S128: Active post discharge surveillance program as a part of Enhanced Recovery After Surgery protocol decreases emergency department visits and readmissions in colorectal patients

2019 ◽  
Vol 33 (11) ◽  
pp. 3816-3827 ◽  
Author(s):  
Daniel J. Borsuk ◽  
Ahmed AL-Khamis ◽  
Andrew J. Geiser ◽  
Dimin Zhou ◽  
Christina Warner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Post Discharge

scholarly journals Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program—United States, January 2017–December 2019

2021 ◽  
Vol 111 (3) ◽  
pp. 485-493
Author(s):  
Ashley Schappell D'Inverno ◽  
Nimi Idaikkadar ◽  
Debra Houry
Keyword(s):  
United States ◽  
Emergency Department ◽  
Sexual Violence ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
The United States ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Time Period ◽  
Ed Visits

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States. Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention’s National Syndromic Surveillance Program data. We stratified the data by sex and age groups. Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years. Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

scholarly journals Community socioeconomic disadvantage drives type of 30-day medical-surgical revisits among patients with serious mental illness

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hayley D. Germack ◽  
Khadejah Mahmoud ◽  
Mandy Cooper ◽  
Heather Vincent ◽  
Krista Koller ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Emergency Department Visits ◽  
Socioeconomic Disadvantage ◽  
Post Discharge ◽  
Disadvantaged Communities ◽  
Discharge Care

Abstract Background Patients with serious mental illness (SMI) are vulnerable to medical-surgical readmissions and emergency department visits. Methods We studied 1,914,619 patients with SMI discharged after medical-surgical admissions in Florida and New York between 2012 and 2015 and their revisits to the hospital within 30 days of discharge. Results Patients with SMI from the most disadvantaged communities had greater adjusted 30-day revisit rates than patients from less disadvantaged communities. Among those that experienced a revisit, patients from the most disadvantaged communities had 7.3 % greater 30-day observation stay revisits. Conclusions These results suggest that additional investments are needed to ensure that patients with SMI from the most disadvantaged communities are receiving appropriate post-discharge care.

scholarly journals Community Socioeconomic Disadvantage Drives Type of 30-Day Medical-Surgical Revisits Among Patients with Serious Mental Illness

2020 ◽  
Author(s):  
Hayley Drew Germack ◽  
Mandy Cooper ◽  
Krista Koller ◽  
Khadejah Mahmoud ◽  
Heather Vincent ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Healthcare Research ◽  
Emergency Department Visits ◽  
Socioeconomic Disadvantage ◽  
Area Deprivation ◽  
Post Discharge ◽  
Disadvantaged Communities

Abstract Background: Patients with serious mental illness (SMI) are vulnerable to medical-surgical readmissions and emergency department visits. Community socioeconomic disadvantage has been associated with readmission risk in the general population, but its impact on other types of revisits (emergency department visits and observation stays), particularly in patients with SMI, is unknown. Methods: We used Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project discharge abstracts for 1,914,619 patients with SMI discharged after medical-surgical admissions in Florida and New York between 2012 and 2015 and their revisits to the hospital within 30 days of discharge. We linked this data to the Area Deprivation Index for the communities that patients returned to.Results: Patients with SMI returning to the most disadvantaged communities had greater adjusted 30-day revisit rates than patients from less disadvantaged communities. Among those that experienced a revisit, patients returning the most disadvantaged communities had 7.3% greater 30-day observation stay revisits. Conclusion: These results suggest that additional investments are needed to ensure that patients with SMI returning the most socioeconomically disadvantaged communities are receiving appropriate post-discharge care.

scholarly journals LO53: Emergency department visits for hyperglycemia: through the eyes of the patient

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S26-S26
Author(s):  
J. Yan ◽  
D. Azzam ◽  
S. Liu ◽  
T. Spaic ◽  
M. Columbus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Glycemic Control ◽  
Patient Experience ◽  
Diabetes Care ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Comparative Approach ◽  
Post Discharge

Introduction: Patients with poorly-controlled diabetes often visit the emergency department (ED) for treatment of hyperglycemia. While previous qualitative studies have examined the patient experience of diabetes as a chronic illness, there are no studies describing patients’ perceptions of ED care for hyperglycemia. The objective of this study was to explore the patient experience regarding ED hyperglycemia visits, and to characterize perceived barriers to adequate glycemic control post-discharge. Methods: This study was conducted at a tertiary care academic centre in London, Ontario. A qualitative constructivist grounded theory methodology was used to understand the experience of adult patient partners who have had an ED hyperglycemia visit. Patient partners, purposively sampled to capture a breadth of age, sex, disease and presentation frequency were invited to participate in a semi-structured individual interview to probe their experiences. Sampling continued until a theoretical framework representing key experiences and expectations reached sufficiency. Data were collected and analyzed iteratively using a constant comparative approach. Results: 22 patients with type 1 or 2 diabetes were interviewed. Participants sought care in the ED over other options because of their concern of having a potentially life-threatening condition, advice from a healthcare provider or family member, or a perceived lack of convenient alternatives to the ED based on time and location. Participants’ care expectations centred around symptom relief, glycemic control, reassurance and education, and seeking referral to specialist diabetes care post-discharge. Finally, perceived system barriers that challenged participants’ glycemic control included affordability of medical supplies and medications, access to follow-up and, in some cases, the transition from pediatric to adult diabetes care. Conclusion: Patients with diabetes utilize the ED for a variety of urgent and emergent hyperglycemic concerns. In addition to providing excellent medical treatment, ED healthcare providers should consider patients’ expectations when caring for those presenting with hyperglycemia. Future studies will focus on developing strategies to help patients navigate some of the barriers that exist within our current limited healthcare system, enhance follow-up care, and improve short- and long-term health outcomes.

