Impact of health care system interventions on emergency department utilization and overcrowding in Singapore

Abstract Background and Aims The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system. Method Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP. Results Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits. Conclusion In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.

Download Full-text

Fatty liver as a radiological incidental finding in the emergency department: An opportunity to lessen a growing burden on the health care system

Emergency Medicine Australasia ◽

10.1111/1742-6723.13506 ◽

2020 ◽

Vol 32 (3) ◽

pp. 528-529

Author(s):

Numan Kutaiba ◽

Zaid Ardalan ◽

Joe‐Anthony Rotella

Keyword(s):

Health Care ◽

Emergency Department ◽

Fatty Liver ◽

Health Care System ◽

Incidental Finding ◽

Care System

Download Full-text

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

BMC Emergency Medicine ◽

10.1186/1471-227x-12-2 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Jarmo Kantonen ◽

Ricardo Menezes ◽

Tuula Heinänen ◽

Juho Mattila ◽

Kari J Mattila ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Emergency Department ◽

Health Care System ◽

Different Parts ◽

Care System

Download Full-text

Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System

Obstetrics and Gynecology ◽

10.1097/aog.0000000000004331 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mary Kathryn Abel ◽

Mubarika X. Alavi ◽

Cassidy Tierney ◽

Miranda Ritterman Weintraub ◽

Andrew Avins ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care System ◽

Integrated Health Care ◽

Emergency Department Visits ◽

Integrated Health ◽

Gynecologic Emergency ◽

Integrated Health Care System ◽

Care System

Download Full-text

From Their Perspective: The Connection between Life Stressors and Health Care Service Use Patterns of Homeless Frequent Users of the Emergency Department

Health & Social Work ◽

10.1093/hsw/hlz010 ◽

2019 ◽

Vol 44 (2) ◽

pp. 113-122 ◽

Cited By ~ 6

Author(s):

Megan Moore ◽

Kelsey M Conrick ◽

Ashok Reddy ◽

Ann Allen ◽

Craig Jaffe

Keyword(s):

Health Care ◽

Emergency Department ◽

Service Utilization ◽

Health Care System ◽

Service Use ◽

Care Service ◽

Health Care Service ◽

Frequent Users ◽

Medical Needs ◽

Care System

Abstract The perspective of homeless adults on their health care service utilization is not well studied. This article describes a study that used in-depth, semistructured interviews with 18 individuals to highlight the viewpoints of homeless people who are frequent users of the emergency department (ED) about the influence of life events on service utilization. Participants reported high levels of pain and comorbid psychiatric, substance use, and medical conditions. They also reported an identifiable pattern of health care utilization, often centered on a crisis event, influenced by high perceived medical needs, inability to cope after crisis, predisposing vulnerability from social determinants of health, and health care system factors. A social work case management intervention often led to a period of stability and use of ED alternatives. Modifiable targets for intervention at the health care system and local levels include improving trust and convenience of ED alternatives, enhancing consistency of care at ED-alternative sites, and educating those at risk of frequent ED use about community alternatives.

Download Full-text

Appropriate Use of Ceftriaxone in the Emergency Department of a Veteran’s Health Care System

Journal of Pharmacy Technology ◽

10.1177/8755122517720293 ◽

2017 ◽

Vol 33 (6) ◽

pp. 215-218 ◽

Cited By ~ 3

Author(s):

Spencer H. Durham ◽

Mary J. Wingler ◽

Lea S. Eiland

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care System ◽

Inappropriate Prescribing ◽

Vital Signs ◽

Retrospective Chart Review ◽

The United States ◽

Generation Cephalosporin ◽

Veteran’S Health ◽

Care System

Background: Ceftriaxone is a third-generation cephalosporin commonly utilized as an empiric antibiotic treatment option in the emergency department (ED). Overuse can lead to decreased susceptibility and emergence of multidrug-resistant pathogens, increased costs, and unnecessary adverse effects. Objective: The purpose of this project was to determine the appropriateness of ceftriaxone usage in the ED of a veteran’s health care system. Methods: This retrospective chart review included all veterans who received at least one dose of ceftriaxone in the ED between June 1, 2014, and June 1, 2015. The primary outcome was the percentage of appropriate ceftriaxone use. Usage appropriateness was determined on a case-by-case basis by examining current published guidelines and local recommendations based on the institutional antibiogram. Results: Ceftriaxone was prescribed for a wide variety of indications and was determined to be inappropriately prescribed in 164 patients (53%). The most common reason for inappropriate prescribing was lack of a first-line indication for ceftriaxone (64%). Only 120 patients (38.5%) exhibited systemic signs of infection based on vital signs and laboratory parameters, and 25 patients (8%) likely did not require antibiotic therapy at all. Conclusions: Ceftriaxone was used inappropriately in more than half of the patients who received the drug in the ED. The literature on the prescribing habits for ceftriaxone is limited in the United States, but these results are similar to studies conducted in other countries. Attempts should be made to educate prescribers on appropriate indications for the use of ceftriaxone.

