scholarly journals Evaluating the transitions in care for children presenting with acute asthma to emergency departments: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kimberly R. Kroetch ◽  
Brian H. Rowe ◽  
Rhonda J. Rosychuk
Keyword(s):  
Emergency Departments ◽  
Acute Asthma ◽  
Initial Assessment ◽  
Multistate Model ◽  
Common Presentation ◽  
Covariate Effects ◽  
Transition Times ◽  
The Individual ◽  
Model Transition ◽  
Ed Crowding

Abstract Background Acute asthma is a common presentation to emergency departments (EDs) worldwide and, due to overcrowding, delays in treatment often occur. This study deconstructs the total ED length of stay into stages and estimates covariate effects on transition times for children presenting with asthma. Methods We extracted ED presentations in 2019 made by children in Alberta, Canada for acute asthma. We used multivariable Cox regressions in a multistate model to model transition times among the stages of start, physician initial assessment (PIA), disposition decision, and ED departure. Results Data from 6598 patients on 8270 ED presentations were extracted. The individual PIA time was longer (i.e., HR < 1) when time to the crowding metric (hourly PIA) was above 1 h (HR = 0.32; 95% CI:0.30,0.34), for tertiary (HR = 0.65; 95% CI:0.61,0.70) and urban EDs (HR = 0.77; 95% CI:0.70,0.84), for younger patients (HR = 0.99 per year; 95% CI:0.99,1.00), and for patients triaged less urgent/non-urgent (HR = 0.89; 95% CI:0.84,0.95). It was shorter for patients arriving by ambulance (HR = 1.22; 95% CI:1.04,1.42). Times from PIA to disposition decision were longer for tertiary (HR = 0.47; 95% CI:0.44,0.51) and urban (HR = 0.69; 95% CI:0.63,0.75) EDs, for patients triaged as resuscitation/emergent (HR = 0.51; 95% CI:0.48,0.54), and for patients arriving by ambulance (HR = 0.78; 95% CI:0.70,0.87). Times from disposition decision to ED departure were longer for patients who were admitted (HR = 0.16; 95% CI:0.13,0.20) or transferred (HR = 0.42; 95% CI:0.35,0.50), and for tertiary EDs (HR = 0.93; 95% CI:0.92,0.94). Conclusions All transition times were impacted by ED presentation characteristics. The sole key patient characteristic was age and it only impacted time to PIA. ED crowding demonstrated strong effects of time to PIA but not for the transition times involving disposition decision and ED departure stages.

scholarly journals Initial assessment in emergency departments by chief complaint and respiratory rate

2021 ◽  
Author(s):  
Shoko Soeno ◽  
Konan Hara ◽  
Ryo Fujimori ◽  
Katsuhiko Hashimoto ◽  
Toru Shirakawa ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Emergency Departments ◽  
Chief Complaint ◽  
Initial Assessment

scholarly journals Acute asthma severity scores for appropriate triage in Emergency Departments: still a balance of simplicity and validity

2013 ◽  
Vol 51 (3) ◽  
pp. 225-226
Author(s):  
Javier Navarro-Esteva ◽  
Pedro Cabrera-Navarro ◽  
Antonio Esquinas Rodríguez
Keyword(s):  
Emergency Departments ◽  
Acute Asthma ◽  
Asthma Severity ◽  
Severity Scores

scholarly journals Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anqi Chen ◽  
Scott Fielding ◽  
X. Joan Hu ◽  
Patrick McLane ◽  
Andrew McRae ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Flow Characteristics ◽  
Initial Assessment ◽  
Cox Models ◽  
Lengths Of Stay ◽  
Random Samples ◽  
High System ◽  
And Control

Abstract Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.

scholarly journals Neuropsychiatric events in systemic lupus erythematosus: a longitudinal analysis of outcomes in an international inception cohort using a multistate model approach

2020 ◽  
Vol 79 (3) ◽  
pp. 356-362 ◽  
Author(s):  
John G Hanly ◽  
Murray B Urowitz ◽  
Caroline Gordon ◽  
Sang-Cheol Bae ◽  
Juanita Romero-Diaz ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Short Form ◽  
Initial Assessment ◽  
Event Analysis ◽  
Multistate Model ◽  
Inception Cohort ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Measured Time

