293 National Pattern of Risk-Standardized Emergency Department Hospital Admission Rates for Adult Patients

Study Design The investigators designed and implemented a 20-year cross-sectional study using the National Electronic Injury Surveillance System database. Objective The purpose of this study is to estimate and compare hospital admission (danger) rates between rugby and football of those who presented to the emergency department with head and neck injuries after playing these sports. Methods The primary predictor variable was sport played. The primary outcome variable was danger, measured by hospital admission rates. Results Over the past 20 years, there has been a trend of decreasing incidence of injuries presenting to the emergency department in both sports. There was no difference in the rate of hospital admission when comparing football and rugby (OR, 1.2; P = .1). Male gender was associated with an increased risk of admission. Other variables associated with hospital admission included white racial group, injury taking place in the fall, being either young (15–24 years old) or senior (65 years of age and over), and being injured at school or at a sport/recreational facility. Conclusions There is no difference in danger as measured by admission rates between American football and rugby. There exists, however, several variables that are associated with admission when sustaining injury to the head and neck, when playing these two sports.

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Models Predicting Hospital Admission of Adult Patients Utilizing Prehospital Data: Systematic Review Using PROBAST and CHARMS

JMIR Medical Informatics ◽

10.2196/30022 ◽

2021 ◽

Vol 9 (9) ◽

pp. e30022

Author(s):

Ann Corneille Monahan ◽

Sue S Feldman

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Real Time ◽

Prediction Models ◽

Assessment Tool ◽

Predictive Performance ◽

Patient Data ◽

Adult Patients ◽

Emergency Department Crowding ◽

Exit Block

Background Emergency department boarding and hospital exit block are primary causes of emergency department crowding and have been conclusively associated with poor patient outcomes and major threats to patient safety. Boarding occurs when a patient is delayed or blocked from transitioning out of the emergency department because of dysfunctional transition or bed assignment processes. Predictive models for estimating the probability of an occurrence of this type could be useful in reducing or preventing emergency department boarding and hospital exit block, to reduce emergency department crowding. Objective The aim of this study was to identify and appraise the predictive performance, predictor utility, model application, and model utility of hospital admission prediction models that utilized prehospital, adult patient data and aimed to address emergency department crowding. Methods We searched multiple databases for studies, from inception to September 30, 2019, that evaluated models predicting adult patients’ imminent hospital admission, with prehospital patient data and regression analysis. We used PROBAST (Prediction Model Risk of Bias Assessment Tool) and CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) to critically assess studies. Results Potential biases were found in most studies, which suggested that each model’s predictive performance required further investigation. We found that select prehospital patient data contribute to the identification of patients requiring hospital admission. Biomarker predictors may add superior value and advantages to models. It is, however, important to note that no models had been integrated with an information system or workflow, operated independently as electronic devices, or operated in real time within the care environment. Several models could be used at the site-of-care in real time without digital devices, which would make them suitable for low-technology or no-electricity environments. Conclusions There is incredible potential for prehospital admission prediction models to improve patient care and hospital operations. Patient data can be utilized to act as predictors and as data-driven, actionable tools to identify patients likely to require imminent hospital admission and reduce patient boarding and crowding in emergency departments. Prediction models can be used to justify earlier patient admission and care, to lower morbidity and mortality, and models that utilize biomarker predictors offer additional advantages.

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Hospital admission rates and emergency department use in relation to glycated hemoglobin in people with diabetes mellitus: a linkage study using electronic medical record and administrative data in Ontario

CMAJ Open ◽

10.9778/cmajo.20170017 ◽

2017 ◽

Vol 5 (3) ◽

pp. E557-E564 ◽

Cited By ~ 3

Author(s):

Richard Birtwhistle ◽

Michael E. Green ◽

Eliot Frymire ◽

Simone Dahrouge ◽

Marlo Whitehead ◽

...

Keyword(s):

Diabetes Mellitus ◽

Emergency Department ◽

Hospital Admission ◽

Medical Record ◽

Electronic Medical Record ◽

Administrative Data ◽

Glycated Hemoglobin ◽

Linkage Study ◽

Emergency Department Use ◽

Admission Rates

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Variation in hospital admission in febrile children evaluated at the Emergency Department (ED) in Europe: PERFORM, a multicentre prospective observational study

PLoS ONE ◽

10.1371/journal.pone.0244810 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244810

Author(s):

Dorine M. Borensztajn ◽

Nienke N. Hagedoorn ◽

Irene Rivero Calle ◽

Ian K. Maconochie ◽

Ulrich von Both ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Disease Severity ◽

