scholarly journals P108: Cannabis hyperemesis syndrome within emergency department users in the Calgary health region: a retrospective analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S95-S95
Author(s):  
N. G. Packer ◽  
A. D. McRae ◽  
D. Wang
Keyword(s):  
Emergency Departments ◽  
Care Center ◽  
Admission Rate ◽  
Cannabis Use ◽  
Urgent Care ◽  
Health Region ◽  
Calgary Health Region ◽  
Number Of Patients ◽  
Ed Visits ◽  
Cannabis Hyperemesis Syndrome

Introduction: Cannabis hyperemesis syndrome (CHS) is associated with long-term, regular use of marijuana. CHS patients typically present to emergency departments (ED) during a hyper-emetic phase of paroxysmal nausea and vomiting. Despite extensive investigations as well as frequent ED presentations, CHS patients have a delayed time to diagnosis, and many are often missed. To date, there is a paucity of research examining CHS in emergency departments. Our objective was to identify CHS cases presenting to EDs within the Calgary health region, and to quantify the number of patients and frequency of ED visits for CHS. Methods: A retrospective chart review was performed on all patients who presented to any Calgary ED or urgent care center between January 1, 2015 and December 31, 2016 (ages 18 55 years) who had an ED discharge diagnosis of either nausea or vomiting alone, nausea with vomiting, or poisoning by cannabis, as identified in administrative data. Data abstraction from medical records was performed by trained personnel using standardized forms with comprehensive inclusion criteria for CHS. Results: The search strategy yielded a total of 320 ED visits from 156 individual patients. 55% of visits were by males, and 45% by females. The average age was 29.5 years. Of the 156 patients, 53% had cannabis use documented in the chart, with 51% reporting daily and/or regular cannabis use. Relief of symptoms from use of hot showers (a pathognomonic finding) was found in 17% of patients. 18% of patients (n=28) met criteria for CHS, and 28% (n=44) met partial criteria for CHS (having documented regular cannabis use, cyclic vomiting and abdominal pain) but no record of symptom resolution with cessation of cannabis use or from the use of hot showers. Patients meeting CHS criteria had an average of five repeat ED visits during the study period with 16% (n=12) of ED visits resulting in hospital admission. Conclusion: We identified a large cohort of patients with confirmed or suspected CHS. Given that nearly one third of the sample met partial criteria for CHS highlights the need for improved patient screening, as it is possible that this cohort may include missed cases. Further, many CHS patients are not responsive to first-line anti-emetics and accurate diagnosis is crucial for managing these patients effectively in the ED. This is of particular importance given the admission rate for CHS and resulting burden on the health system.

Impact of oncology urgent care center on healthcare utilization.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 7-7
Author(s):  
Christopher Davella ◽  
Peter Whooley ◽  
Emily Milano ◽  
Brian L. Egleston ◽  
Martin Edelman ◽  
...  
Keyword(s):  
Care Center ◽  
Inpatient Admission ◽  
Urgent Care ◽  
Cancer Center ◽  
Urgent Care Center ◽  
Number Of Patients ◽  
Ed Visits ◽  
Urgent Care Centers ◽  
The Impact ◽  
Over Time

7 Background: Studies suggest that many Emergency Department (ED) visits and hospitalizations for cancer patients may be preventable. CMS has made changes to the hospital outpatient reporting program (OP-35) targeting ED visits and admissions in treatment patients for preventable conditions. Oncologic urgent care centers aim to streamline care for this population. Fox Chase Cancer Center (FCCC) developed an urgent care center called the Direct Referral Unit (DRU) in July 2011. We sought to assess the impact of the DRU on care utilization. Methods: We abstracted visits to our adjacent hospital (Jeanes) ED and the DRU from January 2014-June 2018. Visit rates represent the ratio of visits over the total number of patients with a clinic visit at FCCC per year. ED and DRU visits were associated with both a cancer and visit diagnosis per the International Classification of Disease (ICD). Patient demographics were abstracted. We also analyzed visit charges, inpatient admission and 30-day therapy utilization (chemotherapy, immunotherapy, radiation). Results: A total of 13,210 visits were analyzed including 5,789 ED visits and 7,421 DRU visits. Visits to the Jeanes ED increased over time. The average age of patients at time of first visit was 63 and visits were most common in females and Caucasians. Hispanic and African American (AA) patients were more likely to visit the ED compared to the DRU (OR: 7.54 and 1.30). Patients with GI (27%) and thoracic (15%) malignancies had the most visits. Commercial insurance use was most common (48%) followed by Medicare (34%) and Medicaid (16%). DRU use was most frequent on Mondays (22%), while ED use occurred the most on Sundays (17%). The most common DRU visit diagnoses in order of prevalence were dehydration, nausea/vomiting, abdominal pain, fever, shortness of breath, fatigue, diarrhea, cellulitis/rash, constipation and anemia. Inpatient admission rates were similar between the two settings (p=.8176). Patients on active cancer treatment more frequently presented to the DRU in comparison to the ED (p<.0001). The average charges were $2226.22 for a DRU visit vs. $10,253.44 for an ED visit. Conclusions: The increase in ED visits over time as well the more frequent ED use in Hispanic and AA patients both suggest a need for greater urgent care access. Many of the most common visit diagnoses to the DRU align with CMS’s list of preventable conditions, demonstrating the DRU’s success as a triage center targeting these conditions. DRU visits were associated with considerable cost savings, supporting the use of cancer urgent care centers as a cost-effective method to reduce acute care.