ObjectivesUsing a reversible multistate model, we prospectively examined neuropsychiatric (NP) events for attribution, outcome and association with health-related quality of life (HRQoL), in an international, inception cohort of systemic lupus erythematosus (SLE) patients.MethodsAnnual assessments for 19 NP events attributed to SLE and non-SLE causes, physician determination of outcome and patient HRQoL (short-form (SF)-36 scores) were measured. Time-to-event analysis and multistate modelling examined the onset, recurrence and transition between NP states.ResultsNP events occurred in 955/1827 (52.3%) patients and 592/1910 (31.0%) unique events were attributed to SLE. In the first 2 years of follow-up the relative risk (95% CI) for SLE NP events was 6.16 (4.96, 7.66) and non-SLE events was 4.66 (4.01, 5.43) compared with thereafter. Patients without SLE NP events at initial assessment had a 74% probability of being event free at 10 years. For non-SLE NP events the estimate was 48%. The majority of NP events resolved over 10 years but mortality was higher in patients with NP events attributed to SLE (16%) versus patients with no NPSLE events (6%) while the rate was comparable in patients with non-SLE NP events (7%) compared with patients with no non-SLE events (6%). Patients with NP events had lower SF-36 summary scores compared with those without NP events and resolved NP states (p<0.001).ConclusionsNP events occur most frequently around the diagnosis of SLE. Although the majority of events resolve they are associated with reduced HRQoL and excess mortality. Multistate modelling is well suited for the assessment of NP events in SLE.

Variations and Gaps in Management of Acute Asthma in Ontario Emergency Departments

CHEST Journal ◽  
2009 ◽  
Vol 135 (3) ◽  
pp. 724-736 ◽  
Author(s):  
M. Diane Lougheed ◽  
Nancy Garvey ◽  
Kenneth R. Chapman ◽  
Lisa Cicutto ◽  
Robert Dales ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Acute Asthma

Acute Pain Management

2003 ◽  
Vol 16 (4) ◽  
pp. 231-248 ◽  
Author(s):  
Peter J. S. Koo
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Professional Education ◽  
Oxygen Demand ◽  
Initial Assessment ◽  
Vascular Perfusion ◽  
Acute Pain Management ◽  
The Individual ◽  
Increase Oxygen Demand

Acute pain management is improving steadily over the past few years, but training and professional education are still lacking in many professions. Untreated or undertreated acute pain could have detrimental effects on the patient in terms of comfort and recovery from trauma or surgery. Acute undertreated pain can decrease a patient's vascular perfusion, increase oxygen demand, suppress the immune system, and possibly risk increased incidence of venous thrombosis. Although acute postoperative pain needs to be managed aggressively, patients are most vulnerable during this period for developing adverse effects, and therefore, patient assessment and careful drug therapy evaluation are necessary processes in therapeutic planning. Acute pain management requires careful and thorough initial assessment and follow-up reassessment in addition to frequent dosage adjustments, and managing analgesic induced side effects. Analgesic selection and dosing must be based on the patient's past and recent analgesic exposure. There is no single acute pain management regimen that is suitable for all patients. Analgesics must be tailored to the individual patient.

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

scholarly journals Presence of atopy increases the risk of asthma relapse

2017 ◽  
Vol 103 (4) ◽  
pp. 346-351 ◽  
Author(s):  
Laurel Teoh ◽  
Ian M Mackay ◽  
Peter P Van Asperen ◽  
Jason P Acworth ◽  
Mark Hurwitz ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Acute Asthma ◽  
Respiratory Viruses ◽  
Prick Test ◽  
Asthma Exacerbations ◽  
A Prospective Study ◽  
Micro Organisms ◽  
The Impact ◽  
Atypical Bacteria

ObjectivesTo describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations.DesignThis was a prospective study performed during 2009–2011.SettingThe study was performed in the emergency departments of two hospitals.Patients244 children aged 2–16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed.Main outcome measuresThe outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days).ResultsPCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23).ConclusionsThe presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.

Sign in / Sign up

Export Citation Format

Share Document