scholarly journals P119: Characteristics and outcomes of patients with neurologic complaints who leave the emergency department without being seen

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S107
Author(s):  
A. Schouten ◽  
A. Gauri ◽  
M. Bullard
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Sensory Loss ◽  
Quality And Safety ◽  
Diagnostic Uncertainty ◽  
University Of Alberta ◽  
Chief Complaints ◽  
Discharged Patients ◽  
Return Visits ◽  
The University

Introduction: Patients with neurologic chief complaints comprised 12.5% of total visits to the University of Alberta Emergency Department (ED) in 2017. Symptoms are often subjective, transient, or atypical, leading to diagnostic uncertainty. Serious diagnoses require timely intervention to mitigate morbidity and mortality, however the proportion of patients who leave the ED without being seen (LWBS) has increased over time. We sought to analyze the characteristics and outcomes of patients with neurologic complaints who LWBS to identify opportunities for improvement in quality and safety of patient care. Methods: Data was extracted from the Emergency Department Information System (EDIS) and National Ambulatory Care Reporting System database to select adult patients presenting to the University of Alberta Hospital in 2017 with neurologic complaints as defined by the Canadian Triage Acuity Scale (CTAS). Using standard descriptive statistics we examined demographic and clinical characteristics to compare LWBS patients to all others. Results: Of 8,726 total visits 7.54% patients LWBS. These patients tended to be younger on average (39 vs 55 years), with a larger proportion presenting at night (37.69%) and on Monday. The majority were triaged CTAS 3 (68.69%). Their mean length of stay was shorter than all other visits (3.70 vs 9.51 hours). Headache (22.74%), extremity weakness/symptoms of CVA (20.19%), head injury (14.32%), seizure (8.28%), and sensory loss/paresthesia (8.14%) comprised the top 5 neurologic complaints, and were disproportionately presented in LWBS patients; headache (31.76%), head injury (23.71%), sensory loss/paresthesia (12.01%), seizure (11.25%). Patients who LWBS also re-presented to the ED within 72 hours (21.43%), more often than those discharged by a physician (8.29%). Conclusion: Patients presenting with neurologic complaints who LWBS are younger, tend to arrive at night, with less acute presentations, however they more frequently return to the ED within 72 hours than those seen and discharged. Patients who LWBS may benefit from education, physician assessment or closer nurse reassessment at triage to increase the quality and safety of care in the ED, reduce return visits and ED utilization.

scholarly journals P120: Characteristics and outcomes of patients with neurologic complaints who have an unscheduled return visit to the emergency department within 72 hours

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S107
Author(s):  
A. Schouten ◽  
A. Gauri ◽  
M. Bullard
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Admission Rate ◽  
Quality And Safety ◽  
University Of Alberta ◽  
Return Visit ◽  
Ed Visits ◽  
Return Visits ◽  
Ischemic Attack ◽  
The University

Introduction: Patients with neurologic presenting complaints comprised 12.5% of total University of Alberta Emergency Department (ED) visits in 2017. This group of patients has high rates of EMS utilization, admission, and ED resources including diagnostic imaging and consult services. We sought to analyze the characteristics and outcomes of the patients with neurologic complaints who have an unscheduled return visit (URV) to the ED within 72 hours to identify opportunities for improvement in quality and safety of patient care. Methods: Data was extracted from the Emergency Department Information System (EDIS) and National Ambulatory Care System databases to select adult patients presenting to the University of Alberta hospital in 2017 with neurologic complaints as defined by the Canadian Triage and Acuity Scale (CTAS). We additionally selected for return visits to Edmonton Zone EDs within 72 hours. Using standard descriptive statistics, we examined demographic and clinical characteristics of patients with 72-hour URV. Results: Of 8,770 total visits, 674 (7.69%) had a 72-hour URV to an Edmonton zone ED. The URV rate was 9.0% in patients seen by a physician and discharged with approval and 23.4-33.3% in patients who left against medical advice (LAMA), prior to completion of treatment (LPCT), or without being seen by a physician (LWBS). The mean age of URV patients was 45.6 years, 56.5% were male, with a mean ED length of stay of 7.37 hours. The top 5 diagnoses for URV patients were headache, migraine, alcohol related disorders, concussion, and transient ischemic attack. 14.7% of URV patients were admitted, 13.5% LWBS, 1.6% LAMA, 1.6% LPCT, and 66.1% were discharged. Conclusion: The majority of neurologic complaint patients with URV within 72 hours are those who LAMA, LPTC, or LWBS at index visit. The admission rate for URV patients (14.7%) is lower than for the index ED visit (55%), however these patients have high LWBS rates. Identifying strategies to limit the LWBS rate for these patients would reduce return visits and improve the quality and safety of patient care.

