scholarly journals P055: Quality assessment and improvement evaluation of return visits to the emergency department for ultrasound

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S83
Author(s):  
D. Giffin ◽  
K. Van Aarsen ◽  
M. Brine ◽  
K. Church ◽  
M. Fotheringham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Surgical Treatment ◽  
Ultrasound Examination ◽  
Hospital Setting ◽  
Medical Intervention ◽  
Initial Presentation ◽  
Return Visit ◽  
Retrospective Audit ◽  
Return Visits

Introduction: Depending on the time and day of initial Emergency Department (ED) presentation, some patients may require a return to the ED the following day for ultrasound examination. Return visits for ultrasound may be time and resource intensive for both patients and the ED. Qualitative experience suggests that a percentage of return ultrasounds could be performed at a non-ED facility. Our objective was to undertake a retrospective audit of return for ultrasound usage, patterns and outcomes at 2 academic EDs. Methods: A retrospective review of all adult patients returning to the ED for ultrasound at both LHSC ED sites in 2016 was undertaken. Each chart was independently reviewed by two emergency medicine consultants. Charts were assessed for day and time of initial presentation and return, type of ultrasound ordered, and length of ED stay on initial presentation and return visit. Opinion based questions were considered by reviewers, including urgency of diagnosis clarification required, if symptoms were still present on return, and if any medical or surgical treatment or follow up was arranged based on ultrasound results. Agreement between reviewers was assessed. Results: After eliminating charts for which the return visit was not for a scheduled ultrasound examination, 328 patient charts were reviewed. 63% of patients were female and median [IQR] age was 40 years [27-56]. Abdomen/pelvis represented 50% of the ultrasounds; renal 24%; venous Doppler 15.9%. Symptoms were still present and documented in 79% of cases. 22% of cases required a medical intervention and 9% an immediate surgical intervention. 11% of patients were admitted to hospital on their return visit. Outpatient follow-up based on US results was initiated in 29% of cases. Median [IQR] combined LOS was 479.5 minutes [358.5-621.75]. Agreement between reviewers for opinion based questions was poor (63%-96%). Conclusion: Ideally, formal ultrasound should be available on a 24 hour basis for ED patients in order to avoid return visits. A percentage of return for ultrasound examinations do not result in any significant change in treatment. Emergency departments should consider the development of pathways to avoid return visits for follow up ultrasound when possible. The low incidence of surgical treatment in those returning for US suggests that this population could be served in a non-hospital setting. Further research is required to support this conclusion.

scholarly journals The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19

2021 ◽  
Author(s):  
Şeref Barbaros Arik ◽  
Elif Gunaydin ◽  
Celal İsmail Bİlgiç ◽  
İnanç Güvenç
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Bridging Therapy ◽  
Emergency Surgical Intervention ◽  
Pelvic Ct Scan

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.

scholarly journals Complication of facial cellulitis: muscle hematoma after surgical treatment of complicated pericoronitis

2018 ◽  
Vol 24 (3) ◽  
pp. 122-124
Author(s):  
Hugo Compain ◽  
Alexandre Berquet ◽  
Ludwig-Stanislas Loison-Robert ◽  
Victorin Ahossi
Keyword(s):  
Emergency Department ◽  
Surgical Treatment ◽  
General Anesthesia ◽  
Secondary Infection ◽  
Third Molar ◽  
Two Stage ◽  
Drainage Procedure ◽  
Mandibular Third Molar ◽  
Dental Emergency

Observation: A 24-year-old man was referred to the dental emergency department for the management of a left submandibular cellulitis. The origin was a mandibular third molar. Drainage of the cellulitis and avulsion of the tooth were performed under general anesthesia. The follow-up was marked by a secondary infection of peri-zygomatic hematoma requiring a second drainage procedure. Discussion: The origin of the hematoma was a tear of the insertions of the mandibular elevators secondary to the trismus. The patient underwent two back-to-back general anesthesia procedures with tight trismus making induction and intubation difficult. Conclusion: A two-stage treatment with initial drainage and delayed avulsion after improvement of trismus is discussed.