scholarly journals Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy

2014 ◽  
Vol 8 (7-8) ◽  
pp. 505 ◽  
Author(s):  
Ryan Kendrick Flannigan ◽  
Geoffrey T. Gotto ◽  
Bryan Donnelly ◽  
Kevin V. Carlson
Keyword(s):  
Radical Prostatectomy ◽  
Urgent Care ◽  
Additional Patient ◽  
Readmission Rates ◽  
Entire Cohort ◽  
Number Of Patients ◽  
Ed Visits ◽  
Hospital Visits ◽  
The Impact

Introduction: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre.Methods: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission.Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively.Conclusions: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

Effect of an Asthma Guideline in 2 Pediatric Emergency Departments and an Urgent Care Center

2017 ◽  
pp. 1 ◽  
Author(s):  
Jennifer J. Dilts ◽  
Sharon G. Humiston ◽  
Brian R. Lee ◽  
Nancy H. Allen ◽  
Jeffrey G. Michael
Keyword(s):  
Emergency Departments ◽  
Care Center ◽  
Pediatric Emergency ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Asthma Guideline

scholarly journals Neurology consults in emergency departments

2019 ◽  
Vol 10 (2) ◽  
pp. 149-155
Author(s):  
Cindy Zhao ◽  
Kathleen Lee ◽  
David Do
Keyword(s):  
Mental Status ◽  
Admission Rate ◽  
Altered Mental Status ◽  
Acute Onset ◽  
Neurologic Deficit ◽  
Number Of Patients ◽  
Ed Overcrowding ◽  
Chief Complaints ◽  
Cumulative Difference ◽  
Ed Visits

ObjectiveTo use the variations in neurology consultations requested by emergency department (ED) physicians to identify opportunities to implement multidisciplinary interventions in an effort to reduce ED overcrowding.MethodsWe retrospectively analyzed ED visits across 3 urban hospitals to determine the top 10 most common chief complaints leading to neurology consultation. For each complaint, we evaluated the likelihood of consultation, admission rate, admitting services, and provider-to-provider variability of consultation.ResultsOf 145,331 ED encounters analyzed, 3,087 (2.2%) involved a neurology consult, most commonly with chief complaints of acute-onset neurologic deficit, subacute neurologic deficit, or altered mental status. ED providers varied most in their consultation for acute-onset neurologic deficit, dizziness, and headache. Neurology consultation was associated with a 2.3-hour-longer length of stay (LOS) (95% CI: 1.6–3.1). Headache in particular has an average of 6.7-hour-longer ED LOS associated with consultation, followed by weakness or extremity weakness (4.4 hours) and numbness (4.1 hours). The largest estimated cumulative difference (number of patients with the specific consultation multiplied by estimated difference in LOS) belongs to headache, altered mental status, and seizures.ConclusionA systematic approach to identify variability in neurology consultation utilization and its effect on ED LOS helps pinpoint the conditions most likely to benefit from protocolized pathways.

scholarly journals MP08: The frequency of emergency departments visits for patients with end-of-life conditions: a call for action

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S44-S45
Author(s):  
S. Kirkland ◽  
M. Kruhlak ◽  
M. Garrido Clua ◽  
C. Villa-Roel ◽  
S. Couperthwaite ◽  
...  
Keyword(s):  
Palliative Care ◽  
Emergency Departments ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Obstructive Pulmonary Disease ◽  
Index Visit ◽  
Number Of Patients ◽  
Ed Visits ◽  
End Stage

