TF-11 Environmental Emergencies Module for Internal Medicine Rotators in the Emergency Department

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

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1111. Characterization of Antibiotic Ordering in Patients with Mental Status Changes and Presumed Urinary Tract Infection in Patients 65 and Older

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.975 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S395-S396

Author(s):

Nicole Harrington ◽

Jessica Leri ◽

Scott Shoop

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Urinary Tract ◽

Mental Status ◽

Asymptomatic Bacteriuria ◽

Altered Mental Status ◽

Practice Change ◽

Antibiotic Selection ◽

Common Diagnosis ◽

Tract Infections

Abstract Background Altered mental status (AMS) is the most common diagnosis among those 65 and older who present to the emergency department (ED). Urinary tract infections (UTIs) account for 15.5% of hospitalizations in this population. The purpose of this study was to determine the incidence of initiation of antibiotics in the ED in patients 65 years and older with mental status changes and asymptomatic bacteriuria or negative urine cultures. Methods A retrospective chart review was performed to evaluate patients aged 65 and older from January 2017 through June 2018 who presented to the ED from home with AMS, a urinalysis that reflexed to culture, and were admitted to an internal medicine unit. The primary outcome was defined as the percentage of patients with AMS who received antibiotics in the ED with asymptomatic bacteriuria or negative urine cultures. Secondary outcomes included adherence to the CCHS UTI antibiotic guideline, incidence of early discontinuation of antibiotics, culture sensitivity to ordered antibiotic, and disposition after discharge. Results A total of 91 patients were included in this study. Seventy-five patients had asymptomatic bacteriuria and antibiotics were started in the ED in 63 (84%) of these patients. Fourteen patients had no growth on culture and seven of these patients (50%) had antibiotics initiated in the ED. Of those who received antibiotics (n = 82), there was 81.7% adherence to the Christiana Care UTI antibiotic selection guideline. Sensitivities were available for 41 isolates and 65.9% were sensitive to the initial antibiotic administered. Antibiotics were discontinued early in 29/82 (35.4%) of patients. Thirty-one patients (33.7%) were discharged to a skilled nursing facility. Conclusion These results indicate that the majority of patients aged 65 and older who presented to the emergency department with altered mental status and no other UTI symptoms such as dysuria, urinary frequency, or urgency were treated with antibiotics. When antibiotics are initiated the majority of providers are adhering to organizational guidelines for antibiotic selection and duration. The results will be shared with Emergency Department and Internal Medicine leadership to foster practice change. Disclosures All authors: No reported disclosures.

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Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients – an observational study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-017-0422-9 ◽

2017 ◽

Vol 25 (1) ◽

Cited By ~ 5

Author(s):

Camilla Strøm ◽

Talie Khadem Mollerup ◽

Laurits Schou Kromberg ◽

Lars Simon Rasmussen ◽

Thomas Andersen Schmidt

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Observational Study ◽

Older Patients ◽

Short Stay ◽

Medicine Department ◽

Internal Medicine Department

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A comparison of machine learning models versus clinical evaluation for mortality prediction in patients with sepsis

10.1101/2020.11.24.20237636 ◽

2020 ◽

Author(s):

William P.T.M. van Doorn ◽

Patricia M. Stassen ◽

Hella F. Borggreve ◽

Maaike J. Schalkwijk ◽

Judith Stoffers ◽

...

Keyword(s):

Internal Medicine ◽

Machine Learning ◽

Emergency Department ◽

Risk Stratification ◽

Roc Curve ◽

Risk Scores ◽

Validation Dataset ◽

Learning Models ◽

Clinical Risk ◽

Machine Learning Models

AbstractIntroductionPatients with sepsis who present to an emergency department (ED) have highly variable underlying disease severity, and can be categorized from low to high risk. Development of a risk stratification tool for these patients is important for appropriate triage and early treatment. The aim of this study was to develop machine learning models predicting 31-day mortality in patients presenting to the ED with sepsis and to compare these to internal medicine physicians and clinical risk scores.MethodsA single-center, retrospective cohort study was conducted amongst 1,344 emergency department patients fulfilling sepsis criteria. Laboratory and clinical data that was available in the first two hours of presentation from these patients were randomly partitioned into a development (n=1,244) and validation dataset (n=100). Machine learning models were trained and evaluated on the development dataset and compared to internal medicine physicians and risk scores in the independent validation dataset. The primary outcome was 31-day mortality.ResultsA number of 1,344 patients were included of whom 174 (13.0%) died. Machine learning models trained with laboratory or a combination of laboratory + clinical data achieved an area-under-the ROC curve of 0.82 (95% CI: 0.80-0.84) and 0.84 (95% CI: 0.81-0.87) for predicting 31-day mortality, respectively. In the validation set, models outperformed internal medicine physicians and clinical risk scores in sensitivity (92% vs. 72% vs. 78%;p<0.001,all comparisons) while retaining comparable specificity (78% vs. 74% vs. 72%;p>0.02). The model had higher diagnostic accuracy with an area-under-the-ROC curve of 0.85 (95%CI: 0.78-0.92) compared to abbMEDS (0.63,0.54-0.73), mREMS (0.63,0.54-0.72) and internal medicine physicians (0.74,0.65-0.82).ConclusionMachine learning models outperformed internal medicine physicians and clinical risk scores in predicting 31-day mortality. These models are a promising tool to aid in risk stratification of patients presenting to the ED with sepsis.

