scholarly journals P123: Retrospective review of transfusions for anemia ordered in the emergency department and concordance with guidelines

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S108
Author(s):  
Z. Siddiqi ◽  
E. Lang ◽  
D. Grigat ◽  
S. Vatanpour
Keyword(s):  
Emergency Department ◽  
Cost Effective ◽  
Deficiency Anemia ◽  
Time Period ◽  
Cost Effective Approach ◽  
Significant Difference ◽  
Blood Banks ◽  
Chi Squared ◽  
Red Blood Cell Transfusions ◽  
The Impact

Introduction: Iron Deficiency Anemia (IDA) is a common presentation to the emergency department (ED) and is often treated with red blood cell transfusions. Choosing Wisely and the American Association of Blood Banks released guidelines in 2016 outlining under what circumstances transfusions should be given for patients with IDA. Few well-powered studies have looked at the impact of these guidelines on transfusions in EDs. The goal of this study was to examine the number of RBC transfusions that were given in EDs in Calgary, Alberta from 2014-2018 and what proportion of these were potentially avoidable (PA). Methods: We analyzed 8651 IDA patient encounters from 2014–2018 at four centers in the Calgary Zone. A transfusion was considered PA if the patient's hemoglobin (hgb) was ≥70 g/L AND if the patient was hemodynamically stable. We performed descriptive statistics to assess the number of transfusions and the number of avoidable transfusions. We used chi-squared tests to determine if there were significant differences between site, time-period, hemoglobin level. Results: In total, 990 (11.4%) of the encounters received transfusions; 711 (71.8%) were indicated while 279 (28.1%) were PA. Out of the transfusions that were indicated, 230 (32.3%) were given to patients with a hgb <70 g/L and 481 (67.7%) were given to patients with a hgb >70 g/L but who were hemodynamically unstable. Out of the transfusions that were PA, the highest number were given to those in the 71-80 g/L hgb group (142) and the lowest number were given to those in the 110-130 g/L hgb group (9), a difference that was statistically significant (p < 0.001). The PA transfusion rates from 2014 to 2018 were 30.8%, 25.6%, 34.5%, 23.6%, 20.7% respectively, which was a statistically significant difference (p = 0.004). Conclusion: Our data suggest that the number of PA transfusions at the hospitals in the Calgary zone is comparable to the rates reported in the existing literature. In addition, the rate of PA transfusions has decreased since the release of the guidelines. A limitation of the present study was that it did not look at the number of units of red blood cells transfused and since many patients receive more than one unit, it is possible that the number of PA transfusions was underestimated. Nevertheless, we intend to use our results to create a safer and more cost-effective approach to managing IDA.

scholarly journals Emergency Department Crowding is Harder to Solve: The Impact of COVID-19 of Longer Length of Stay

2021 ◽  
Author(s):  
Fengbao Guo ◽  
Yan Qin ◽  
Hailong Fu ◽  
Feng Xu
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Department Crowding ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
Chi Squared ◽  
The Difference ◽  
Emergency Neurology ◽  
The Impact ◽  
Case Data

Abstract Objectives To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the emergency department (ED). Methods A retrospective review of case data of patients in the ED during the early stages of the COVID-19 pandemic in the First Affiliated Hospital of Soochow University (January 15, 2020– January 14, 2021) was performed and compared with that during the pre-COVID-19 period (January 15, 2019 – January 14, 2020). Patient information including age, sex, length of stay, and death was collected. Wilcoxon Rank sum test was utilized to compare the difference in LOS between the two cohorts. Chi-Squared test was utilized to analyze the prognosis of patients. The LOS and prognosis in different departments (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed. Results Of the total 8278 patients, 4159 (50.24%) were ordered in the COVID-19 pandemic group and 4119 (49.76%) were ordered in the pre-COVID-19 group. The length of stay prolongs significantly in the COVID-19 group compared with that in the pre-COVID-19 group(13h vs 9.8h; p < 0.001). There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%; p=0.341). Conclusion The COVID-19 pandemic was associated with a significant increase in the length of stay, which may lead to emergency department crowding. And the influence of the COVID-19 pandemic on patients in different emergency departments is different. There is no significant impact on the LOS of emergency neuropathy. Across departments, COVID-19 didn’t have a significant impact on the prognosis of ED patients.

scholarly journals Safety and efficacy of a single total dose infusion (1020 mg) of ferumoxytol

2021 ◽  
Vol 12 ◽  
pp. 204062072110060
Author(s):  
Harris Khan ◽  
Paige May ◽  
Elim Kuo ◽  
Preetika Pai ◽  
Katherine Boles ◽  
...  
Keyword(s):  
Single Dose ◽  
Total Dose ◽  
Treatment Option ◽  
Deficiency Anemia ◽  
Utilization Review ◽  
Veterans Health ◽  
Significant Difference ◽  
Dose Infusion ◽  
Iv Iron ◽  
The Impact

