scholarly journals LO65: Safety and satisfaction of a new program redirecting low-acuity emergency department patients to medical clinic: a prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S29-S30 ◽  
Author(s):  
J. Morris ◽  
R. Daoust ◽  
A. Cournoyer ◽  
M. Marquis ◽  
J. Chauny ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Medical Clinics ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
Computer Based

Introduction: Overcrowding in emergency departments (EDs) is a constant problem. One of the major factors contributing to this situation is the inappropriate ED use by patients with low-acuity problems. In order to reduce overuse, EDs have developed agreements with clinics to reorient low-acuity ambulatory patients toward them. These agreements often leave the burden of decision on the triage personnel as to which patients can be safely redirected. The aim of this study was to evaluate the safety of redirecting patients to nearby medical clinics and to evaluate their satisfaction with this program. Methods: In the ED of a tertiary care facility, a computer-based algorithm allowing triage personnel to reorient patients presenting with one of 52 medical complaints, was implemented in 2016. Our prospective cohort study was composed of reorientation admissible ED patients between March 2017 and August 2017. Patient safety was evaluated with patient follow-up phone interviews one week after their visit to the ED to identify the number of patients who needed to return to a medical facility after their reorientation. Patient satisfaction with the reorientation program was evaluated during the same follow-ups. Results: Of the 980 reoriented patients interviewed, only 57 (5.9%; 95% confidence interval [CI] 4.57.5) had to unexpectedly go back to a health care facility. None of these returns were for severe complications. Over 84% of the reoriented patients were satisfied with their reorientation and 89% say they would use this program again. Having a transportation problem was most common reason mentioned by patients for refusing to be reoriented. Conclusion: Reorientation to medical clinics using a new computer-based algorithm was safe and no case of urgent return was seen during the 6-month study period. In addition, patients who were reoriented to medical clinics were satisfied by their treatment experience.

scholarly journals Epidemiological Risk Factors for Acquiring Severe COVID-19: Prospective Cohort Study

2021 ◽  
Vol 36 (5) ◽  
pp. e301-e301
Author(s):  
Salah T. Al Awaidy ◽  
Faryal Khamis ◽  
Ozayr Mahomed ◽  
Ronald Wesonga ◽  
Muna Al Shuabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Facility ◽  
Health Care Facility ◽  
Factors Associated ◽  
Epidemiological Risk

Objectives: We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization. Methods: A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients. Results: We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p =0.029). Conclusions: Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions.

scholarly journals Normal renal sonogram identifies renal colic patients at low risk for urologic intervention: a prospective cohort study

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Justin W. Yan ◽  
Shelley L. McLeod ◽  
Marcia L. Edmonds ◽  
Robert J. Sedran ◽  
Karl D. Theakston
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Medical Records ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Tertiary Care ◽  
Low Risk ◽  
Ureteric Stone ◽  
Tertiary Care Centre ◽  
Imaging Department

AbstractIntroductionDetermining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively.MethodsThis was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit.ResultsOf 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings.ConclusionA normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.

scholarly journals P143: A prospective cohort study characterizing 30-day recurrent emergency department visits for hyperglycemia

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S116
Author(s):  
J. Yan ◽  
D. Azzam ◽  
M. Columbus ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Diabetes Management ◽  
Care Delivery ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Local Health

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), often recur in patients who have poorly controlled diabetes. Identification of those at risk for recurrent hyperglycemia visits may improve health care delivery and reduce ED utilization for these patients. The objective of this study was to prospectively characterize patients re-presenting to the emergency department (ED) for hyperglycemia within 30 days of an initial ED visit. Methods: This is a prospective cohort study of patients ≥18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS from Jul 2016-Nov 2018. Trained research personnel collected data from medical records, telephoned patients at 10-14 days after the ED visit for follow-up, and completed an electronic review to determine if patients had a recurrent hyperglycemia visit to any of 11 EDs within our local health integration network within 30 days of the initial visit. Descriptive statistics were used where appropriate to summarize the data. Results: 240 patients were enrolled with a mean (SD) age of 53.9 (18.6) years and 126 (52.5%) were male. 77 (32.1%) patients were admitted from their initial ED visit. Of the 237 patients (98.8%) with 30-day data available, 55 (23.2%) had a recurrent ED visit for hyperglycemia within this time period. 21 (8.9%) were admitted on this subsequent visit, with one admission to intensive care and one death within 30 days. For all patients who had a recurrent 30-day hyperglycemia visit, 22/55 (40.0%) reported having outpatient follow-up with a physician for diabetes management within 10-14 days of their index ED visit. 7/21 (33.3%) patients who were admitted on the subsequent visit had received follow-up within the same 10-14 day period. Conclusion: This prospective study builds on our previous retrospective work and describes patients who present recurrently for hyperglycemia within 30 days of an index ED visit. Further research will attempt to determine if access to prompt follow-up after discharge can reduce recurrent hyperglycemia visits in patients presenting to the ED.

