An Interrupted Time Series Analysis of the Dissemination of a Sickle Cell Vaso-Occlusive Episode Treatment Algorithm and a Case Management Referral Form for Individuals With Sickle Cell Disease in the Emergency Department

2021 ◽  
Vol 47 (1) ◽  
pp. 40-49.e1 ◽  
Author(s):  
Dominique Bulgin ◽  
Emily Bonnabeau ◽  
Angie Alexander ◽  
Emilia Frederick ◽  
Gary Rains ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Sickle Cell Disease ◽  
Time Series Analysis ◽  
Sickle Cell ◽  
Treatment Algorithm ◽  
Interrupted Time Series ◽  
Cell Disease ◽  
Interrupted Time Series Analysis ◽  
Referral Form

scholarly journals Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036182
Author(s):  
Megan Doheny ◽  
Janne Agerholm ◽  
Nicola Orsini ◽  
Pär Schön ◽  
Bo Burström
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Integrated Care ◽  
Older Persons ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Stockholm County ◽  
Series Analysis ◽  
Ed Visits

ObjectiveTo investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits.DesignInterrupted time series analysis from 2000 to 2015.SettingStockholm County.ParticipantsAll inhabitants 65+ years in Stockholm County on 31 December of each study year.InterventionIC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County.OutcomeRates of hospital-based ED visits.ResultsIC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years.ConclusionThe implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.

scholarly journals Patient Controlled Analgesia for Adults with Sickle Cell Disease Awaiting Admission from the Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Josue Santos ◽  
Sasia Jones ◽  
Daniel Wakefield ◽  
James Grady ◽  
Biree Andemariam
Keyword(s):  
Emergency Department ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Treatment Algorithm ◽  
Retrospective Chart Review ◽  
Cell Disease ◽  
Patient Controlled Analgesia ◽  
Analgesic Treatment ◽  
Pain Scores ◽  
Ed Visits

Background.A treatment algorithm for sickle cell disease (SCD) pain in adults presenting to a single emergency department (ED) was developed prioritizing initiation of patient controlled analgesia (PCA) for patients awaiting hospitalization.Objectives.Evaluate the proportion of ED visits in which PCA was started in the ED.Methods.A two-year retrospective chart review of consecutive SCD pain ED visits was undertaken. Data abstracted included PCA initiation, low versus high utilizer status, pain scores, bolus opioid number, treatment times, and length of hospitalization.Results.258 visits resulted in hospitalization. PCA was initiated in 230 (89%) visits of which 157 (68%) were initiated in the ED. Time to PCA initiation was longer when PCA was begun after hospitalization versus in the ED (8.6 versus 4.5 hours,p<0.001). ED PCA initiation was associated with fewer opioid boluses following decision to admit and less time without analgesic treatment (allp<0.05). Mean pain intensity (MPI) reduction did not differ between groups. Among visits where PCA was begun in the ED, low utilizers demonstrated greater MPI reduction than high utilizers (2.8 versus 2.0,p=0.04).Conclusions.ED PCA initiation for SCD-related pain is possible and associated with more timely analgesic delivery.

scholarly journals Effect of the Colombian Emergency Department Triage Policy on the timeliness of ED care and the mortality in patients with cerebrovascular attack: A controlled interrupted time series analysis

2020 ◽  
Author(s):  
Carlos Eduardo Vallejo ◽  
Daniel Felipe Patiño-Lugo ◽  
Daniel Camilo Aguirre-Acevedo ◽  
Juan Pablo Acosta
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Reperfusion Therapy ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Emergency Department Triage ◽  
The City

