Operational metrics, patient demographics, acuity, and treatment times at privately owned freestanding emergency departments

Abstract Background Pediatric patients present to Emergency Departments (EDs) with a variety of medical conditions. An appreciation of the common presenting conditions can aid EDs in the provision of pediatric emergency care. In this study, we established the common pediatric diagnoses seen at the general EDs, with reference to a pediatric ED. Methods A retrospective review of medical records was performed for patients less than 16 years old at a pediatric ED and two general EDs from 1 January to 31 December 2018. Information including patient demographics, triage category, case type and diagnoses were collected. Results There were 159,040 pediatric attendances, of which 3477 (2.2%) were seen at the general EDs. Non-traumatic conditions were most prevalent at both general (N = 1933, 55.6%) and pediatric (N = 128,415, 82.5%) EDs. There was a higher proportion of trauma related conditions seen at the general EDs (N = 1544, 44.4%) compared to the pediatric ED (N = 27,148, 17.5%; p < 0.01). Across all EDs, upper respiratory tract infection, unspecified musculoskeletal pain and gastroenteritis were the three most common non-trauma related diagnoses, while fracture, wound and contusion were the three most common trauma related diagnoses. There was a greater proportion of emergent (P1) cases seen at the general EDs (N = 233, 6.7%) than the pediatric ED (N = 3821, 2.5%; p < 0.01). Respiratory conditions including bronchiolitis, asthma and bronchitis were the most common emergent (P1) diagnoses. Conclusions The common diagnoses among pediatric attendances varied between pediatric and general EDs. Therefore, general EDs should focus their efforts on these common diagnoses, especially the emergent (P1) ones, so that they can enhance their preparedness and work towards providing quality pediatric emergency care.

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Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000959 ◽

2016 ◽

Vol 31 (6) ◽

pp. 675-679 ◽

Cited By ~ 5

Author(s):

Olindi Wijesekera ◽

Amanda Reed ◽

Parker S. Chastain ◽

Shauna Biggs ◽

Elizabeth G. Clark ◽

...

Keyword(s):

Infectious Disease ◽

Emergency Medical Services ◽

Emergency Departments ◽

Chart Review ◽

Retrospective Chart Review ◽

Medical Services ◽

Publication Type ◽

Patient Demographics ◽

Emergency Medical ◽

Chief Complaints

AbstractIntroductionWithout a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) utilization in four Indian emergency departments. Prehosp Disaster Med. 2016;31(6):675–679.

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Comparing Physician Assistant and Nurse Practitioner Practice in U.S. Emergency Departments, 2010–2017

Western Journal of Emergency Medicine ◽

10.5811/westjem.2021.5.51988 ◽

2021 ◽

Vol 22 (5) ◽

pp. 1150-1155

Author(s):

Fred Wu ◽

Michael Darracq

Keyword(s):

Nurse Practitioner ◽

Emergency Departments ◽

Physician Assistant ◽

Secondary Analysis ◽

Patient Demographics ◽

The Past ◽

Practice Characteristics ◽

Care Survey ◽

Ed Visits ◽

Ambulatory Medical Care

Introduction: We sought to compare physician assistant (PA) and nurse practitioner (NP) practice in United States emergency departments (ED) based on ED visits as reported by the National Hospital Ambulatory Medical Care Survey (NHAMCS). Methods: We performed a retrospective, secondary analysis of the 2010 to 2017 NHAMCS with analysis of ED visits, patient demographics, and hospital characteristics. Results: Between 2010 to 2017, 21.0% (95% confidence interval, [CI] +/-3.1%) of ED visits were seen by either a PA/NP (with and without physician involvement) and 8.6% (+/-2.9%) were seen by PA/NP alone. We identified an increase for NP visits between 2014–2016 and found that PA/NP visits share many of the same characteristics. Conclusion: While emergency medicine has predominately been a specialty for PAs, the number of ED visits with NPs has been increasing over the past several years. While there are some differences, PAs/NPs share many similar practice characteristics in the ED.