scholarly journals UNSAFE ABORTIONS AND THEIR COMPLICATIONS: RECENT EXPERIENCES IN A RURAL TERTIARY CARE FACILITY

2020 ◽  
pp. 1-3
Author(s):  
Nilesh Doshi ◽  
Gaddam Thapasya Reddy ◽  
Amit Kumar
Keyword(s):  
Health Facility ◽  
Rural Population ◽  
Tertiary Care ◽  
Care Facility ◽  
Therapeutic Interventions ◽  
Clinical Feature ◽  
Spontaneous Abortions ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
Medical Facilities

Introduction The number of abortions when classified into facility based , medical abortions outside facilities and other type of abortions constituted a medium of 3375252, 14837497 and 807251 cases respectively, when adjusted for various parameters for India. The present study was conducted to include abortions outside medical facilities including methods of abortion, clinical complaints, complications and their management. Material and methods The hospital records for patients who underwent abortions were accessed for a four year period from 2016-2020. The number of patients undergoing supervised abortions and patients presenting with incomplete abortions or related complications were recorded. The presenting complaints for spontaneous abortions and abortions done outside medical health facility along with the therapeutic interventions for such unsafe abortions including complications were assessed. Results The total numbers of abortions were 4316, out of which hospital supervised termination of pregnancies constituted 59.8% where as abortions or related complications outside a medical facility were 40.2 %. The modes of abortion, presenting features and complications of abortions performed outside medical facilities (total number=1824) and the treatment were recorded. Out of these patients with spontaneous abortions were 36.8% whereas those presenting with complications constituted 63.2%. The commonest method for such abortions was use of abortions pills but other abortifacients and crude instrumentation were also recorded. The commonest clinical feature was discharge per vagina, with retained products of conception causing most complications. The main therapeutic procedure done was dilatation and curettage. Conclusion The rural population needs a robust health facility for abortion related care. The sale of abortion pills needs to be tightly regulated . Similarly, crude instrumentation which is a significant cause of morbidity, in unsupervised abortions can be eliminated by awareness and strengthening the health care system making it more approachable for women in rural population.

scholarly journals Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study.

2022 ◽  
Author(s):  
Paul W Blair ◽  
Trishul Siddharthan ◽  
Gigi Liu ◽  
Jiawei Bai ◽  
Joshua East ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Progression ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Tertiary Care ◽  
High Flow ◽  
Pleural Line ◽  
High Flow Oxygen

Objective: The clinical utility of point-of-care lung ultrasound (LUS) for disease severity triage of hospitalized patients with COVID-19 is unclear. Design: Prospective cohort study Setting: A large tertiary care center in Maryland, USA between April 2020 to September 2021. Patients: Hospitalized adults (18 years of age or greater) with positive SARS-CoV-2 RT-PCR results. Interventions: None. Measurements and Main Results: All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean Lung Ultrasound Score (ranging from 0 to 3) across lung zones (mLUSS) was determined. The primary outcome was time to ICU-level care, defined as high flow oxygen, noninvasive, or mechanical ventilation, within 28-days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 59 years and 114 (43.2) % of participants were female. The median mLUSS was 1 (interquartile range: 0.5 to 1.3). Following enrollment, 29 (11.0%) participants went on to require ICU-level care and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (aHR = 3.63; 95% CI: 1.23 to 10.65) and 28-day mortality (aHR = 4.50; 95% CI: 1.52 to 13.31). Pleural line abnormalities were independently associated with disease progression to ICU-level care (aHR = 18.86; CI: 1.57 to 226.09). Conclusions: Participants with a mLUSS of 1 or more or pleural line changes on LUS had an increased likelihood of subsequent requirement of high flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

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