After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

AbstractThe first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient “lockdown and fear” phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January–August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.

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P118: Older adults in the emergency department: a retrospective cross-sectional study of the geriatric population in Edmonton emergency departments

CJEM ◽

10.1017/cem.2019.309 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S106-S107

Author(s):

K. Morch ◽

R. Schonnop ◽

A. Gauri ◽

D. Ha

Keyword(s):

Older Adults ◽

Emergency Department ◽

Geriatric Patient ◽

Geriatric Patients ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Health Region ◽

Area Of Interest ◽

Ed Visits

Introduction: The geriatric patient population accounts for an ever increasing proportion of emergency department (ED) visits. Geriatric centered EDs are an emerging area of interest and research. Though there have been past studies looking at older patient presentations at individual hospitals, there is limited data describing geriatric presentations within an entire Canadian geographic health region. This study characterizes the population of older adults utilizing the EDs in the Edmonton Zone, a health region that comprises a total of eleven tertiary (T), urban community (UC) and rural community (RC) hospitals. Methods: This retrospective cross-sectional study targeted all patients ≥65 years presenting to the Edmonton Zone EDs between April 1, 2017 to March 31, 2018. Data was extracted from the Emergency Department Information System (EDIS) database for ten EDs in the health region. Clinical and administrative data points were extracted and examined for each site. Results: We analyzed 100,813 ED geriatric patient visits during our study period, accounting for 18.7% of total ED visits to the Edmonton Zone. The five most common triage complaints at ED presentation were shortness of breath, abdominal pain, chest pain with cardiac features, general weakness, and back pain. CTAS scores 1-3 were assigned to 77.8% of geriatric presentations (T: 86.3%, UC: 77.4%, RC: 60.9%). 27.3% of geriatric patients had presented to an ED within the past 30 days (T: 30.0%, UC: 25.4%, RC: 27.7%). On average, 35.3% of older adult ED visits involved a consultation (T: 51.7%, UC 30.8%, RC 14.6%) and approximately 25% of geriatric patients were admitted to hospital during their ED visit (T: 42.8%, UC: 19.4%, RC: 7.1%). The average length of stay (LOS) in the ED (hh:mm) was 10:19 (T: 10:24, UC: 11:38, RC: 5:43). Overall, 2.4% of all geriatric patients left an ED without being seen after initial registration (T: 2.7%, UC: 2.2%, RC: 2.1%). Conclusion: Older adults represent a significant proportion of the ED visits in the Edmonton Zone. The triage acuity, LOS, re-presentation, consultation and admission rates varied based on the type of ED, which has implications for resource allocation within the health region. Our results can also direct future targeted initiatives and quality improvement projects to the various types of EDs in the Edmonton Zone, and facilitate planning of ED services for older adults in other health regions who have a similar geographic distribution of care sites.

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High-Cost, High-Need Users of Acute Unscheduled HIV Care: A Cross-Sectional Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa037 ◽

2020 ◽

Vol 7 (2) ◽

Author(s):

Conor Grant ◽

Colm Bergin ◽

Sarah O’Connell ◽

John Cotter ◽

Clíona Ní Cheallaigh

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

High Volume ◽

Cross Sectional Study ◽

Emergency Department Visits ◽

Hiv Care ◽

Psychiatric Disease ◽

Cross Sectional ◽

Unscheduled Care ◽

Cumulative Length

Abstract Background High-cost, high-need users are defined as patients who accumulate large numbers of emergency department visits and hospital admissions that might have been prevented by relatively inexpensive early interventions and primary care. This phenomenon has not been previously described in HIV-infected individuals. Methods We analyzed the health records of HIV-infected individuals using scheduled or unscheduled inpatient or outpatient health care in St James’s Hospital, Dublin, Ireland, from October 2014 to October 2015. Results Twenty-two of 2063 HIV-infected individuals had a cumulative length of stay >30 days in the study period. These individuals accrued 99 emergency department attendances and 1581 inpatient bed days, with a direct cost to the hospital of >€1 million during the study period. Eighteen of 22 had potentially preventable requirements for unscheduled care. Two of 18 had a late diagnosis of HIV. Sixteen of 18 had not been successfully engaged in outpatient HIV care and presented with consequences of advanced HIV. Fourteen of 16 of those who were not successfully engaged in care had ≥1 barrier to care (addiction, psychiatric disease, and/or homelessness). Conclusions A small number of HIV-infected individuals account for a high volume of acute unscheduled care. Intensive engagement in outpatient care may prevent some of this usage and ensuing costs.