Download Full-text

Patient Flow at Emergency Department – The Safety Net of Health Care System

JMS SKIMS ◽

10.33883/jms.v15i2.150 ◽

2012 ◽

Vol 15 (2) ◽

pp. 132-135 ◽

Cited By ~ 1

Author(s):

Farooq Ahmad Jan ◽

Malik Aubid ◽

Anil Manhas ◽

Abdul Hakim ◽

Amir Saeed Khan ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care System ◽

Patient Flow ◽

Systemic Disease ◽

Tertiary Care ◽

Safety Net ◽

Tertiary Care Centre ◽

Total Capacity ◽

Care System

BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the safety net of the health care system. Unfortunately the increasing problem of crowding has strained this safety net to the breaking point according to some recent reports. OBJECTIVE: To study the patient flow at Emergency Department of a tertiary care centre. METHODS: This prospective study was carried over a period of two weeks at SKIMS in the month of December 2011. RESULTS: Of 175 patients attending on an average within twenty four hours to SKIMS emergency department, 22.3% of patients were admitted. 50 patients on an average were being treated at ED reception, the space which is meant for maximum of 16 patients. The hospital crowding was primarily regarded as a consequence of inadequate medical resources. Patients were seen more likely to leave without being seen when ED occupancy exceeded 100% of the total capacity. The shifting of admitted patients from ED depended on throughput factors in the parent speciality. It was also observed that patients who historically would be admitted through OPD would also find entry through ED. CONCLUSION: ED crowding is a local manifestation of a systemic disease. The focus has to be multipronged i.e., on Input, Throughput and Output Factors. While as control on input demands wider participation at multicentric community levels, hospitals can focus on the other two class of factors. There has to be clear focus on efficient use of inpatient resources. JMS 2012;15(2):132-35

Download Full-text

Cost impact of sobering centers on national health care spending in the United States

Translational Behavioral Medicine ◽

10.1093/tbm/ibz075 ◽

2019 ◽

Vol 10 (4) ◽

pp. 998-1003 ◽

Cited By ~ 2

Author(s):

Claudia Scheuter ◽

Danielle H Rochlin ◽

Chuan-Mei Lee ◽

Arnold Milstein ◽

Robert M Kaplan

Keyword(s):

Health Care ◽

Emergency Department ◽

Monte Carlo ◽

Health Care System ◽

Alcohol Intoxication ◽

Health Care Spending ◽

Acute Alcohol Intoxication ◽

Monte Carlo Modeling ◽

The U.S ◽

Care System

Abstract Acute alcohol intoxication is responsible for a sizable share of emergency department visits. Intoxicated individuals without other medical needs may not require the high level of care provided by an emergency department. We estimate the impact on U.S. health care spending if individuals with uncomplicated, acute alcohol intoxication were treated in sobering centers instead of the emergency department. We performed a budget impact analysis from the perspective of the U.S. health care system based on published and gray literature reports. Ninety-five percent confidence intervals (CI) were estimated using Monte Carlo modeling with random variation for three variables (cost of an emergency department visit, cost of a sobering center visit, and start-up costs per sobering center visit) and the percentage of cases diverted from emergency departments to sobering centers. Outcomes were expressed in terms of national savings in 2017 U.S. dollars. Assuming a diversion rate of 50% based on previous studies, national savings range from $230 million to $1.0 billion annually. In the Monte Carlo modeling, we found annual national savings of $99.02 million (95% CI: $95.89–$102.19 million), $792.34 million (95% CI: $767.09–$817.58 million), and $1,185.51 million (95% CI: $1,150.64–$1,226.37 million) with diversion rates of 5%, 40%, and 60%, respectively. Implementing sobering centers as a treatment alternative for individuals with uncomplicated acute alcohol intoxication could yield substantial cost savings for the U.S. health care system.

Download Full-text