Emergency Department Resource Use by Supervised Residents vs Attending Physicians Alone

Abstract Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

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Patients' Understanding of the Roles of Interns, Residents, and Attending Physicians in the Emergency Department

Academic Emergency Medicine ◽

10.1111/j.1553-2712.1999.tb00399.x ◽

1999 ◽

Vol 6 (4) ◽

pp. 339-344 ◽

Cited By ~ 36

Author(s):

Robin R. Hemphill ◽

Sally A. Santen ◽

C. Bart Rountree ◽

Andrew R. Szmit

Keyword(s):

Emergency Department ◽

Attending Physicians

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P094: The frequency of stroke risk assessment tools used to assess patients presenting to the emergency department with atrial fibrillation and flutter

CJEM ◽

10.1017/cem.2016.270 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S109-S110

Author(s):

T. Nikel ◽

S.W. Kirkland ◽

S. Campbell ◽

B.H. Rowe

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Stroke Risk ◽

Grey Literature ◽

Anticoagulation Therapy ◽

Adult Patients ◽

Assessment Tools ◽

Risk Scores ◽

Atrial Fibrillation And Flutter ◽

Attending Physicians

Introduction: Acute atrial fibrillation or flutter (AFF) is the most common dysrhythmia managed in the emergency department (ED). A key component of managing AFF in the ED is the prevention of stroke. Predictive indices (e.g., CHADS2 , HAS-BLED) should be used to assess each patient’s risk of stroke and bleeding to determine the appropriate anticoagulation therapy. The frequency of use of these predictive indices in the emergency department to determine appropriate anticoagulation therapy remains unclear. This systematic review is designed to examine the use of risk scores in the ED to determine the management of patients presenting to the ED for atrial fibrillation and flutter. Methods: An extensive search of eight electronic databases and grey literature was conducted. Quasi-experimental studies were eligible for inclusion. Studies had to report on the ED management of adult patients presenting with AFF to be included. Two independent reviewers judged the relevance, inclusion, and risk of bias of the studies. Individual and pooled statistics were calculated as odds ratios (OR) with 95% CI using a random effects model and heterogeneity (I2) was reported. Results: From 1,648 citations, 37 studies were included in this review. Heterogeneity was very high, precluding pooling. Only one of the included studies documented the use of CHADS2 scores by attending physicians; while no studies documented the use of HAS-BLED. There was variability in the ED management strategies of AFF. The utilization of rhythm control in the treatment of AFF ranged considerable (OR: 0.04-9.84) in comparison to rate control. Of the 17 studies reporting cardioversion approaches, chemical (9 {53%}) cardioversion was the most common management strategy of AFF. Conclusion: Our results suggests that either few physicians are documenting stroke risk scores in adult patients with AFF, or that research studies assessing ED management of AFF are not reporting scores documented by the attending physicians. Future research needs to examine the use of stroke risk scores to determine the optimal and appropriate care for patients.

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Trends in ED Resource Use for Infants 0 to 60 Days Evaluated for Serious Bacterial Infection

Hospital Pediatrics ◽

10.1542/hpeds.2021-005966 ◽

2021 ◽

Author(s):

Christina S. Hernandez ◽

Michael C. Monuteaux ◽

Richard G. Bachur ◽

Jeanine E. Hall ◽

Pradip P. Chaudhari

Keyword(s):

Emergency Department ◽

Bacterial Infection ◽

Resource Use ◽

Temporal Trends ◽

Health Information System ◽

Cross Sectional Study ◽

Antibiotic Administration ◽

Hospital Level ◽

Cross Sectional ◽

Department Evaluation

OBJECTIVES We examined trends in resource use for infants undergoing emergency department evaluation for serious bacterial infection, including lumbar puncture (LP), antibiotic administration, hospitalization, and procalcitonin testing, as well as the association between procalcitonin testing and LP, administration of parenteral antibiotics, and hospitalization. METHODS We performed a cross-sectional study of infants aged 0 to 60 days who underwent emergency department evaluation for serious bacterial infection with blood and urine cultures from 2010 to 2019 in 27 hospitals in the Pediatric Health Information System. We examined temporal trends in LP, antibiotic administration, hospitalization, and procalcitonin testing from 2010 to 2019. We also estimated multivariable logistic regression models for 2017–2019, adjusted for demographic factors and stratified by age (<28 and 29–60 days), with LP, antibiotic administration, and hospitalization as dependent variables and hospital-level procalcitonin testing as the independent variable. RESULTS We studied 106 547 index visits. From 2010 to 2019, rates of LP, antibiotic administration, and hospitalization decreased more for infants aged 29 to 60 days compared with infants aged 0 to 28 days (annual decrease in odds of LP, antibiotics administration, and hospitalization: 0 to 28 days: 5%, 5%, and 3%, respectively; 29–60 days: 15%, 12%, and 7%, respectively). Procalcitonin testing increased significantly each calendar year (odds ratio per calendar year 2.19; 95% confidence interval 1.82–2.62), with the majority (91.1%) performed during 2017–2019. From 2017 to 2019, there was no association between hospital-level procalcitonin testing and any outcome studied (all P values > .05). CONCLUSIONS Rates of LP, antibiotic administration, and hospitalization decreased significantly for infants 29 to 60 days during 2010–2019. Although procalcitonin testing increased during 2017–2019, we found no association with hospital-level procalcitonin testing and patterns of resource use.

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