54 The Impact of a Follow-Up Clinic on Unscheduled Return Visits to an Emergency Department

2015 ◽  
Vol 66 (4) ◽  
pp. S19
Author(s):  
M.A. Grasso ◽  
B. Cotter ◽  
D.A. Jerrard
Keyword(s):  
Emergency Department ◽  
Return Visits ◽  
The Impact

scholarly journals Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vida V. Bliokas ◽  
Alex R. Hains ◽  
Jonathan A. Allan ◽  
Luise Lago ◽  
Rebecca Sng
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Suicide Attempt ◽  
Repeated Measures ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Community Based ◽  
Treatment As Usual ◽  
The Impact

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

scholarly journals Profile and follow-up of patients with tuberculosis in a priority city in Brazil

2015 ◽  
Vol 49 (0) ◽  
Author(s):  
Jisleny da Cruz Pereira ◽  
Marcio Roberto Silva ◽  
Ronaldo Rodrigues da Costa ◽  
Mark Drew Crosland Guimarães ◽  
Isabel Cristina Gonçalves Leite
Keyword(s):  
Surveillance System ◽  
Reporting System ◽  
Southeastern Brazil ◽  
Chi Square ◽  
Significance Level ◽  
Treatment Default ◽  
Chi Square Test ◽  
Return Visits ◽  
The Impact

OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes.METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups.RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively).CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality.

Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis

2015 ◽  
Vol 22 (5) ◽  
pp. 521-525 ◽  
Author(s):  
Jeffrey S. Quon ◽  
Rafael Glikstein ◽  
Christopher S. Lim ◽  
Betty Anne Schwarz
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Initial Diagnosis ◽  
The Impact

Impact of Follow-up Calls From the Pediatric Emergency Department on Return Visits Within 72 Hours

2014 ◽  
Vol 30 (9) ◽  
pp. 613-616 ◽  
Author(s):  
Ran D. Goldman ◽  
Julia J. Wei ◽  
John Cheyne ◽  
Blake Jamieson ◽  
Bat Chen Friedman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Return Visits

Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits

2017 ◽  
Vol 31 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Tina Joseph ◽  
Rebecca A. Barros ◽  
Elise Kim ◽  
Bupendra Shah
Keyword(s):  
Emergency Department ◽  
Clinical Pharmacist ◽  
Medication Reconciliation ◽  
Emergency Department Visits ◽  
Optimal Timing ◽  
Significant Difference ◽  
The Impact ◽  
Late Group ◽  
Hospital Use

Background: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. Objective: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. Methods: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. Results: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). Conclusion: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

Follow-up Observations on 24-Hour Pharmacotherapy Services in the Emergency Department

1992 ◽  
Vol 26 (4) ◽  
pp. 476-480 ◽  
Author(s):  
Nada S. Berry ◽  
Jon E. Folstad ◽  
Jerry L. Bauman ◽  
Jerrold B. Leikin
Keyword(s):  
Emergency Department ◽  
Consultation Service ◽  
University Of Illinois ◽  
Clinical Pharmacists ◽  
Drug Concentrations ◽  
Frequency Of Use ◽  
The University ◽  
Consultation Services ◽  
The Impact

OBJECTIVE: To analyze the impact of 24-hour clinical pharmacy (CP) services in the emergency department (ED). DESIGN: A review of the “on-call report forms” and written consultations provided by CP between July 1985 and December 1987. SETTING: The University of Illinois Hospital. MAIN OUTCOME MEASURES: Patient-related versus non—patient-related cases; solicitor, type of and time per consultation; drug concentration determinations by CP; and comparison with other ED consultation services. RESULTS: Of 3787 consultations 3650 (96 percent) were patient-related, 137 (4 percent) were non—patient-related. Consultations were solicited from another individual in 2774 cases (73 percent); they were initiated by the clinical pharmacists in 831 cases (22 percent). Of the patient-related consultations, 1215 (33.3 percent) involved pulmonary disease, 796 (21.8 percent) toxicology, 635 (17.4 percent) seizures, 411 (11.3 percent) cardiac cases, 268 (7.3 percent) pharmacokinetics, and 325 (8.9 percent) miscellaneous. Consultations were solicited by physicians (1806, 65 percent), nurses (652, 23.5 percent), cardiac arrest page (237, 8.5 percent), patients (45, 2 percent), or pharmacists (34, 1 percent). They averaged 100 minutes each. Of 2197 drug concentrations, 1939 (88 percent) were completed by the clinical pharmacist. Concentrations were obtained for theophylline (1055, 54.4 percent), phenytoin (511, 26.4 percent), phenobarbital (324, 16.7 percent), and acetaminophen (49, 2.5 percent). Compared with other consultation services, CP ranked first in regard to frequency of use. CONCLUSIONS: The CP consultation service in the ED was as well used as most physician consultation services and tended to involve specific therapeutic areas that have implications for the training of emergency department clinical pharmacists.

scholarly journals P094: Meeting patient expectations in the emergency department: preliminary findings from the preparing emergency patients and providers study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S110
Author(s):  
J. Nunn ◽  
C. Cassidy ◽  
D. Chiasson ◽  
S. MacPhee ◽  
J. Curran
Keyword(s):  
Emergency Department ◽  
Response Rate ◽  
Phase 1 ◽  
Patient Expectations ◽  
Satisfaction With Care ◽  
Medical Encounter ◽  
X Ray ◽  
Phase Study ◽  
The Impact

Introduction: Effective communication to develop a shared understanding of patient expectations is critical in establishing a positive medical encounter in the emergency department (ED). However, there is limited research examining patient/caregiver expectations in the ED, and their impact on the beliefs, attitudes and behaviours during and after an ED visit. The objective of this study is to examine patient/caregiver expectations and satisfaction with care in the ED using a patient expectation questionnaire and a follow up survey. Methods: As a part of a larger 3-phase study on patient/caregiver expectations in adult and pediatric EDs, a 7-item, paper-based questionnaire was distributed to all patients and/or caregivers who presented to one of four EDs in Nova Scotia with a Canadian Triage and Acuity Scale (CTAS) score of 2 to 5. A follow-up survey was distributed to all willing participants via email to determine their satisfaction with care received in ED. Descriptive statistics were used to analyze responses. Results: Phase 1 was conducted from January to September 2016. In total, 24,788 expectation questionnaires were distributed to ED patients/caregivers, 11,571 were collected (47% response rate), and 509 patients were contacted for a follow-up survey. Preliminary analysis of 4,533 questionnaires shows the majority of patients (67.1%) made the decision by themselves to present to the ED, while others were advised by a family/friend (22%). Respondents were most worried about an injury (17.8%) followed by illness (15.6%) and expected to talk to a physician (69.9%) and receive an x-ray (39.3%). The majority of physicians (53.3%) reported the expectation tool helped in caring for the patient and 87.5% felt they met patient expectations. There were 147 patient/caregiver responses to a follow-up survey (29% response rate) and 87.1% of responders reported that ED clinicians met their expectations. Conclusion: Patient/caregivers have a variety of concerns, questions, and expectations when presenting to the ED. Obtaining expectations early in the patient encounter may provide opportunities for improved communication between clinicians and patients while enhancing satisfaction with care received. Further analysis is needed to determine the impact of the expectation questionnaire on productivity in the ED.

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