scholarly journals P052: Utility of data captured by transition referral forms for program evaluation and research

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S75-S75
Author(s):  
L.A. Gaudet ◽  
L.D. Krebs ◽  
S. Couperthwaite ◽  
M. Kruhlak ◽  
N. Loewen ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Decline ◽  
Community Services ◽  
Goals Of Care ◽  
University Of Alberta ◽  
Transition Coordinators ◽  
Discharged Patients ◽  
The University

Introduction: Increase in functional decline of older adults after discharge from the emergency department (ED) has been reported; however, evaluations of interventions to mitigate this problem are infrequent. Data collected in the ED on older adults may document functional status, yet their utility for research is unknown. This study aimed to assess the usability of data collected by ED Transition Coordinators (EDTC) during routine assessments for functional decline research. Methods: EDTCs assess all patients 75 years old presenting to the ED and complete a standardized Transitional Assessment Referral (TAR) form that documents patients independence and daily functioning. To measure the utility of these forms for research purposes, trained research staff evaluated the TARs completed in April 2017 by TCs in the University of Alberta Hospital ED by extracting data from the TARs into a purpose-built REDCap database. Researchers selected and assessed for completeness and clarity the following variables unique to the TARs: facility vs. non-facility living, goals of care and personal directive, fall history, falls in the past 90 days, independence in 14 activities of daily living (ADLs)/instrumental activities of daily living (IADLS), community services in place, and homecare referrals for discharged patients. The proportion of TARs with data for each variable and the proportion of forms with unambiguous responses in each section are reported. Results: Overall, 500 forms were analysed; patients were 41% male with a mean age of 82 (SD=11.2). Homecare referrals, facility vs. non-facility living, and independence with 14 ADLs/IADLs were the most frequently documented variables (81%, 78%, and 79%, respectively); however for ADLs/IADLs, 59% of the 79% had one or more missing components. While fall history was reported in 301 forms (60%), only 107/301 (36%) reported the number of falls in the last 90 days. The referral to homecare variable was complete in 217/268 (81%) forms; however, 99% of files were missing data about goals of care, personal directives, and receipt of community services. Conclusion: Although some information on elderly patients is consistently reported, many of the social service/human factors associated with functional decline are not recorded. While data on the TARs may be useful for studying functional decline in the ED, exploring the barriers to form completion may improve adherence thereby increasing their research utility.

scholarly journals Physician’s changes in management of return visits to the Emergency Department

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Adrianna Long ◽  
Robert Cambridge ◽  
Melissa Rosa
Keyword(s):  
Emergency Department ◽  
Online Survey ◽  
Statistical Significance ◽  
The United States ◽  
Chief Complaint ◽  
Repeat Visit ◽  
Chief Complaints ◽  
Case Vignettes ◽  
Return Visits ◽  
Work Up