Abstract Background: Ischemic Cerebrovascular Accident (CVA) is the second cause of death and one of the leading causes of disability in the world. In Colombia, there is a prevalence of 0.16% and a mortality rate of 16.82 deaths per 100,000 inhabitants. This study assessed the Colombian Ministry of Health’s Emergency Department Triage Policy (TP) on the timeliness of hospital care, the mortality, and change in reperfusion therapy of patients with the first episode of an CVA in the Emergency Department (ED) of a hospital in the city of Medellín.Methods: A controlled interrupted time series analysis between January 2011 and November 2017 was performed in one emergency department using segmented regression analysis. The emergency department of other hospital was used as a control. Data were aggregated by month for both ED, including 60 pre-intervention and 23 intervention points.Results: No decrease in the timeliness of care in the ED was found in patients with a stroke after implementing the Colombian Ministry of Health’s TP (12.55 minutes, IC -17.07, 42.17; p: 0.4). The TP intervention produced a level change in the timeliness of care in Triage I and II subgroups, of 28.34 minutes (IC 95% 16.9, 39.79; p valor 0.00), there was no change in the trend. The classification of Triage I and II was more frequent in the post-intervention period. There was evidence of the increase in reperfusion therapy with tissue plasminogen activator (rTPA) in 4% (95% CI – 0.08, - 0.01; p value 0.01). Mortality increased 4% in the post-intervention period without being statistically significant (0.04, IC 95% - 0.08 – 0; p valor 0.06). There were no significant changes in the same outcomes in the control group.Conclusions: The implementation of the triage policy allowed improving the timeliness of ED care only in patients with ischemic CVA classified as Triage I and II, in an Emergency Department in the city of Medellín, Colombia.

scholarly journals Impact of COVID-19 on emergency department attendance in an Australia hospital: a parallel convergent mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049222
Author(s):  
Rebecca Leigh Jessup ◽  
C Bramston ◽  
A Beauchamp ◽  
A Gust ◽  
N Cvetanovska ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Mixed Methods ◽  
Time Series Analysis ◽  
Hospital Care ◽  
Interrupted Time Series ◽  
Mixed Methods Study ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Frequent Attenders

ObjectivesThe COVID-19 pandemic has changed the way people are accessing healthcare. The aim of this study was to examine the impact of COVID-19 on emergency department (ED) attendance for frequent attenders and to explore potential reasons for changes in attendance.DesignThis convergent parallel mixed methods study comprised two parts.SettingAn interrupted time-series analysis evaluated changes in ED presentation rates; interviews investigated reasons for changes for frequent ED users in a culturally and linguistically diverse setting.ParticipantsA total of 4868 patients were included in the time series. A subgroup of 200 patients were interviewed, mean age 66 years (range 23–99).ResultsInterrupted time-series analysis from 4868 eligible participants showed an instantaneous decrease in weekly ED presentations by 36% (p<0.001), with reduction between 45% and 67% across emergency triage categories. 32% did not know they could leave home to seek care with differences seen in English versus non-English speakers (p<0.001). 35% reported postponing medical care. There was a high fear about the health system becoming overloaded (mean 4.2 (±2) on 6-point scale). Four key themes emerged influencing health-seeking behaviour: fear and/or avoidance of hospital care; use of telehealth for remote assessment; no fear or avoidance of hospital care; not leaving the house for any reason.ConclusionsThis study demonstrated reduced ED use by a vulnerable population of previously frequent attenders. COVID-19 has resulted in some fear and avoidance of hospitals, but has also offered new opportunity for alternative care through telehealth.

scholarly journals Effect of number of open charts on intercepted wrong-patient medication orders in an emergency department

2017 ◽  
Vol 25 (6) ◽  
pp. 739-743 ◽  
Author(s):  
Thomas G Kannampallil ◽  
John D Manning ◽  
David W Chestek ◽  
Jason Adelman ◽  
Hojjat Salmasian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Empirical Evidence ◽  
Interrupted Time Series ◽  
Anecdotal Evidence ◽  
Interrupted Time Series Analysis ◽  
Patient Chart ◽  
Patient Medication ◽  
The Impact

Abstract To reduce the risk of wrong-patient errors, safety experts recommend allowing only one patient chart to be open at a time. Due to the lack of empirical evidence, the number of allowable open charts is often based on anecdotal evidence or institutional preference, and hence varies across institutions. Using an interrupted time series analysis of intercepted wrong-patient medication orders in an emergency department during 2010–2016 (83.6 intercepted wrong-patient events per 100 000 orders), we found no significant decrease in the number of intercepted wrong-patient medication orders during the transition from a maximum of 4 open charts to a maximum of 2 (b = −0.19, P = .33) and no significant increase during the transition from a maximum of 2 open charts to a maximum of 4 (b = 0.08, P = .67). These results have implications regarding decisions about allowable open charts in the emergency department in relation to the impact on workflow and efficiency.

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