Impact of Follow-up Calls From the Pediatric Emergency Department on Return Visits Within 72 Hours

2014 ◽  
Vol 30 (9) ◽  
pp. 613-616 ◽  
Author(s):  
Ran D. Goldman ◽  
Julia J. Wei ◽  
John Cheyne ◽  
Blake Jamieson ◽  
Bat Chen Friedman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Return Visits

Evaluation of Unscheduled Return Visits to the Pediatric Emergency Department and Risk Factors for Admission After Return Visit

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Funda Kurt ◽  
Damla Hanalioğlu ◽  
Fatmanur Can ◽  
Fatma Eren Kurtipek ◽  
Halil İbrahim Yakut ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Return Visit ◽  
Return Visits

scholarly journals P050: Unplanned return visits to the paediatric emergency department: Caregiver and physician perspectives

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S81
Author(s):  
K. Gardner ◽  
B. Taylor
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Health Centre ◽  
Final Analysis ◽  
Primary Outcome Measure ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Return Visit ◽  
Return Visits

Introduction: Unplanned return visits to the pediatric emergency department contribute to overcrowding and are used as a quality measure. They have not been well characterized in the literature making it difficult to design interventions to reduce unnecessary return visits. The aim of this study was to understand the reasons for return from the caregiver and physician perspective. Methods: This was a cross sectional survey performed on a convenience sample of unplanned return visits within 72 hours at the IWK Health Centre ED between February and October 2016. Exclusion criteria were: planned return visit, admission during the index visit, or triaged as Canadian Triage and Acuity Score (CTAS) 1 on return visit. Caregiver and physician surveys were developed based on themes identified in published literature. The caregiver was approached to complete a survey after triage and the most responsible physician from the return visit was asked to complete a survey immediately after discharge of the patient from their care. Demographic and clinical data were collected from the ED record from the index and return visits. The primary outcome measure was most important reason for return from the caregiver perspective. Results: There were 461 return visits during the study period and 67 caregivers (14.5%) were included in the final analysis. The response rate for the physician survey was 71%. Caregivers and physicians reported that the most important reason for return was a perceived progression of illness requiring reassessment (79.1% and 66.7% respectively). The majority of caregivers had a family physician on record (95%) but a minority attempted to access their family physician (19.4%) or a walk-in clinic (11.9%). Of those who contacted their family physician only 3 (23%) were offered an appointment within 48 hours and of those who did not contact their family physician 21 (38.2%) stated they would not be able to get an appointment in a reasonable amount of time. Despite this 97% would have trusted their family physician to manage their child's illness. Physicians surveyed stated that the return visit was necessary in 64.6% of cases. Conclusion: Caregivers returned to the ED due to a perceived progression of disease. While some cases may have been appropriate for management in a primary care setting, perceived difficulty with timely access was a barrier. Improved caregiver education about the natural history of disease and the urgency of follow up may reduce return ED visits.

scholarly journals LO26: The efficacy of high dose cephalexin in the outpatient management of moderate cellulitis for pediatric patients

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S36
Author(s):  
B. Farley St-Amand ◽  
E. D. Trottier ◽  
J. Autmizguine ◽  
M. Vincent ◽  
S. Tremblay ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Success Rate ◽  
Pediatric Patients ◽  
Day Treatment ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Treatment Center ◽  
High Dose ◽  
Return Visit

Introduction: Children with moderate cellulitis are often treated with IV antibiotics in the hospital setting, as per recommendations. Previously in our hospital, a protocol using daily IV ceftriaxone with follow-up at the day treatment center (DTC) was used to avoid admission. In 2013, a new protocol was implanted and suggested the use of high dose (HD) oral cephalexin with follow-up at the DTC for those patients. The aim of this study was to evaluate the safety and efficacy of the HD cephalexin protocol to treat moderate cellulitis in children as outpatient. Methods: A retrospective chart review was conducted. Children were included if they presented to the ED between January 2014 and 2016 and were diagnosed with a moderate cellulitis sufficiently severe to request a follow up at DTC and who were treated according to the standard of care with the HD oral cephalexin (100 mg/kg/day) protocol. Descriptive statistics for clinical characteristics of patients upon presentation, as well as for treatment characteristics in the ED and DTC were analyzed. Treatment failure was defined as: need for admission at the time of DTC evaluation, change for IV treatment in DTC or return visit to the ED. Outcomes were compared to historic controls treated with IV ceftriaxone at the DTC, where admission was avoided in 80% of cases. Results: During the study period, 682 children with cellulitis were diagnosed in our ED. Of these, 117 patients were treated using the oral HD cephalexin outpatient protocol. Success rate was 89.5% (102/114); 3 patients had an alternative diagnosis at DTC. Treatment failure was reported in 12 cases; 10 patients (8.8%) required admission, one (0.9%) received IV antibiotics at DTC, and one (0.9%) had a return visit to the ED without admission or change to the treatment. This compares favorably with the previous study using IV ceftriaxone (success rate of 80%). No severe deep infections were reported or missed; 4 patients required drainage. The mean number of visits per patient required at the DTC was 1.6. Conclusion: Treatment of moderate cellulitis requiring a follow-up in a DTC, using an oral outpatient protocol with HD cephalexin is a secure and effective option. By reducing hospitalization rate and avoiding the need for painful IV insertion, HD cephalexin is a favourable option in the management of moderate cellulitis for pediatric patients, when no criteria of toxicity are present.

