  
Clinical Decision Unit

AbstractObjectivesOur objectives were to describe disposition decisions and emergency department return (EDR) rates following a clinical decision unit (CDU) stay; and to determine changes to short stay (<48 hour) hospitalization rates after CDU implementation.MethodsWe conducted a retrospective cohort study of pediatric emergency department (PED) visits with a CDU stay from January 1 to December 31, 2015. Health records data were extracted onto standardized online forms, then used to determine disposition and 7-day EDR rates. Two trained investigators blindly reviewed EDR visits to determine if they were related to the index CDU stay. We compared short stay inpatient admission rates (i.e., hospital length of stay <48 hours) in 2013 and 2015, before and after CDU implementation.ResultsOf 1696 index CDU stays, 1503 (89%) were discharged, and 139 discharged patients (9.2%) had ≥1 clinically-related EDR. Median (IQR) CDU length of stay (LOS) was 4.4 hours (2.7-7.8) and total PED LOS (including CDU) was 7.8 hours (5.4-12.0). Asthma represented 31% of cases. Short stay hospitalization rate decreased from 3.62% in 2013 to 3.23% in 2015 (difference=0.39%; 95% CI=0.15-0.63; p=0.001).ConclusionsMost CDU patients were discharged, but 9% had a clinically-related ED revisit. CDU implementation was associated with a small but significant reduction in short stay hospitalization.

Developing and Evaluating Nurse led Discharge in Acute Medicine

2014 ◽  
Vol 13 (4) ◽  
pp. 159-162
Author(s):  
Vera Nina Gotz ◽  
◽  
Andrew Thompson ◽  
Kevin Jones ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Clinical Decision ◽  
Medical Setting ◽  
Acute Medicine ◽  
Decision Unit ◽  
Patient Groups ◽  
Clinical Decision Unit ◽  
Discharge Criteria ◽  
New System

Aims: To develop and evaluate nurse-led discharge criteria for a clinical decision unit in a large NHS Foundation Trust Method: Criteria for nurse led discharge were developed for patients presenting to hospital via the emergency department with chest pain, headache and deliberate self poisoning. Data on length of stay on CDU and readmission were collected for these patient groups during a 2 month period, during which the nurse-led criteria were introduced. Following introduction of the criteria a survey was conducted to evaluate staff opinions of the new system. Results: A trend towards reduced length of stay was noted during the month after introduction of nurse-led discharge (18.26hrs vs 20 hours p=0.582). Our staff survey indicated that the process was popular and has been continued since the study period. Conclusion: Nurse-led discharge using defined criteria is feasible and popular with staff in an acute medical setting.

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