scholarly journals The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

2020 ◽  
Vol 8 (4) ◽  
pp. 1-188
Author(s):  
Andrew Judge ◽  
Andrew Carr ◽  
Andrew Price ◽  
Cesar Garriga ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Knee Replacement ◽  
Natural Experiment ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Post Discharge ◽  
Replacement Surgery ◽  
Patient Reported ◽  
And Function

Background There is limited evidence concerning the effectiveness of enhanced recovery programmes in hip and knee replacement surgery, particularly when applied nationwide across a health-care system. Objectives To determine the effect of hospital organisation, surgical factors and the enhanced recovery after surgery pathway on patient outcomes and NHS costs of hip and knee replacement. Design (1) Statistical analysis of national linked data to explore geographical variations in patient outcomes of surgery. (2) A natural experimental study to determine clinical effectiveness of enhanced recovery after surgery. (3) A qualitative study to identify barriers to, and facilitators of, change. (4) Health economics analysis to establish NHS costs and cost-effectiveness. Setting Data from the National Joint Registry, linked to English Hospital Episode Statistics and patient-reported outcome measures in both the geographical variation and natural experiment studies, together with the economic evaluation. The ethnographic study took place in four hospitals in a region of England. Participants Qualitative study – 38 health professionals working in hip and knee replacement services in secondary care and 37 patients receiving hip or knee replacement. Interventions Natural experiment – implementation of enhanced recovery after surgery at each hospital between 2009 and 2011. Enhanced recovery after surgery is a complex intervention focusing on several areas of patients’ care pathways through surgery: preoperatively (patient is in best possible condition for surgery), perioperatively (patient has best possible management during and after operation) and postoperatively (patient experiences best rehabilitation). Main outcome measures Patient-reported pain and function (Oxford Hip Score/Oxford Knee Score); 6-month complications; length of stay; bed-day costs; and revision surgery within 5 years. Results Geographical study – there are potentially unwarranted variations in patient outcomes of hip and knee replacement surgery. This variation cannot be explained by differences in patients, case mix, surgical or hospital organisational factors. Qualitative – successful implementation depends on empowering patients to work towards their recovery, providing post-discharge support and promoting successful multidisciplinary team working. Care processes were negotiated between patients and health-care professionals. ‘Good care’ remains an aspiration, particularly in the post-discharge period. Natural experiment – length of stay has declined substantially, pain and function have improved, revision rates are in decline and complication rates remain stable. The introduction of a national enhanced recovery after surgery programme maintained improvement, but did not alter the rate of change already under way. Health economics – costs are high in the year of joint replacement and remain higher in the subsequent year after surgery. There is a strong economic incentive to identify ways of reducing revisions and complications following joint replacement. Published cost-effectiveness evidence supports enhanced recovery pathways as a whole. Limitations Short duration of follow-up data prior to enhanced recovery after surgery implementation and missing data, particularly for hospital organisation factors. Conclusion No evidence was found to show that enhanced recovery after surgery had a substantial impact on longer-term downwards trends in costs and length of stay. Trends of improving outcomes were seen across all age groups, in those with and without comorbidity, and had begun prior to the formal enhanced recovery after surgery roll-out. Reductions in length of stay have been achieved without adversely affecting patient outcomes, yet, substantial variation remains in outcomes between hospital trusts. Future work There is still work to be done to reduce and understand unwarranted variations in outcome between individual hospitals. Study registration This study is registered as PROSPERO CRD42017059473. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system

2014 ◽  
Vol 8 (11-12) ◽  
pp. 418 ◽  
Author(s):  
Hiba Abou-Haidar ◽  
Samuel Abourbih ◽  
David Braganza ◽  
Talal Al Qaoud ◽  
Lawrence Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Radical Prostatectomy ◽  
Enhanced Recovery ◽  
Care Pathway ◽  
Clinical Care ◽  
Hospital Readmissions ◽  
Emergency Department Visits ◽  
Complication Rates ◽  
Universal Healthcare ◽  
Clinical Care Pathway

Introduction: Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system.Methods: Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients’ pre-pathway implementation was compared with 99 consecutive patients’ post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups.Results: Length of hospital stay decreased from a median of 3 (interquartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design.Conclusions: The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions. 

scholarly journals Reducing Emergency Department Visits and Opioid-Related Deaths in Maryland

2021 ◽  
Vol 18 (04) ◽  
Author(s):  
Spencer Andrews ◽  
Cara DeAngelis ◽  
Somayeh Hooshmand ◽  
Neysha Martinez-Orengo ◽  
Melissa Zajdel
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
The State ◽  
Emergency Department Visits ◽  
Treatment Programs ◽  
Opioid Use ◽  
Mobile Clinic ◽  
Emergency Rooms ◽  
Post Discharge ◽  
Vague Language

The state of Maryland has consistently ranked among the top states by opioid-involved overdose deaths. Emergency rooms in Maryland have been overrun with patients struggling with opioid use disorder (OUD). While hospitals are heavily burdened, it has become clear that they serve as a critical entry point for OUD prevention programs. Despite this, when section 19-310 of the Maryland Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 passed, it included vague language requiring hospitals to create their own discharge protocols for such patients rather than putting into place statewide mandates. We propose two alternative solutions. First, the Maryland General Assembly can amend the HOPE and Treatment Act of 2017 to mandate that peer recovery services be made available during inpatient care, within the emergency department, and post-discharge for patients presenting with OUD. Second, we recommend the addition of a subtitle to describe how to establish and operate mobile clinic treatment programs. The former amendment would offer a prompt solution that could reduce opioid-related hospitalizations and deaths in the state. It will also help reach underrepresented populations who are the least likely to access peer recovery support and other health services in response to OUD.

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