Operationalizing influenza vaccination in an urban safety-net emergency department

PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.

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Unmet Social Needs and Emergency Department Use in an Im/migrant Cohort at an Urban Safety Net Institution

10.21203/rs.3.rs-579906/v1 ◽

2021 ◽

Author(s):

Stephanie Loo ◽

Sarah Kimball ◽

Lauren Ng ◽

Megan B. Cole

Keyword(s):

Emergency Department ◽

Safety Net ◽

Sociodemographic Factors ◽

Social Needs ◽

Care Utilization ◽

Social Barriers ◽

Migrant Populations ◽

Safety Net Hospital ◽

Urban Safety ◽

Employment Needs

Abstract Im/migrants are a vulnerable population who face numerous social barriers. These barriers likely contribute to unmet social needs, which may increase avoidable health care utilization such as emergency department (ED) visits. Within an im/migrant cohort at a large urban safety-net hospital (N = 1405 patients), we describe types and levels of unmet social needs, and estimate the relationship between level of unmet social needs and ED visit rates. Food insecurity was the most prevalent reported social need (30%), followed by educational needs (29%); employment needs (19%); barriers to paying for medications (18%); lack of transportation (17%); and housing insecurity (10%). After adjusting for sociodemographic factors, having ≥ 4 unmet social needs was associated with an additional 249.47 visits/1000 im/migrant patients/year (95% CI 15.95-482.99, p-value = 0.036), relative to those with no reported needs. Our findings emphasize the importance of rigorously assessing and addressing social needs within im/migrant populations, which may narrow disparities in ED use.

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97 Evaluation and Diagnosis of Pulmonary Tuberculosis Among Emergency Department Patients at a Large Urban Safety-Net Hospital in Los Angeles

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2014.07.122 ◽

2014 ◽

Vol 64 (4) ◽

pp. S35

Author(s):

S. Lopez ◽

B. Baker ◽

S. Terp ◽

S. Desai

Keyword(s):

Emergency Department ◽

Los Angeles ◽

Pulmonary Tuberculosis ◽

Safety Net ◽

Safety Net Hospital ◽

Urban Safety ◽

Emergency Department Patients

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COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Journal of Surgical Research ◽

10.1016/j.jss.2021.02.037 ◽

2021 ◽

Vol 264 ◽

pp. 117-123

Author(s):

Katherine F Vallès ◽

Miriam Y Neufeld ◽

Elisa Caron ◽

Sabrina E Sanchez ◽

Tejal S Brahmbhatt

Keyword(s):

Safety Net ◽

Safety Net Hospital ◽

Urban Safety

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140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.450 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S200-S200

Author(s):

Michael Hansen ◽

Barbara Trautner ◽

Roger Zoorob ◽

George Germanos ◽

Osvaldo Alquicira ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Departments ◽

Primary Care Clinic ◽

Antibiotic Use ◽

Safety Net ◽

Care Clinic ◽

Primary Care Clinics ◽

Primary Care Patients ◽

Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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