MP13: Characteristics and outcomes of older emergency department patients assigned a low acuity triage score

Introduction: Older patients are a high-risk population in the Emergency Department (ED) for poor outcomes after ED visit, including return presentation and hospital admission. Little is known however about outcomes in older patients identified as “low acuity” by triage. We aim to describe the characteristics, ED workup, disposition, and 14-day outcomes of ED patients 65 years and up who are triaged as low acuity and compare them to a younger cohort. Methods: This health records review was done in a Canadian tertiary care ED. Included patients received a Canadian Triage Acuity score (CTAS) of 4 or 5 and were either 65 years and up (“older” group), or 40-55 years (controls). Data collected included patient demographics, tests and services involved in ED, and disposition. Return ED visit and hospital admission rates at 14 days were tracked. Data were analyzed descriptively and chi-square testing conducted to assess for differences (p < 0.05) between groups. A pre-planned stratified analysis of patients 65-74 years, 75-84, and 85 and older was conducted. Results: 350 patients (mean age 76.5, 56.6% female) were included in the older group and 150 in the control group (mean age 47.3, 55.3% female). Most patients presented with musculoskeletal or skin complaints (older cohort: 28.6% extremity pain/injury, 10% rash, 8.9% laceration, versus control 30% extremity pain/injury, 14.7% rash, 14.0% laceration) and were triaged to the ambulatory care area (88.6% elderly, 99.3% control). Older patients were significantly more likely than younger controls to be admitted on index visit (5.0% vs 0.3% admit rate, p=0.016). They had a trend towards increased re-presentation rates within 14 days (13.7% vs 8.7% control, p=0.11) and were more likely to be admitted on re-presentation (4.0% vs 0.7%, p=0.045). In sub-group analysis, very elderly patients (85 years and up, n=79) were more likely to be admitted (8.9%, p=0.003). Conclusion: Patients 65 years of age and older who present to the ED with issues labelled as “less acute” at triage are 16 times more likely to be admitted than younger controls. Patients 85 years and up are the primary drivers of this higher admit rate. This study characterizes “low acuity” elders presenting to ED and indicates these patients are high risk for re-presentation and admission within 14 days.

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Characteristics and outcomes of older emergency department patients assigned a low acuity triage score

CJEM ◽

10.1017/cem.2018.17 ◽

2018 ◽

Vol 20 (5) ◽

pp. 762-769 ◽

Cited By ~ 4

Author(s):

Ariel Hendin ◽

Debra Eagles ◽

Victoria Myers ◽

Ian G. Stiell

Keyword(s):

Emergency Department ◽

Older Patients ◽

Admission Rate ◽

High Risk Population ◽

Chi Square ◽

Patients Âgés ◽

Patient Demographics ◽

Included Patient ◽

Emergency Department Patients ◽

Stratified Analysis

AbstractObjectiveAlthough older patients are a high-risk population in the emergency department (ED), little is known about those identified as “less acute” at triage. We aimed to describe the outcomes of patients ages 65 years and older who receive low acuity triage scores.MethodsThis health records review assessed ED patients who were ages 65 years and above or ages 40 to 55 years (controls) who received a Canadian Triage Acuity Scale score of 4 or 5. Data collected included patient demographics, ED management, disposition, and a return visit or hospital admission at 14 days. Data were analysed descriptively and chi-square testing performed. A pre-planned stratified analysis of patients ages 65 to 74, 75 to 84, and 85 and older was conducted.ResultsThree hundred fifty older patients with a mean age of 76.5 years and 150 control patients were included. Most patients presented with musculoskeletal or skin complaints and were triaged to the ambulatory care area. Older patients were significantly more likely than controls to be admitted on the index visit (5.0% v. 0.3%, p=0.016) and on re-presentation (4.0% v. 0.7%, p=0.045). In a subgroup analysis, patients ages 85 years and above were most likely to be admitted (8.9%, p=0.003).ConclusionsOlder patients who present to the ED with issues labelled as “less acute” at triage are 16 times more likely to be admitted than younger controls. Patients ages 85 years and up are the primary drivers of this higher admission rate. Our study indicates that even “low acuity” elders presenting to the ED are at risk for re-presentation and admission within 14 days.