Severe Disease ◽

Patient Characteristics ◽

Care Utilization ◽

Upper Respiratory Tract ◽

Admission Rates ◽

Patient Groups ◽

Tract Infections

Objectives Hospitalisation is frequently used as a marker of disease severity in observational Emergency Department (ED) studies. The comparison of ED admission rates is complex in potentially being influenced by the characteristics of the region, ED, physician and patient. We aimed to study variation in ED admission rates of febrile children, to assess whether variation could be explained by disease severity and to identify patient groups with large variation, in order to use this to reduce unnecessary health care utilization that is often due to practice variation. Design MOFICHE (Management and Outcome of Fever in children in Europe, part of the PERFORM study, www.perform2020.org), is a prospective cohort study using routinely collected data on febrile children regarding patient characteristics (age, referral, vital signs and clinical alarming signs), diagnostic tests, therapy, diagnosis and hospital admission. Setting and participants Data were collected on febrile children aged 0–18 years presenting to 12 European EDs (2017–2018). Main outcome measures We compared admission rates between EDs by using standardised admission rates after adjusting for patient characteristics and initiated tests at the ED, where standardised rates >1 demonstrate higher admission rates than expected and rates <1 indicate lower rates than expected based on the ED patient population. Results We included 38,120 children. Of those, 9.695 (25.4%) were admitted to a general ward (range EDs 5.1–54.5%). Adjusted standardised admission rates ranged between 0.6 and 1.5. The largest variation was seen in short admission rates (0.1–5.0), PICU admission rates (0.2–2.2), upper respiratory tract infections (0.4–1.7) and fever without focus (0.5–2.7). Variation was small in sepsis/meningitis (0.9–1.1). Conclusions Large variation exists in admission rates of febrile children evaluated at European EDs, however, this variation is largely reduced after correcting for patient characteristics and therefore overall admission rates seem to adequately reflect disease severity or a potential for a severe disease course. However, for certain patient groups variation remains high even after adjusting for patient characteristics.

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Frequency of Emergency Department Visits for Sickle Cell Disease Vaso-Occlusive Crisis and Its Contribution to Hospital Admission Rates

Blood ◽

10.1182/blood.v126.23.5569.5569 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5569-5569

Author(s):

Patrick Loeffler ◽

Taylor Mueller ◽

Abdullah Kutlar ◽

Robert Gibson ◽

LaShon Sturgis ◽

...

Keyword(s):

Emergency Department ◽

Sickle Cell Disease ◽

Hospital Admission ◽

Admission Rate ◽

Cell Disease ◽

Admission Rates ◽

Time Period ◽

Number Of Visits ◽

The Difference ◽

First Time

Abstract Background: Patients with sickle cell disease (SCD) vaso-occlusive crisis (VOC) frequently seek care in the emergency department (ED). To improve and increase consistency of care patients with uncomplicated VOC, are treated in the Emergency Department Observation Unit (EDOU) where they are treated with an individualized protocol-based pathway. EDOUs have been shown to be effective in meeting treatment guidelines and reducing hospital admission. Objective: This study examines the admission rates of individuals with SCD stratified by frequency of presentation at the EDOU. Methods: A retrospective review of an ED database was completed to explore the relationship between EDOU utilization and admission rate for patients with uncomplicated VOC. All patient records meeting pathway inclusion criteria for uncomplicated VOC during the time period September 2013 through May 2015 were included in the study. Visits were first associated with individual patients. Then, based on the number of visits per time period, patients were categorized as high users, moderate users, or low users. Categorization was done using the number of visits during the first, 12-month period (9/11/13 - 9/10/14), or the second, nine-month period (9/10/14 - 5/31/15). Adaptations to the categorization scheme for the nine-month time period were as follows. Low users were patients that had no more than one visit in either the first or second time period; moderate users were patients with two or three visits in the first time period or two visits in the second; high users were patients with four or more visits in the first time period, or three or more visits in the second time period. Admission rates were calculated as percentages of visits to the EDOU. Rates of admission for high, middle, and low users were compared using an unpaired, one-tailed Student's t-test. This study was approved by expedited review by the institution's Institutional Review Board (IRB). Results: A total of 727 visits for 154 patients were included in the analysis. High users (n=44) had a total of 539 visits and an average patient admission rate of 22% (n=118). Moderate users (n=49) had a total of 108 visits and an admission rate of 31% (n=33). Low users (N=61) had a total of 80 visits and an admission rate of 36% (n=29). The difference between the number of high user admissions and low user admissions was significant (p<0.01) as was the difference between the number of moderate-user visits and the number of high-user visits (p=0.04). The difference between the number of moderate and low user admissions was not significant (p=0.14). Conclusion: This study found that the difference in the number of admissions between high and low users and between high and moderate users was significant. The findings provide support for the value of the EDOU in reducing unnecessary hospital admissions. These findings also raise important questions regarding the phenotypic expression of pain in SCD and the availability of care. Although the criteria for categorization of patients in this study was limited and the time periods unequal the results suggest different patterns of personal response to pain and treatment seeking. It is unknown how these groups may be different in regards to access to care, treatment preferences, self-care practices, or severity of disease. It can be hypothesized from these results that there may be two different patterns of care seeking with some patients only using the EDOU when crisis is severe (low users) and other patients (high users) using the EDOU as part of their regular pain treatment strategy. To address these questions it is necessary to further examine the differences between these groups to look for explanations that can address increased utilization of the EDOU among some patients. Disclosures No relevant conflicts of interest to declare.

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Everyday J.

Legal and Ethical Issues in Emergency Medicine ◽

10.1093/med/9780190066420.003.0019 ◽

2020 ◽

pp. 141-146

Author(s):

Chadd K. Kraus

Keyword(s):

Primary Care ◽

Health Care ◽

Emergency Department ◽

Hospital Admission ◽

Health Care Services ◽

Medical Emergency ◽

State Laws ◽

Admission Rates ◽

Care Services ◽

Ed Visits

Commonly defined as having greater than four emergency department (ED) visits in a year, patients who are frequent users of the ED make up an estimated 3.5% to 10% of all ED visits and have been reported to account for nearly a third of all ED use. Frequent ED users have higher mortality, higher hospital admission rates, and higher use of all health care services, both specialty and primary care, compared to other patients using the ED. These patients should have the autonomy to access ED evaluation and care if he or she believes he or she has a medical emergency. This principle has been codified into both federal and many state laws protecting the “prudent layperson standard.” These patients should not be coerced to not seek ED care if the person believes he or she has an emergent condition.

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