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Medical Practice Differences Among Internal Medicine Fellows During in-hospital Emergency Department 24-hour Shifts

10.21203/rs.3.rs-54661/v1 ◽

2020 ◽

Author(s):

Marina Repusic ◽

Matea Kolacevic Zeljkovic ◽

Alen Babacanli ◽

Vida Olujic ◽

Sandra Radovanic ◽

...

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Medical Practice ◽

University Hospital ◽

Limited Data ◽

Hospital Emergency ◽

Specific Knowledge ◽

Cross Sectional ◽

Emergency Medical Team ◽

Using Data

Abstract Background There are limited data which show how Emergency Department (ED)-specific knowledge and skills are acquired throughout the internal medicine fellowship, especially during 24-hour shifts. The aim of the study was to assess the differences in medical practice between fellows among different fellowship-years in ED settings. Methods We conducted a cross-sectional, retrospective study at a large university hospital using data on every ED examination done during 2016. All data were taken from the hospital information system. We compared 1st-year fellows with all older fellows, as well as 5th-year fellows with all younger fellows. Results In 2016, 55 fellows had ≥ 15 24-hour shifts with 3 attending fellows during one shift. A total of 19’916 patients were examined by attending fellows in the ED. When compared to 2nd-year fellows, 1st-year fellows examined more patients brought to ED by out-of-hospital emergency medical team and had significantly higher share of examined patients per 24-hour shift with lower length of stay. When compared to 5th-year fellows, 1st-year fellows examined older patients, but had lower share of examined patients during one 24-hour shift and participated in fewer CPR cases. When compared to younger fellows, 5th-year fellows participated in more CPR cases and had higher proportion of patients admitted to hospital. Conclusion To our knowledge, this is the first report on the ED medical practice differences among fellows of different fellowship-year. When compared to other fellows, 1st-year fellows participated less in CPR cases, but were faster in providing medical care in ED. 5th-year fellows had the highest proportion of patients admitted to hospital and more CPR cases.

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P021: Impact of emergency department surge and end of shift on patient workup and treatment prior to referral to internal medicine

CJEM ◽

10.1017/cem.2016.197 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S85-S85

Author(s):

V. Charbonneau ◽

I.G. Stiell ◽

E.S. Kwok ◽

L. Boyle

Keyword(s):

Internal Medicine ◽

Heart Failure ◽

Emergency Department ◽

Tertiary Care ◽

Time Of Day ◽

Therapeutic Interventions ◽

Weighted Mean ◽

Admission Rates ◽

Medicine Service ◽

The Impact

Introduction: The goal of this study was to determine if emergency department (ED) surge and end of shift assessment of patients affect the extent of diagnostic tests, therapeutic interventions performed and accuracy of diagnosis prior to referral of patients to Internal Medicine as well as the impact on patient outcomes. Methods: This study was a health records review of consecutive patients referred to the internal medicine service with an ED diagnosis of heart failure, COPD or sepsis, at two tertiary care EDs. We developed a scoring system in consultation with senior emergency and internal medicine physicians to uniformly assess the treatments and investigations performed for patients diagnosed in the ED with heart failure, COPD or sepsis. These scores were then correlated with surge levels and time of day at patient assessment and disposition. Rate of admission and diagnosis disagreements were also assessed. Results: We included 308 patients (101 with heart failure, 101 with COPD, 106 with sepsis). Comparing middle of shift to end of shift, the overall weighted mean scores were 92.2% vs. 91.7% for investigations and 73.5% vs. 70.0% for treatments. Comparing low to high surge times, the overall weighted mean scores were 89.9% vs. 92.6% for investigations and 68.6% vs. 71.7% for treatments. Evaluating each condition separately for investigations and treatments according to time of shift or surge conditions, there were no consistent differences in scores. We found overall high admission rates (93.1 % for heart failure, 91.1% for COPD, 96.2% for sepsis patients), and low rates of diagnosis disagreement (4.0 % heart failure, 10.9% COPD, 8.5% sepsis). Conclusion: We found that surge levels and end of shift did not impact the extent of investigations and treatments provided to patients diagnosed in the emergency department with heart failure, COPD or sepsis and referred to internal medicine. Admission rates for the patients referred were above 90% and there were very few diagnosis disagreements or diversion to alternate service by internal medicine. We believe this supports the emergency physician's ability to adapt to time and surge constraints, particularly in the context of commonly encountered conditions.