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LO071: Influenza and pneumococcal vaccinations in the emergency department

CJEM ◽

10.1017/cem.2016.108 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S54-S54

Author(s):

J.A. Taylor ◽

E.N. Vu ◽

M. Dawar ◽

J. Li Brubacher ◽

A. Leon

Keyword(s):

Emergency Department ◽

High Risk ◽

Pneumococcal Disease ◽

Primary Outcome ◽

Tertiary Care ◽

Adult Patients ◽

High Risk Population ◽

Exclusion Criteria ◽

Convenience Sample ◽

Risk Population

Introduction: Influenza and pneumococcal disease are vaccine preventable diseases that account for significant morbidity and mortality in Canada. Influenza vaccination has been shown to reduce mortality and pneumococcal vaccination reduces invasive pneumococcal disease. Previous studies have shown that emergency department (ED) patients are often at high risk for influenza and pneumococcal disease and willing to be vaccinated during their ED stay. Our study set out to determine what proportion of adult patients in the ED qualify for and are willing to be vaccinated against influenza and pneumococcus during their ED visit. Methods: Our study used a convenience sample of patients presenting to the ED at a large Canadian tertiary care centre (Vancouver General Hospital). Inclusion criteria were: adult patients (19 years or greater); consenting to be screened for immunization status; and able to communicate in English. The exclusion criteria were: critically ill patients and patients in severe pain. The primary outcome was the proportion of patients presenting to the ED that could be immunized for influenza and pneumococcus (member of a high risk group, unvaccinated and willing to be vaccinated). Secondary outcomes included additional demographic characteristics and patient attitudes regarding vaccination. Results: We screened 413 patients of which 55 did not meet inclusion/exclusion criteria and 104 declined participation. A total of 254 patients completed the survey for a response rate of 71%. Our primary outcome was present in 20% of patients for influenza (high risk for complications, unvaccinated and willing to be vaccinated in the ED). For pneumococcus, 15% were at high risk, unvaccinated and willing to be vaccinated in the ED. In our population, 83% were at high risk of complications from influenza and 58% were at high risk of complications from pneumococcus. In total, 53% of patients would accept influenza vaccine and 44% would accept pneumococcal vaccine. Conclusion: Our study demonstrates that there is a significant high-risk population that is otherwise unreached and are willing to be vaccinated for influenza and pneumococcus in the ED. Our patient population has a very high prevalence of risk factors for complications of pneumonia and influenza. This data suggests that ED patients are a high-risk population and could be a target group for vaccination campaigns.

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Bridging the Intergenerational Gap: The Outcomes of a Student-Initiated, Longitudinal, Inter-professional, Inter-generational Home Visit Program

10.21203/rs.2.21251/v1 ◽

2020 ◽

Author(s):

Kennedy Ng ◽

Gloria Yao Chi Leung ◽

Angeline Jie-Yin Tey ◽

Jia Quan Chaung ◽

Si Min Lee ◽

...

Keyword(s):

Emergency Department ◽

Service Learning ◽

Hospital Admission ◽

Older Patients ◽

Hospital Admissions ◽

Emergency Department Visits ◽

Learning Program ◽

Post Intervention ◽

Admission Rates ◽

Before And After

Abstract Background The older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aimed to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. Methods Teams consisting of healthcare undergraduates and lay volunteers – secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes. Patients’ satisfaction and clinical outcomes were also assessed. Results 226 healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1% and 62.4% respectively. 106 patients participated in TriGen. There was a statistically significant increase in Kogan’s Attitudes towards Old Persons scores pre- and post-intervention for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5 – 16.2, p < 0.001) and 8.3 (95%CI: 6.2 – 10.3, p < 0.001) respectively. There was a statistically significant increase in Palmore FAQ score pre- and post-intervention for SS students. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was a statistically significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. 51 patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. Conclusion TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of lay students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst lay volunteers (SS students) and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.

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Bridging the Intergenerational Gap: The Outcomes of a Student-Initiated, Longitudinal, Inter-professional, Inter-generational Home Visit Program

10.21203/rs.2.21251/v2 ◽

2020 ◽

Author(s):

Kennedy Ng ◽

Gloria Yao Chi Leung ◽

Angeline Jie-Yin Tey ◽

Jia Quan Chaung ◽

Si Min Lee ◽

...

Keyword(s):

Emergency Department ◽

Service Learning ◽

Hospital Admission ◽

Older Patients ◽

Hospital Admissions ◽

Soft Skills ◽

Emergency Department Visits ◽

Learning Program ◽

Post Intervention ◽

Admission Rates

Abstract Background Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. Methods Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients’ reported satisfaction and clinical outcomes were also assessed. Results 226 healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1% and 62.4% respectively. 106 patients participated in TriGen. There was a significant increase in Kogan’s Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5 – 16.2, p < 0.001) and 8.3 (95%CI: 6.2 – 10.3, p < 0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. 51 patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. Conclusion TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.