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Paediatric dermatological conditions in an emergency department: a single-centre study in Thailand

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001215 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001215

Author(s):

Leelawadee Techasatian ◽

Rattapon Uppala ◽

Pariwat Phungoen

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Associated Factors ◽

Hospital Admissions ◽

Cross Sectional Study ◽

Cross Sectional ◽

Paediatric Patients ◽

Drug Eruptions ◽

Dermatological Condition ◽

Mucosal Involvement

BackgroundFew studies have evaluated paediatric dermatological conditions and their associated factors that warrant admission at the emergency department.ObjectivesThe main objective of this study was to present the demographic information of paediatric dermatological conditions encountered in the emergency department and identify possible associated factors for hospital admission.MethodsThis retrospective cross-sectional study included paediatric patients who visited the emergency department between 1 January 2016 and 31 December 2019. Data collection was performed using an authorised electronic medical records programme at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.ResultsA total of 40 683 paediatric patients visited the emergency department during the study period, with 1701 cases presenting dermatological conditions. Infections were the most frequent conditions encountered in the emergency department (647, 38.0%), followed by urticaria/anaphylaxis (478, 28.1%), eczematous diseases (463, 27.2%), cutaneous drug eruptions (64, 3.7%) and miscellaneous (49, 2.9%). Among 1701 paediatric cases with dermatological conditions, only 182 cases (10.7%) were admitted to the hospital and required further management. Cases presenting cutaneous drug eruptions had the highest proportion of hospital admissions (60.9%) and were significantly different from cases in other dermatologic categories (p<0.001). The association of admission found an OR of 0.96 for every year of increase in age (95% CI 0.93 to 0.99, p=0.003).ConclusionThe present study found that the majority of patients with cutaneous conditions visiting the emergency department were non-urgent; however, dermatological emergencies exist and should not be underestimated. Younger paediatric patients presenting with dermatological condition is a population with a high risk for hospital admission. Cutaneous drug eruptions showed the highest proportion of hospital admissions compared with other dermatological categories. Therefore, physicians in the emergency department should always look for specific cutaneous signs of drug eruptions, such as target-like lesions and mucosal involvement in Steven-Johnsons syndrome/toxic epidermal necrolysis to prevent misdiagnosis of this dermatological condition.

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COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i58b34227 ◽

2021 ◽

pp. 471-483

Author(s):

Maram Mohammed Jaboua ◽

Warif Jameel Abdulhaq ◽

Nada Saeed Almuntashiri ◽

Sarah Saud Almohammdi ◽

Asayel Qeblan Aldajani ◽

...

Keyword(s):

Emergency Department ◽

Cross Sectional Study ◽

Emergency Department Visits ◽

Critical Conditions ◽

Sectional Study ◽

Cross Sectional ◽

Coronary Syndrome ◽

Number Of Patients ◽

Ed Visits

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied. Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED. Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively. Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

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Association of asthma with osteopenia, osteoporosis, osteomalacia, and fractures

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.190035 ◽

2020 ◽

Vol 41 (2) ◽

pp. 112-119 ◽

Cited By ~ 2

Author(s):

Mohammed S. Shaheen ◽

Jonathan I. Silverberg

Keyword(s):

Emergency Department ◽

The United States ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Pathologic Fractures ◽

Ed Visits ◽

National Emergency ◽

The Relationship

Background: Previous studies that examined the relationship between asthma, osteoporosis, and pathologic fractures found conflicting results. Objective: To determine whether asthma is associated with osteopenia, osteoporosis, osteomalacia, and fractures in U.S. adults. Methods: A cross-sectional study of 198,102,435 children and adults, including 10,129,307 with asthma, from the 2006‐2012 National Emergency Department Sample, which includes a representative 20% sample of emergency department (ED) visits throughout the United States. Results: ED visits of patients with versus without asthma were associated with higher odds of osteopenia (7 of 7 years: multivariable logistic regression of all years pooled; adjusted odds ratio [aOR] 1.45 [95% confidence interval {CI}, 1.41‐1.50]), osteoporosis (7 of 7 years: aOR 1.85 [95% CI, 1.82‐1.88]), osteomalacia (7 of 7 years: aOR 2.00 [95% CI, 1.61‐2.49]), and pathologic fractures (7 of 7 years: OR 1.24 [95% CI, 1.20‐1.27]). Patients with asthma and with long-term glucocorticoid use had higher odds of osteoporosis, osteopenia, osteomalacia, and fractures compared with patients with asthma and without long-term glucocorticoid use. Patients with asthma and with fractures incurred significantly more inpatient admissions, and higher costs of ED and inpatient care. Conclusion: ED visits with asthma were associated with osteopenia, osteoporosis, osteomalacia, and pathologic fractures.

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Health care provided to asylum-seeking and non-asylum-seeking paediatric patients at a Swiss tertiary hospital

10.21203/rs.2.19022/v1 ◽

2019 ◽

Author(s):

Julia Regina Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Hospital Admissions ◽

Tertiary Care ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional ◽

Admission Rates ◽

Number Of Visits

Abstract Background & Methods To compare health care provided to asylum-seeking and non-asylum-seeking children, we performed a cross-sectional study in a paediatric tertiary care hospital in Switzerland. Patients were identified using administrative and medical electronic health records from January 2016 - December 2017. Results A total of 202’316 visits by 55’789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) patients. The emergency department had the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64’315/200’642) respectively. Hospital admissions were more common in asylum-seeking patients 11% (184/1674) and 7% (14’692/200’642). Frequent visits accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49’886/200’642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients and was less frequently used in asylum-seeking children. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that asylum-seeking patients may present with more complex diseases.