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Clinical Characteristics of Influenza in Season 2017/2018 in a German Emergency Department: A Retrospective Analysis

Microbiology Insights ◽

10.1177/1178636119890302 ◽

2019 ◽

Vol 12 ◽

pp. 117863611989030 ◽

Cited By ~ 4

Author(s):

Sonia Mohammad ◽

Klaus Korn ◽

Barbara Schellhaas ◽

Markus F Neurath ◽

Ruediger S Goertz

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

Emergency Department ◽

Influenza A ◽

Clinical Presentation ◽

Clinical Symptoms ◽

Influenza Infection ◽

University Hospital ◽

Influenza B ◽

Younger Patients

Introduction: Influenza infection is a viral disease with significant morbidity and mortality during the cold months. Clinical presentation typically includes cough, fever, and pain. Influenza disease is hardly diagnosed only on the basis of clinical symptoms due to similar clinical presentation of other diseases such as a typical cold or other flu-like diseases. We evaluated patients with proven influenza who presented at an emergency department of internal medicine in a university hospital according to the clinical presentation and different age groups. Materials and Methods: From October 2017 to April 2018, 723 reverse transcription-polymerase chain reaction (RT-PCR) tests for influenza were performed in the emergency department on patients with suspected influenza diagnosed clinically. A total of 240 influenza-positive patients were retrospectively assessed for documented main symptoms, vital parameters, risk factors for an unfavorable course, hospitalization, and death. Results: The mean age of influenza patients was 65 years. Overall, 30 patients were aged 18 to 39 years, 48 patients 40 to 59 years, and 162 patients ⩾60 years. Influenza B in 168 (70%) was predominant to 72 influenza A (mostly H1N1). In only 30% of the patients all three typical symptoms (cough, fever, and headache/myalgia) were documented. Headache or myalgia (with 34%) was rather uncommon in influenza B. Sudden onset was cited in only 5.4%; 57% of all influenza patients were in hospital for a mean of 7.1 days, and 5.8% of all influenza patients died. Patients aged above 60 years had more risk factors, showed typical symptoms less frequently, and were hospitalized longer than younger patients (<60 and <40 years). Conclusions: At an emergency department of internal medicine, influenza-diseased patients are of higher age, show an increased number of comorbidities, and are more likely to have milder symptoms documented. Elderly patients with influenza have a higher hospitalization rate with a longer hospital stay as compared with younger patients.

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The Impact of Suspension of Dermatology On-Call Services

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475420926987 ◽

2020 ◽

Vol 24 (4) ◽

pp. 380-385

Author(s):

Annie Langley ◽

Mark G. Kirchhof

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

Clinical Work ◽

Descriptive Statistics ◽

Ottawa Hospital ◽

General Internal ◽

Life Threatening ◽

Survey Results ◽

Survey Responses ◽

The Impact

Background Dermatological conditions are commonly seen in the emergency department and inpatient wards. The ability to access dermatology on-call services improves the accuracy of diagnosis and management of common and sometimes life-threatening conditions. Limitations of dermatologist availability led to the suspension of the dermatology on-call service for 3 months in Ottawa, Canada. Objectives Our objective was to assess the impact of this call suspension on patient care and the need for a dermatology on-call service at our hospital, as perceived by nondermatologist physicians at our center. Methods A survey was sent to all departments at The Ottawa Hospital, addressed to staff physicians and residents. Participation was entirely voluntary. Descriptive statistics were used to analyze survey responses. Results A total of 105 physicians completed the survey including staff physicians (85%) and resident trainees (15%). The most represented specialties were emergency medicine ( N = 21), general internal medicine ( N = 19), nephrology ( N = 17), neurology ( N = 13), and plastic surgery ( N = 13). Over half of the respondents felt that the lack of dermatology on-call service impacted the care of their patients by a moderate or great extent. Over half reported performing dermatology-related clinical work during the call suspension and two-thirds of these individuals reported feeling uncomfortable or very uncomfortable doing so. Most (94%) participants felt that an on-call dermatology service was useful and 57% deemed it essential. Conclusion Our survey results demonstrate a significant impact of the suspension of a dermatology on-call service, as perceived by nondermatologist physicians. Hospitals need to recognize the importance of on-call dermatology consultations and provide support for divisions to enable this service to continue.

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