An Emergency Department-initiated, Web-based, Multidisciplinary Approach to Decreasing Emergency Department Visits by the Top Frequent Visitors Using Patient Care Plans

Background: An increasing number of pharmacists use technology and social media to connect with patients. However, such means may pose confidentiality issues and legal problems. To correct this situation, a platform of teleconsultation services provided by pharmacists, titled “Ask Your Pharmacist,” was created in Quebec, Canada. Methods: A web-based satisfaction survey was carried out among patients and pharmacists who have used the Ask Your Pharmacist platform to describe their experience and satisfaction with the platform and explore the perceived usefulness of this service in the province of Quebec. Results: A total of 53 patients and 27 pharmacists completed the survey. Most patients were satisfied or very satisfied with their experience with Ask Your Pharmacist (96.2%), said that it met their need (88.7%), and agreed they would not have to consult again about the matter discussed with the pharmacist (75.5%). The main motivation of pharmacists for volunteering on Ask Your Pharmacist was to meet the needs of patients (85.1%), promote their profession (55.6%), improve drug utilization in the population (55.6%) and increase accessibility to a pharmacist (51.9%). Most (81.5%) felt that providing written consultation (rather than oral) required more research on their part. Discussion: Most patients judged they would not have to have another consultation about the matter discussed with the pharmacist, suggesting that Ask Your Pharmacist may avoid the need for physician and emergency department visits. Conclusion: Most patients and pharmacists were satisfied with their experience with Ask Your Pharmacist and perceived this service as useful. Further studies should assess the impact of this platform on the utilization of other health care services. Can Pharm J (Ott) 2021;154:xx-xx.

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Screening urine for drugs of abuse in the emergency department: Do test results affect physicians’ patient care decisions?

CJEM ◽

10.1017/s1481803500009064 ◽

2004 ◽

Vol 6 (02) ◽

pp. 104-111 ◽

Cited By ~ 14

Author(s):

Jeffrey S. Eisen ◽

Marco L.A. Sivilotti ◽

Kirsty U. Boyd ◽

Douglas G. Barton ◽

Christopher J. Fortier ◽

...

Keyword(s):

Emergency Department ◽

Patient Care ◽

Drugs Of Abuse ◽

A Priori ◽

Test Results ◽

Care Plans ◽

Independent Expert ◽

Management Plans ◽

Consultant Physician ◽

The Impact

ABSTRACT Background: Drug abuse is a frequent factor in emergency department (ED) visits. Although commonly performed, qualitative testing of urine for drugs of abuse (u-DOA) is inherently limited in its ability to establish the identity, timing or dose of substances used. Previous studies have demonstrated these limitations, but their designs cannot be used to determine whether the results of u-DOA tests affect physicians’ patient care decisions. Our objective was to determine the impact of u-DOA testing on the care of patients who present to the ED. Methods: All adults 18 years of age or older who had u-DOA testing in 2 urban teaching EDs were eligible. Victims of vehicular trauma or sexual assault were excluded. Just prior to communicating the results of u-DOA testing for a patient, an investigator interviewed the ordering physician or consultant physician about the patient care plans for that patient. Test results were then revealed, and the questions immediately repeated. This design isolated the impact of knowledge of u-DOA test results on physicians’ patient care decisions. Any intended changes in patient care plans reported by the interviewed physician were compared to a priori criteria for substantive change and then subsequently reviewed by an independent expert to determine whether that change was justified. Results: Of the 110 u-DOA test results studied and the resultant 133 opportunities to influence physician management plans, there were 4 reported changes in management. One management change was judged to be substantive, but none of the 4 reported changes were considered by the independent expert reviewer to be justified. Urine-DOA testing thus led to a justified change in management in 0/133 instances (95% confidence interval 0%–2.3%). Conclusions: Urine-DOA is rarely helpful in guiding patient care decisions in the ED. The results of this study call into question the need for this test in the ED setting.

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Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163520929734 ◽

2020 ◽

Vol 153 (4) ◽

pp. 224-231

Author(s):

Mohamed Gazarin ◽

Brian Devin ◽

Darren Tse ◽

Emily Mulligan ◽

Mary Naciuk ◽

...

Keyword(s):

Emergency Department ◽

Multidisciplinary Approach ◽

Effective Means ◽

Outcome Evaluation ◽

Emergency Department Visits ◽

Rural Hospital ◽

Added Value ◽

Cross Sectional ◽

Subacute Care ◽

Phone Calls

Background: Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. Methods: We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital’s medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. Results: Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. Conclusions: This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.

