The Emergency to Home Project: Impact of an Emergency Department Care Coordinator on Hospital Admission and Emergency Department Utilization Among Seniors

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

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Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Hospital Pediatrics ◽

10.1542/hpeds.2015-0254 ◽

2016 ◽

Vol 6 (10) ◽

pp. 587-594 ◽

Cited By ~ 10

Author(s):

D. A. Paul ◽

A. Agiro ◽

M. Hoffman ◽

C. Denemark ◽

A. Brazen ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Emergency Department Utilization ◽

Medicaid Population

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Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.786 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S332-S332

Author(s):

Anisha Ganguly ◽

Larry Brown ◽

Deepak Agrawal ◽

Kavita Bhavan

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Antimicrobial Therapy ◽

Hospital Admissions ◽

Hospital Charges ◽

Emergency Department Utilization ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Before And After ◽

Ed Visits ◽

Hospital To Home

Abstract Background Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment. Methods We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT. Results Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1). Conclusion Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home. Disclosures All authors: No reported disclosures.

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Emergency department utilization by patients with gynecologic cancer in the United States

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001520 ◽

2020 ◽

pp. ijgc-2020-001520

Author(s):

Benjamin B Albright ◽

Mucio K Delgado ◽

Nawar A Latif ◽

Robert L Giuntoli ◽

Emily M Ko ◽

...

Keyword(s):

United States ◽

Cervical Cancer ◽

Emergency Department ◽

Gynecologic Cancer ◽

The United States ◽

Emergency Department Visits ◽

Emergency Department Utilization ◽

Gynecologic Cancers ◽

Emergency Department Care ◽

Co Morbidity

IntroductionPayment reform will give oncologists increasing responsibility for how patients with cancer meet unexpected care needs.ObjectiveTo differentiate how patients with gynecologic cancers use emergency care, and to assess the characteristics associated with potentially avoidable treat-and-release visits.MethodsWe performed a retrospective cohort study using the Nationwide Emergency Department Sample, a stratified sample of visits in United States hospital-based emergency departments, from 2010 to 2014. Visits by patients with a diagnosis of gynecologic cancer were selected. Sample weights were applied to calculate national estimates of care patterns and trends. Associations with treat-and-release disposition were assessed with weighted logistic regression.ResultsIn the study period, patients with gynecologic cancer made an estimated 370 104 annual emergency department visits (95% CI 351 997 to 388 211). A total of 50.2% of patients were treated and released, 48% were admitted, 1.6% were transferred, and 0.1% died. These visits corresponded to over US$1.27 billion in annual charges, with an average charge of US$3428 per visit (95% CI 3348 to 3509). Driven by growing treat-and-release utilization, annual visits increased, while admission rates fell over time. Patients with cervical cancer represented the plurality (36%) of visits; they were relatively younger, of lower socioeconomic status, and had fewer co-morbidities. Models for treat-and-release disposition did not vary significantly across different cancer populations. In the all-cancer model, increased odds of treat-and-release disposition was associated with cervical cancer diagnosis, younger age, lesser Elixhauser co-morbidity, Medicare coverage (OR=1.19; p<0.001), Medicaid coverage (OR=1.25; p<0.001), uninsured status (OR=1.70; p<0.001), and weekend visits. Visits in the northeast, at urban hospitals, and in winter months showed decreased odds of treat-and-release disposition.DiscussionPatients with gynecologic cancers have been using the emergency department at increasing rates, primarily driven by treat-and-release visits that did not result in admission or death. Patients with cervical cancer have higher rates of treat-and-release utilization and may over-use emergency department care.

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