Introduction: An increasing number of patients with end-stage diseases present to emergency departments (EDs) for physical, spiritual, psychological and social care. The objective of this study was to identify patients with end-stage diseases with palliative care (PC) needs and document their frequency of ED visits. Methods: This prospective cohort study was conducted in two Canadian EDs. Using a modified palliative care screening tool, volunteer ED physicians were asked to identify adult patients with end-stage, chronic conditions including cancer, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), heart failure (HF), cirrhosis, dementia and/or progressive central nervous system (PCNS) disease. Demographic data were collected from these tools and data regarding patients’ visits in both the 6 months prior to and 30 days following their index visits were collected from the ED Information System. Bivariate analyses were completed using Student's t and chi-square test. Results: A total of 663 patients with end-stage illness were identified; 338 (51%) were female and the median age was 76 (IQR: 63, 85). Cancer was the most common presentation (41%), followed by dementia (23%), COPD (16%), HF (9%), CKD (9%), PCNS disease (9%) and cirrhosis (7%). These patients made a total of 1277 visits in the 6 months prior to and 288 in the 30 days following the index visit. Patients presenting to the EDs with cancer (p = 0.001), cirrhosis (p = 0.005) and CKD (p = 0.03) were more likely to visit an ED in the 6 months prior to their index visit. In contrast, patients presenting with dementia (p &lt; 0.0001) and PCNS disease (p = 0.02) were significantly less likely to present to an ED in the 6 months prior to their index visit. Patients presenting with cirrhosis or CKD had the highest average number of ED visits in the 6 months prior to their index visit (cirrhosis: 4.59 visits, SD: 3.8, p &lt; 0.0001; CKD: 4.39 visits, SD: 3.8, p = 0.0001). Of these patients, those presenting with end-stage cirrhosis were significantly more likely to make a return visit to an ED within 30 days after their index visit (p = 0.014). Conclusion: Cancer is the most common condition for patients with end-stage, chronic illnesses in these EDs. Those presenting with cirrhosis or CKD are at a significantly higher risk of repeat visits to the EDs. This study has identified potential deficits in care and can serve as a baseline for future intervention studies.

scholarly journals Epidemiological profile of non-urgent patient visits to emergency department in a tertiary care hospital in South India

2019 ◽  
Vol 7 (1) ◽  
pp. 128
Author(s):  
Arun Anbumani ◽  
Moses Kirubairaj Amos Jegaraj ◽  
Reka Karruppusami
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Admission Rate ◽  
Urgent Care ◽  
Minor Trauma ◽  
Care Hospital ◽  
Ed Visits ◽  
Epidemiological Profile

Background: Non-urgent visits to emergency department (ED) form a significant proportion of ED visits. The reasons vary from minor injuries, fever of short duration, parental anxiety, and even serious conditions like myocardial infarctions presenting atypically. Non-urgent visits stress the ED services while prolonged waiting affects the patients. The aim was to study the profile of non-urgent visits to emergency department of a tertiary care hospital in South India.Methods: Prospective and descriptive study of patients aged 15 years and above categorized as non-urgent after triage was conducted. Data such as age, gender, reason for visit, time of presentation during the day, duration of ED stay and need for referral were recorded. Quantitative variables were presented as Mean±SD and frequency with percentage for qualitative variables.Results: Non-urgent visits contributed to 47.1% of total ED visits. Reasons for non-urgent visits were fever (15.4%), vomiting (13.9%), breathlessness (7.6%), minor trauma (7.3%), giddiness (7.0%) and dysuria (5.5%). 80.8% of all non- urgent visits were seen by ED doctor within two hours of being triaged. Most patients were treated for their immediate symptoms and 64.8% needed follow-up out-patient appointments. Admission rate was 1.2%. Majority of non-urgent visits (55.7%) were daytime visits and 13% were after-hours.Conclusions: Non-urgent visits contribute to about half of all ED visits and can stress ED. A local triage guideline is necessary to run these services in ED. Extended general practice or family physician run urgent care can relieve the stress on ED while rendering to patients accessible and affordable care. 

The impact of GP referrals on overcrowding in emergency departments and acute medicine

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ayaz A Abbasi ◽  
Shams Khan ◽  
Victor Ameh ◽  
Ilyas Muhammad
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
General Medicine ◽  
Service Evaluation ◽  
Urgent Care ◽  
Ambulatory Assessment ◽  
Acute Medicine ◽  
Number Of Patients ◽  
The Impact