scholarly journals COVID-19 Follow-App. Mobile App-Based Monitoring of COVID-19 Patients after Hospital Discharge: A Single-Center, Open-Label, Randomized Clinical Trial

2022 ◽  
Vol 12 (1) ◽  
pp. 24
Author(s):  
Ester Marquez-Algaba ◽  
Marc Sanchez ◽  
Maria Baladas ◽  
Claudia España ◽  
Hermes Salvatore Dallo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Hospital Discharge ◽  
Mobile App ◽  
Control Group ◽  
Primary Care Center ◽  
Open Label ◽  
Return Visits ◽  
Experimental Group

Introduction: In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people (both patients and health professionals), and reduce the risk of infection. Objective: To adapt and validate the use of a smartphone application for outpatient follow-up of COVID-19 patients after hospital discharge. Methods: We conducted an open-label clinical trial at Hospital Universitari Vall d’Hebron in Barcelona, Spain. Patients were randomly assigned in a 1:1 ratio to be followed by the Farmalarm app or by their primary care center. The primary endpoint was the reduction in the need for in-person return visits. Results: From 31 March to 4 May 2020, 150 patients were enrolled in the study at hospital discharge: 74 patients were randomized to the experimental group, and 76 to the control group. All patients in the control group and all except for six in the experimental group completed the study. During hospitalization, before study inclusion, all but 4 (97.3%) had viral pneumonia, 91 (60.7%) required supplemental oxygen, and 16 (10.7%) required intensive care unit (ICU) admission. COVID-19–related return visits to the emergency department were significantly higher in the control group (7.9% vs. 0%; p = 0.028) in the per-protocol analysis. Telephone consultations with the emergency department were performed by 12 (15.8%) patients in the control group and 0 (0%) in the experimental group (p < 0.001). Satisfaction with outpatient monitoring was rated higher by the experimental group (5 vs. 4 points; p < 0.001). Conclusions: Following COVID-19 hospital discharge, home follow-up via a mobile app was effective in reducing in-person return visits without undermining patient satisfaction or perception of health, compared with standard follow-up.

scholarly journals P068: Predictors of admission in unscheduled return visits to the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S81-S81
Author(s):  
J. Hayward ◽  
R. Hagtvedt ◽  
W. Ma ◽  
M. Vester ◽  
A. Gauri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Performance Indicator ◽  
Multivariable Analysis ◽  
Distinct Subgroup ◽  
Return Visit ◽  
Index Visit ◽  
System Data ◽  
Return Visits ◽  
One Year ◽  
Ed Crowding

Introduction: The 72-hr unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in Emergency Medicine. Patients with unscheduled return visits and admission to hospital (URVA) may represent a distinct subgroup of URVs compared to unscheduled return visits with no admission (URVNA). Methods: A retrospective cohort study of all 72-hr URVs in adults across nine EDs in the Edmonton Zone (EZ) over a one-year period (Jan 1 2015 Dec 31 2015) was performed using ED information system data. URVA and URVNA populations were compared and a multivariable analysis identified predictors of URVA. Results: Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, OR 3.6), fewer annual ED visits (<4 visits, OR 2.0), higher disease acuity (CTAS 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a large referral hospital (OR 1.4), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit was also a risk factor (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion: We demonstrate that URVA patients comprise a distinct subgroup of 72-hr URVs across an entire health region. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.

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