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Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing

Pharmacy ◽

10.3390/pharmacy6030076 ◽

2018 ◽

Vol 6 (3) ◽

pp. 76 ◽

Cited By ~ 6

Author(s):

Majed Alshamrani ◽

Abdullah Almalki ◽

Mohamed Qureshi ◽

Oyindamola Yusuf ◽

Sherine Ismail

Keyword(s):

Respiratory Diseases ◽

Hospital Admissions ◽

Medication Use ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Therapeutic Interventions ◽

Electronic Prescribing ◽

Cross Sectional ◽

Hemodialysis Unit ◽

The Mean

Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%–99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients.

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Factors and outcomes associated with paediatric emergency department arrival patterns through the day

Paediatrics & Child Health ◽

10.1093/pch/pxy173 ◽

2018 ◽

Vol 24 (5) ◽

pp. 323-329

Author(s):

Hathami Almubarak ◽

Garth Meckler ◽

Quynh Doan

Keyword(s):

Emergency Department ◽

Resource Allocation ◽

Cross Sectional Study ◽

Time Of Day ◽

Minor Trauma ◽

Patient Acuity ◽

Cross Sectional ◽

Utilization Patterns ◽

Multivariable Regression ◽

Ed Visits

Abstract Introduction Steadily increasing emergency department (ED) utilization has prompted efforts to increase resource allocation to meet demand. Little is known about the distribution and characteristics of patient arrivals by time of day. This study describes the variability and patterns of ED resource utilization related to patient, acuity, clinical, and disposition characteristics over a 24-hour period. Methods Retrospective cross-sectional study of all visits to a tertiary children’s hospital over a 1-year period. We use descriptive statistics to present ED visit details stratified by shift of arrival, and multivariable regression to explore the association between shift of presentation and hospital admission at index and 7-day return ED visits. Results Of 46,942 visits during the study period, 12% arrived overnight, 42% during the day, and 45% during the evening with variability in pattern of shift arrival by day of week. Overnight arrivals had a higher acuity (Canadian Triage and Acuity Scale [CTAS]) and different presenting complaints (more viral infection, less minor trauma) than day and evening arrivals, but similar ED length of stay. Shift of arrival was not associated with admission to hospital, but age, gender, socioeconomic status (SES), and day of week were. Discussion ED utilization patterns vary by shift of arrival. Though overnight arrivals represent a smaller proportion of total daily arrivals, their acuity is higher, and the spectrum of disease differs from day or evening arrivals. Conclusions Understanding variations and patterns of ED utilization by shift of arrival and day of week may be helpful in tailoring resource allocation to more accurately and specifically meet demands.

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Utilization of Emergency Department Services by the Bedouin Population in Southern Israel

The Scientific World JOURNAL ◽

10.1100/tsw.2007.35 ◽

2007 ◽

Vol 7 ◽

pp. 330-335 ◽

Cited By ~ 4

Author(s):

Arnon Dov Cohen ◽

Jacob Dreiher ◽

Amir Sharf ◽

Daniel Aharon Vardy

Keyword(s):

Emergency Department ◽

Family Physician ◽

Jewish Population ◽

Cross Sectional Study ◽

Cross Sectional ◽

Primary Care Clinics ◽

The Family ◽

Ed Visits ◽

Central Database ◽

Age Adjusted Rates

Excessive use of the emergency department (ED) is associated with increased costs and workload in the ED, patients' inconvenience and disruption of the continuity of care. The study's goal was to describe trends in ED utilization among Bedouins living in southern Israel. A retrospective cross-sectional study was conducted in primary care clinics in southern Israel. Patients included Bedouin and Jewish patients insured by Clalit Health Services. Data was retrieved from a central database. The number of visits to the ED and age-adjusted rates of ED visits during 2000-2003 were determined in the Bedouin vs. Jewish population. All visits that ended in hospitalization were excluded. Data was stratified according to patients' residence (semi-nomadic vs. urban Bedouins) and referral origin. Age-adjusted rates of ED visits decreased from 42.9/1000 patients/month in 2000 to 38.3/1000 patients/month in 2003. There were more ED visits in the Bedouin as compared to Jewish population (38.3/1000 vs. 21.8/1000 patients/month). The decrease in ED utilization was more prominent among adult semi-nomadic Bedouins (from 60.8/1000 to 40.3/1000 patients/month). The proportion of referrals by the family physician to ED significantly decreased (among urban Bedouins: from 54.3% to 43.2%, p<0.001; among semi-nomadic Bedouins: from 53.9% to 39.9%, p<0.001), while the proportion of selfreferrals and referrals from physicians other than the family physician increased. A decrease in ED utilization by the Bedouin population during the last years was demonstrated. Utilization of ED services is still increased as compared to the non-Bedouin population. Interventions to control excessive use of ED services in the Bedouin population are currently underway.

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