Background/Aims A long-standing issue common to most emergency departments worldwide is overcrowding, and the UK is no exception. Overcrowding can have many adverse consequences, such as increased medical errors, decreased quality of care and poor patient outcomes. This service evaluation aimed to review the number of patients referred to acute specialties by their GPs and to evaluate the impact of these referrals on the flow of patients in and out of the emergency department and acute medicine. Methods GP referral letters were collected at an emergency department in Greater Manchester, England, between 15 May 2019 and 28 May 2019. A proforma was used by a consultant in acute medicine and a consultant in emergency medicine to evaluate each letter. Result A total of 139 GP referrals were received by the emergency department, of which 43 were to general medicine and 96 to other specialties. Of the latter, 54 cases were directed to the emergency department, 20 were directed to a different specialty and 23 did not have a specialty clearly specified. The majority of referrals were for gastrointestinal conditions or abdominal pain, with the next largest category being chest infections. Most of these patients were eventually seen in the trust's ambulatory assessment area to relieve pressure on the emergency department. Conclusions Planned and specific use of urgent care centres and ambulatory assessment areas can help to relieve pressure on emergency departments, but appropriate intervention at the primary care level is also necessary to improve patient flow.

scholarly journals Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems

2014 ◽  
Vol 2 (48) ◽  
pp. 1-126 ◽  
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Janette Turner ◽  
Ravi Maheswaran ◽  
Steve Goodacre ◽  
...  
Keyword(s):  
Case Studies ◽  
Emergency Departments ◽  
Admission Rate ◽  
Mixed Methods Study ◽  
Urgent Care ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Avoidable Admissions ◽  
Care Systems ◽  
Age And Sex

BackgroundRecent increases in emergency admission rates have caused concern. Some emergency admissions may be avoidable if services in the emergency and urgent care system are available and accessible. A set of 14 conditions, likely to be rich in avoidable emergency admissions, was identified by expert consensus.ObjectiveWe aimed to understand variation in avoidable emergency admissions between different emergency and urgent care systems in England.MethodsThe design was a sequential mixed-methods study in three phases. In phase 1 we calculated an age- and sex-adjusted avoidable admission rate for 2008–11. We located routine data on characteristics of emergency and urgent care systems and used linear regression to explain variation in avoidable admissions rates in 150 systems. In phase 2 we undertook in-depth case studies in six systems to identify further factors. A key part of these case studies was interviews with commissioners, service providers and patient representatives, totalling 82 interviews. In phase 3 we returned to the linear regression to test further factors identified in the case studies.ResultsThe 14 conditions accounted for 3,273,395 admissions in 2008–11 (22% of all emergency admissions). The mean age- and sex-adjusted admission rate was 2258 per year per 100,000 population, with a 3.4-fold variation between systems (1268–4359). Characteristics of the population explained the majority of variation: deprivation explained 72% of variation, with urban/rural status explaining 3% more. Systems serving populations with high levels of deprivation and in urban areas had high rates of potentially avoidable admissions. Interviewees described the complexity of deprivation, representing high levels of morbidity, low awareness of alternative services to emergency departments and high expressed need for immediate access to urgent care. Factors related to emergency departments (EDs), hospitals, emergency ambulance services and general practice explained a further 10% of variation in avoidable admissions. Systems with high, potentially avoidable, admission rates had high rates of acute beds (suggesting supply-induced demand), high rates of attendance at EDs (which have been associated with poor perceived access to general practice), high rates of conversion from ED attendances to admissions, and low rates of non-transport to emergency departments by emergency ambulances. The six case studies revealed further possible explanations of variation: there was variation in how hospitals coded admissions; some systems focused proactively on admission avoidance whereas others were more interested in hospital discharge, for example use of multidisciplinary teams based at acute trusts; there were different levels of integration between different services such as health and social care, and acute and community trusts; and some systems faced more challenging problems around geographical boundaries operating for different services in the system. Interviewees often described admission as the easy or safe option.ConclusionsDeprivation explained most of the variation in avoidable admission rates. Research is needed to understand the complex relationship between deprivation and avoidable admission, and to develop interventions tailored to avoid admissions from deprived communities. Standardisation of coding of admissions would reduce variation.FundingThe National Institute for Health Research Health Service and Research Delivery programme.

Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization

2021 ◽  
pp. OP.21.00183
Author(s):  
Bonnie E. Gould Rothberg ◽  
Maureen E. Canavan ◽  
Sophia Mun ◽  
Tannaz Sedghi ◽  
Tracy Carafeno ◽  
...  
Keyword(s):  
Acute Care ◽  
Hospital Admissions ◽  
Clinical Pathways ◽  
Care Center ◽  
Hospitalization Rate ◽  
Urgent Care ◽  
Advanced Practice ◽  
Urgent Care Center ◽  
Care Clinic ◽  
Ed Visits

PURPOSE: Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS: We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS: Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, –8.92/100 to –0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: –3.29 admissions/100 patients; 95% CI, –8.24/100 to 1.67/100; P = .19). CONCLUSION: Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.

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