Return visits to the Emergency Department (ED) are estimated between 2-3.1%, which impacts ED care costs and wait times. Adverse events for unscheduled return visits (URVs) have been reported to be as high as 30%. The objective of this study was to characterize the attitudes and management of Emergency Medicine (EM) physicians regarding patients presenting with the same chief complaint to the ED for an URV. An online survey questionnaire was developed and sent to 160 accredited EM Graduate Medical Education programs in the United States. The questionnaire consisted of case vignettes wherein providers were asked to submit what orders they would place for each scenario. The mean numbers of tests and treatments were compared from initial visit to repeat visit with same chief complaint. Physicians also provided feedback regarding their management of URVs. There were estimated 6988 eligible participants with 397 responses (response rate 5.7%). There was a statistical significance (P<0.001) in provider management of URVs with pediatric fever, but there was no statistical significance for management of the other chief complaints. There were 77% of physicians that felt an increased work up is warranted for URVs. The results of this study indicate that majority of EM residents and staff working in training programs feel that they should approach the management of URV patients with a more extensive workup despite no clinical change. These findings suggest that further analysis should be performed regarding provider management of URVs and the associated healthcare costs.

scholarly journals An electronic audit tool to track the donning and doffing practices of personal protective equipment in the emergency department

2021 ◽  
Vol 44 (2) ◽  
pp. 11-12
Author(s):  
Ramya Sridhar ◽  
Jennifer Woods ◽  
Maya Jusza ◽  
Sharon Drury
Keyword(s):  
Emergency Department ◽  
Data Collection ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Infection Prevention ◽  
Protective Equipment ◽  
Audit Tool ◽  
University Of Alberta ◽  
The University

An electronic audit tool to track the donning and doffing practices of personal protective equipment in the emergency department Maya Jusza, Ramya Sridhar, Jennifer Woods, Sharon Drury Background: Maintaining the safety of patients and healthcare professionals is a priority in all healthcare settings. Infection prevention measures such as donning and doffing practices of personal protective equipment (PPE) have become even more imperative in light of the SARS-CoV-2 pandemic. Potential PPE breaches and the degree of frontline compliance are currently being analyzed through the use of paper PPE audit tools which can be laborious and time-consuming. The development of an electronic alternative would improve frontline safety and enhance the efficiency of data collection, while optimizing the ability to share these observations with the frontline team in real time. Two nursing leadership students from the University of Alberta were tasked with developing an electronic PPE audit tool prototype for the University of Alberta Hospital’s emergency department. Implementation: An electronic PPE audit tool prototype was developed using Google Forms which provided a user-friendly interface. Google applications were used as no confidential or patient data was collected during PPE audits. The prototype auto-populated the data entries into linked spreadsheets and interactive data dashboards that visualized the data using graphs in real time. This enabled users to easily identify trends and direct educational interventions as required. Instructional one pagers and screencast videos were also created to accompany the prototype. The prototype was reviewed by and received extensive support from: Unit Managers, Patient Care Managers, Process Improvement Nurses, Infection Prevention Control (IPC), the Executive Director of the University of Alberta Hospital and Stollery emergency department and Edmonton Zone medicine programs, and the University of Alberta Hospital and Mazankowski Executive Leadership Team. Several changes and improvements were made using the Plan-Do-Study-Act cycle. This prototype has currently been replicated onto an Alberta Health Services (AHS) server and has completed the formal testing phase with a planned application launch date. Evaluation Methods: Plan-Do-Study-Act cycles were used to guide the implementation of this audit tool prototype. After development, the prototype was tested and revised which included six rounds of audit trials at the University of Alberta Hospital’s emergency department and on some inpatient medicine units. This prototype was consistently evaluated at various stages of development and changes were made to include feedback. After approval was received to recreate this prototype onto an AHS compatible server, additional changes were made to ensure functionality. These changes included adding designations and simplifying certain questions. IPC was consulted to ensure the steps outlined for donning and doffing in the prototype were accurate and reflected requirements in the clinical environment. Results: This audit tool prototype has gathered tremendous support through various demonstrations of its ability to streamline data collection in the healthcare setting. This data is relevant to the safety of both frontline workers and patients as it identifies inconsistencies in donning and doffing practices. In addition, the prototype also complements the Edmonton zone-wide PPE coaching initiative by allowing for a quantitative measurement of its efficacy. This has prompted the fast-tracked replication of an AHS compatible version with the assistance of a dedicated team that includes the creators of the prototype tool, IPC, Quality Assurance, Information Technology, and Clinical Services Development. This version has a scheduled launch date on March 22, 2021 and is to be initially rolled out to University of Alberta’s emergency department and medicine units. The objective is to eventually make this the standardized PPE audit tool throughout Alberta. Advice and Lessons Learned: 1) In order to be sustainable and implemented site-wide, an AHS compatible tool isrequired. The use of Google applications is not preferred as data will be stored outside ofthe AHS server. Even though there is no confidential information, wide-spread use mayoverwhelm the Google platform and a Gmail account is required to view data. An in-house AHS alternative has been developed. 2) Several discussions took place regarding discretions on what steps can be auditedaccording to IPC protocols. For example, some clinical nurse educators prefer handhygiene to be completed between donning steps, while this is not mandatory or auditableaccording to IPC. In addition, several discussions took place to identify the operationaland business owners of this tool which are required to support the AHS compatibleversion of the application. 3) PPE audits are vital across all hospital departments to improve the quality of healthcare.The use of PPE during patient care has grown exponentially due to the SARS-CoV2pandemic and has amplified the need for an electronic alternative to the existing paperPPE audit tool. The electronic audit tool offers an innovative way to accurately andefficiently collect and display data which will promote an improved quality of care.