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Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians

CJEM ◽

10.2310/8000.2014.141327 ◽

2015 ◽

Vol 17 (2) ◽

pp. 123-130 ◽

Cited By ~ 4

Author(s):

Cheryl Hunchak ◽

David Tannenbaum ◽

Michael Roberts ◽

Thrushar Shah ◽

Predrag Tisma ◽

...

Keyword(s):

Emergency Department ◽

Patient Care ◽

Family Physician ◽

Family Physicians ◽

Communication Tool ◽

Web Based ◽

Absolute Increase ◽

Baseline Rate ◽

Ed Visits ◽

The Impact

AbstractObjective: Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information.Methods: Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys.Results: Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ‘‘often’’ or ‘‘always’’ aware of patient ED visits, used the portal ‘‘always’’ or ‘‘regularly’’ to access patients’ health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care.Conclusion: Introduction of a web-based ED visit communication tool improved ED–family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.

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Factors Affecting Emergency Department Visits, Readmissions, and Reoperations within 30 Days of Ankle Fracture Surgery: An Institutional Retrospective Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00391 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0039

Author(s):

John C. Prather ◽

Bradley Alexander ◽

Jared R. Halstrom ◽

Charles R. Sutherland ◽

Akshar Patel ◽

...

Keyword(s):

Emergency Department ◽

Risk Factor ◽

Patient Care ◽

Healthcare Cost ◽

Ankle Fracture ◽

Emergency Department Visits ◽

Open Fractures ◽

Psychiatric Disease ◽

Care Providers ◽

Fracture Surgery

Category: Ankle; Trauma Introduction/Purpose: With the U.S. healthcare system focused on value of care, providers and hospitals are increasingly measured by factors that increase patient care and decrease healthcare cost. Early postoperative adverse events not only increase healthcare cost, but also illuminate areas of potential improvement in patient care. This study aims to delineate factors that may influence emergency department visits, admissions, and reoperations within 30 days of ankle fracture surgery. Methods: This retrospective review of patients at a Level 1 trauma center evaluated 30-day outcomes after ankle fracture surgery over a 4-year period (2015-2018). The outcome measures assessed were emergency department visits within 30 days, unplanned readmissions within 30 days and unplanned return to the operating room (OR) within 30 days. Patient and injury characteristics were investigated as potential factors related to these 30-day outcomes. Multiple linear regression was used for outcomes. P-values less than 0.05 were considered significant. Results: A total of 619 patients were identified. After exclusion of concurrent pilon fractures, 596 patients were eligible for final analysis. Forty-three (7.2%) patients visited the emergency department within thirty days, 30 (5.0%) patients were readmitted within thirty days, and 10 (1.7%) patients requiring unplanned return to the OR within thirty days. Sex, insurance status, comorbidities such as pulmonary disease, diabetes mellitus, psychiatric disease, and chronic kidney disease, smoking status, and fracture type/location were not found to be significantly related to 30-day events. Age less than 45 was a significant risk factor for returning to the ED within 30 days (RR 2.1, p=0.02). Open fractures were more likely to require unplanned reoperation than closed fractures (RR 5.7, p<0.01). Conclusion: Age less than 45 years old was a risk factor for early ED visits. Open fractures were found to be at increased risk of needing unplanned reoperation. While further investigation into these risk factors is necessary to fully delineate a causal relationship, these findings can help physicians identify ‘at-risk’ populations after ankle fracture surgery and provide the necessary care to minimize early postoperative events. [Table: see text]

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Determinants Associated With the Risk of Emergency Department Visits Among Patients Receiving Integrated Home Care Services: A 6-Year Retrospective Observational Study in a Large Italian Region

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.79 ◽

2020 ◽

Author(s):

Sara Campagna ◽

Alberto Borraccino ◽

Gianfranco Politano ◽

Alfredo Benso ◽

Marco Dalmasso ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Home Care ◽

Emergency Department Visits ◽

Clinical Record ◽

Retrospective Observational Study ◽

Italian Region ◽

Care Plans ◽

Increased Risk ◽

Ed Visits

Background: Allowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). Methods: A retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. Results: A total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR]=1.29), younger patients, those with a family caregiver (OR=1.13), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR=1.91) showed the highest risk of ED visits. Conclusion: Evidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.

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