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P087: Cellulitis and erysipelas management at an academic emergency department: current practice vs the literature

CJEM ◽

10.1017/cem.2017.289 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S107-S108

Author(s):

J. Martin ◽

C.R. Wilson ◽

T. Chaplin

Keyword(s):

Emergency Departments ◽

Retrospective Chart Review ◽

Current Evidence ◽

Emergency Physicians ◽

Patient Demographics ◽

Academic Hospitals ◽

Kingston General Hospital ◽

Management Plans ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns

Introduction: Cellulitis and erysipelas are common presentations for the general practitioner. Antibiotic therapy targeting beta-hemolytic streptococci and Staphylococcus aureus is the mainstay of treatment for children and adults with these infections. Although evidence-based Canadian guidelines for appropriate management exist, inconsistent practices persist. Our objective was to determine the level of adherence to current evidence by emergency physicians at two academic hospitals in Kingston, Ontario. Methods: We conducted a retrospective chart review of 200 randomly selected electronic medical records. Records belonged to patients with a discharge diagnosis of cellulitis or erysipelas who were seen in the emergency departments of Kingston General Hospital or Hotel Dieu Hospital between January 1 and June 30, 2015. We manually collected data describing patient demographics, medical history, and medical management. Results: There were 707 total visits to the emergency departments in the study period for cellulitis or erysipelas. In our random sample, for those diagnosed with cellulitis, 44% received oral cephalexin alone, which was the most common form of therapy for uncomplicated infection. Of all the patients who received any antibiotics, 36% received at least one dose of parenteral antibiotics, despite only 6.7% showing systemic signs of illness. Emergency physicians chose ceftriaxone for 88% of the patients who received parenteral antibiotics. Conclusion: There was wide variation in antibiotic selection and route of administration for patients with cellulitis or erysipelas. Ceftriaxone was chosen for most patients receiving parenteral antibiotics, but it may not have been the most effective antibiotic in some cases. Overuse of antibiotics is common, and we believe medication choice should be justified based on disease severity, spectrum of activity, and regional antibiotic resistance patterns, among other factors. In conclusion, we found that emergency physicians could more closely align management plans with current guidelines to improve management of uncomplicated infection and reduce unnecessary administration of parenteral antibiotics.

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Management of Mental Health Patients Attending Victorian Emergency Departments

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670701517934 ◽

2007 ◽

Vol 41 (9) ◽

pp. 759-767 ◽

Cited By ~ 48

Author(s):

Jonathan C. Knott ◽

Alex Pleban ◽

David Taylor ◽

David Castle

Keyword(s):

Mental Health ◽

Emergency Department ◽

Median Time ◽

Emergency Departments ◽

Significant Variation ◽

Mental Health Disorder ◽

Patient Demographics ◽

Mental Health Patients ◽

Optimal Patient Care ◽

Icd 10

Objective: To evaluate the management of mental health presentations to Victorian emergency departments. Method: An observational study in five Victorian emergency departments (four metropolitan and one regional). All patients with an ICD-10 discharge diagnosis for a predetermined mental health disorder were included. Data were collected on patient demographics, presentation, clinical management (emergency and mental health) and disposition. Results: There were 3702 patients enrolled (96.0% of all mental health presentations). At presentation 39.1% were intoxicated and 39.9% arrived by ambulance, 17.6% with the police. There was a significant variation (p <0.001) between sites for: the median time to be seen by a clinician (14 vs 43 min), the time between referral to and review by mental health services (15 vs 50 min), the median time in the emergency department (208 min vs 380 min), the proportion who spent >24 h in the emergency department (0.0% vs 11.6%) and disposition (proportion discharged home from ED 49.8% vs 63.5%). Conclusion: Important variations were identified in the management of patients with mental health presentations to Victorian emergency departments. This variation is most likely due to differing access to resources. All levels of administration must work with carers and patients to ensure that optimal patient care is provided at every site.

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Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000001 ◽

2010 ◽

Vol 31 (1) ◽

pp. 1-6 ◽

Cited By ~ 62

Author(s):

Gregory Luke Larkin ◽

Annette L. Beautrais

Keyword(s):

Suicide Prevention ◽

Emergency Departments

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Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽

10.1027/0227-5910/a000499 ◽

2018 ◽

Vol 39 (5) ◽

pp. 318-325 ◽

Cited By ~ 8

Author(s):

Barbara Stanley ◽

Glenn W. Currier ◽

Megan Chesin ◽

Sadia Chaudhury ◽

Shari Jager-Hyman ◽

...

Keyword(s):

Emergency Departments ◽

Suicide Attempts ◽

The United States ◽

Administrative Claims ◽

Suicide Attempters ◽

Self Injury ◽

Axis I ◽

Ed Visits ◽

External Causes ◽

Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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