Centres for Health Evidence Demonstration Project

2013 ◽  
Author(s):  
Tracy Stewart ◽  
Denise Koufogiannakis ◽  
Robert S.A. Hayward ◽  
Ellen Crumley ◽  
Michael E. Moffatt
Keyword(s):  
Evidence Based Practice ◽  
Demonstration Project ◽  
Evidence Based ◽  
Research Opportunities ◽  
University Of Alberta ◽  
Information Usage ◽  
University Of Manitoba ◽  
The University ◽  
Hospital Wards ◽  
Support Evidence

This paper will report on the establishment of the Centres for Health Evidence (CHE) Demonstration Project in both Edmonton at the University of Alberta and in Winnipeg at the University of Manitoba. The CHE Project brings together a variety of partners to support evidence-based practice using Internet-based desktops on hospital wards. There is a discussion of the CHE's cultural and political experiences. An overview of the research opportunities emanating from the CHE Project is presented as well as some early observations about information usage.

scholarly journals Is the Letter ‘t’ in the Word ‘gourmet’? Disruption in Task-Evoked Connectivity Networks in Adults with Impaired Literacy Skills

NeuroSci ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 75-94
Author(s):  
Kulpreet Cheema ◽  
William E. Hodgetts ◽  
Jacqueline Cummine
Keyword(s):  
Developmental Disorders ◽  
Brain Networks ◽  
Literacy Skills ◽  
Resting State Networks ◽  
Skilled Readers ◽  
University Of Alberta ◽  
Domain Specific ◽  
Probe Task ◽  
The University ◽  
General Networks

Much work has been done to characterize domain-specific brain networks associated with reading, but very little work has been done with respect to spelling. Our aim was to characterize domain-specific spelling networks (SpNs) and domain-general resting state networks (RSNs) in adults with and without literacy impairments. Skilled and impaired adults were recruited from the University of Alberta. Participants completed three conditions of an in-scanner spelling task called a letter probe task (LPT). We found highly connected SpNs for both groups of individuals, albeit comparatively more connections for skilled (50) vs. impaired (43) readers. Notably, the SpNs did not correlate with spelling behaviour for either group. We also found relationships between SpNs and RSNs for both groups of individuals, this time with comparatively fewer connections for skilled (36) vs. impaired (53) readers. Finally, the RSNs did predict spelling performance in a limited manner for the skilled readers. These results advance our understanding of brain networks associated with spelling and add to the growing body of literature that describes the important and intricate connections between domain-specific networks and domain-general networks (i.e., resting states) in individuals with and without developmental disorders.

scholarly journals Injuries and frequent use of emergency department services: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040272
Author(s):  
Catherine Laferté ◽  
Andréa Dépelteau ◽  
Catherine Hudon
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Cohort Studies ◽  
Eligibility Criteria ◽  
Geriatric Population ◽  
Physical Injuries ◽  
Frequent Use ◽  
Different Types ◽  
Ed Visits ◽  
Return Visits

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

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