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Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study. (Preprint)

10.2196/preprints.20555 ◽

2020 ◽

Author(s):

Gobi Hariyanayagam ◽

Sera Selvanthan Sundram Gunasekaran ◽

Shargunan Selvanthan Gunasekaran ◽

Nur Syafina Insyirah Zaimi ◽

Nor Amirah Abdul Halim

Keyword(s):

High Risk ◽

General Population ◽

Binary Logistic Regression ◽

Final Analysis ◽

High Risk Population ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Hygiene Measures ◽

Wet Market ◽

Medical Grade

BACKGROUND In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal market in Wuhan, Hubei, China. This event has instigated negative stigma among the general population to view the wet market as a high-risk location for potential transmission of coronavirus. OBJECTIVE This study investigated the prevalence of facemask use among general population visiting the wet market as well as factors contributing to unacceptable facemask practice. Setting The visitors to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak was observed for facemask practice. METHODS All Individuals visiting the market were observed for the type, category and practice of wearing facemas. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. RESULTS Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028) more likely to have unacceptable facemask practice respectively. CONCLUSIONS High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.

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Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-020-01837-9 ◽

2021 ◽

Author(s):

Laura C. Blomaard ◽

Bas de Groot ◽

Jacinta A. Lucke ◽

Jelle de Gelder ◽

Anja M. Booijen ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Older Patients ◽

Screening Program ◽

Admission Rate ◽

Older Patient ◽

Hospital Admission Rate ◽

High Risk Patients ◽

Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

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Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽

10.1161/circ.142.suppl_3.14721 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ghufran adnan ◽

Osman Faheem ◽

Maria Khan ◽

Pirbhat Shams ◽

Jamshed Ali

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Reduction Rate ◽

Care Hospital ◽

Chi Square ◽

Coronary Syndrome ◽

Significant Difference ◽

Drastic Increase ◽

Chi Square Test ◽

The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

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The Most Dangerous Game: A Review of Head and Neck Injuries in American Football and Rugby

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211073437 ◽

2022 ◽

pp. 194338752110734

Author(s):

Jordan Richardson ◽

Dani Stanbouly ◽

Harrison Moynihan ◽

Renée M. Reynolds ◽

Matthew J. Recker ◽

...

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Head And Neck ◽

Predictor Variable ◽

American Football ◽

Outcome Variable ◽

Neck Injuries ◽

Injury Surveillance System ◽

Admission Rates ◽

Increased Risk

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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Spinal Surgery During COVID-19 Pandemic in Saudi Arabia

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9772 ◽

2021 ◽

pp. 12

Author(s):

Faisal Konbaz ◽

Taif Alqahtani ◽

Nada Alharthi ◽

Mohammad Baraja ◽

Nazish Masud ◽

...

Keyword(s):

Hospital Admission ◽

Tertiary Care ◽

Case Series ◽

Medical Intervention ◽

Care Hospital ◽

Hospital Data ◽

Chi Square ◽

Chi Square Test ◽

The Mean ◽

American Society

Introduction: The COVID-19 pandemic has challenged the healthcare system’s capacities around the world. Due to the alarming situation, medical activities have been restricted to allocate resources to treat COVID-19-infected patients. However, medical emergencies still need urgent medical intervention. Considering the lack of reliable data regarding spinal surgeries during the COVID-19 pandemic, the present study sought to analyze the pattern of spinal surgeries in KSA. Methodology: A case series of patients who had urgent spine surgeries during COVID-19 pandemic was conducted in a tertiary care hospital. Data on patients’ demographics, COVID-19 test result, American Society of Anesthesia Score, SSS grade, diagnosis, and data related to surgery and postoperative findings were collected. All collected data were then processed and analyzed. Surgical outcomes based on source of admission were compared using Chi-square test. Result: A total of 63 patients who underwent spine surgery during the COVID-19 pandemic were included. The mean age of the patients was 53 ± 18 years and males were predominant (59%). The positive COVID-19 patients were 3%. Almost half of the patients were classified into ASA II. The majority were categorized into grade B (65%) according to SSS. The frequently diagnosed condition was fracture (33%), followed by spinal stenosis (18%) and metastatic (10%), while the most mentioned location was lumbar (61%). Postoperative complications were found in 11% of the patients. The readmission rate within 30 days, unplanned return to OR and ICU admission were 19%, 13%, and 11%, respectively. While the mean duration between admission and surgery was 8 ± 20 days, the mean duration of length of stay was 20 ± 29 days. Further, a significant association was seen between the admission source and the surgical procedure performed and surgical indication. Conclusion: It has been demonstrated that the surgical intervention was only provided to patients requiring immediate or urgent spinal management. However, the length of hospitalization and duration between hospital admission and surgery was substantially prolonged. Further studies are warranted to determine the factors leading to prolonged hospitalization and time between hospital admission and surgery.

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