Purpose: Iron deficiency anemia (IDA) is the most common type of anemia. A single dose infusion of intravenous (IV) iron is a convenient treatment option. Ferumoxytol is an IV formulation of iron that is typically given in two doses of 510 mg each. Utilizing a single dose of 1020 mg over 15 min has previously been described as safe and effective. In July 2018, we began to administer a single 1020 mg dose of ferumoxytol to patients needing IV iron replacement at the North Florida/South Georgia Veterans Health System. To evaluate the impact of this change, a utilization review was conducted. Methods: Outcomes of all patients who received ferumoxytol injections in the 6 months prior to and after the dosing strategy change were analyzed. A total of 140 patients, who received 270 separate IV ferumoxytol infusions, were included in the analysis. Results: No significant difference in safety was observed, with one infusion reaction occurring in each group ( p = 1.00). Efficacy also appeared equivalent with no significant difference between the change in hemoglobin for those who received a single 1020 mg dose versus those who received two 510 mg doses ( p = 0.764). As expected, those who received a single total dose infusion of 1020 mg had less clinic utilization ( p < 0.0001). Conclusion: In summary, ferumoxytol administered as a 1020 mg single dose infusion was more convenient and should be considered a safe and effective treatment option for IDA.

scholarly journals Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

2021 ◽  
Author(s):  
Chang Park ◽  
Kapil Sugand ◽  
Arash Aframian ◽  
Catrin Morgan ◽  
Nadia Pakroo ◽  
...  
Keyword(s):  
Best Practice ◽  
Neck Of Femur ◽  
Health Crisis ◽  
Femur Fractures ◽  
Time Period ◽  
Vulnerable Patients ◽  
Significant Difference ◽  
Usual Residence ◽  
Hip Trauma ◽  
The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

scholarly journals Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Joseph A. Gil ◽  
Avi D. Goodman ◽  
Andrew P. Harris ◽  
Neill Y. Li ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Operating Room ◽  
Cost Effective ◽  
Initial Management ◽  
Fingertip Amputation ◽  
Significant Difference ◽  
Initial Procedure ◽  
The Cost ◽  
Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

Quantitative Selection of Variation Reduction Plans

1998 ◽  
Author(s):  
Anna C. Thornton
Keyword(s):  
Risk Mitigation ◽  
Cost Effective ◽  
Variation Reduction ◽  
Multiple Quality Characteristics ◽  
Cost Effective Approach ◽  
Manufacturing Performance ◽  
The Impact ◽  
Manufacturing Variation ◽  
Selection Of

Abstract Quality has been a rallying call in the design and manufacturing world for the last two decades. One way to improve quality is to reduce the impact of manufacturing variation. Variation risk mitigation is challenging especially when a product has multiple quality characteristics and complex production and assembly. It is common wisdom that companies should identify and mitigate the risk associated with variation throughout the design process. As yield problems are identified, they should be mitigated using the most cost effective approach. One approach to variation risk mitigation is variation reduction (VR). VR targets reduction of variation introduced by existing manufacturing processes using tools such as Design of Experiments (DOE) and robust design. Many companies have specialized groups that specialize in these methods. VR teams have the role of improving manufacturing performance; however, these teams are limited in their resources. In addition, no tools exist to quantitatively determine where a VR team’s efforts are most effectively deployed. This paper provides a mathematical and optimization model to best allocate VR resources in a complex product.

scholarly journals Avoiding biopsy in iron deficiency anemia is not a cost-effective approach

2012 ◽  
Vol 104 (6) ◽  
pp. 334-334
Author(s):  
Sauid Ishaq ◽  
Rizwan Mahmood ◽  
Vicenzo Vilannacci ◽  
Gabrio Bassotti ◽  
Kamran Rostami
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Cost Effective ◽  
Deficiency Anemia ◽  
Cost Effective Approach

scholarly journals Rheometer enabled study of cartilage frequency-dependent properties

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Stefano Perni ◽  
Polina Prokopovich
Keyword(s):  
Applied Load ◽  
Cost Effective ◽  
Constant Load ◽  
Hydraulic Permeability ◽  
Frequency Dependent ◽  
Shear Moduli ◽  
Tissue Replacement ◽  
Cost Effective Approach ◽  
The Impact

AbstractDespite the well-established dependence of cartilage mechanical properties on the frequency of the applied load, most research in the field is carried out in either load-free or constant load conditions because of the complexity of the equipment required for the determination of time-dependent properties. These simpler analyses provide a limited representation of cartilage properties thus greatly reducing the impact of the information gathered hindering the understanding of the mechanisms involved in this tissue replacement, development and pathology. More complex techniques could represent better investigative methods, but their uptake in cartilage research is limited by the highly specialised training required and cost of the equipment. There is, therefore, a clear need for alternative experimental approaches to cartilage testing to be deployed in research and clinical settings using more user-friendly and financial accessible devices. Frequency dependent material properties can be determined through rheometry that is an easy to use requiring a relatively inexpensive device; we present how a commercial rheometer can be adapted to determine the viscoelastic properties of articular cartilage. Frequency-sweep tests were run at various applied normal loads on immature, mature and trypsinased (as model of osteoarthritis) cartilage samples to determine the dynamic shear moduli (G*, G′ G″) of the tissues. Moduli increased with increasing frequency and applied load; mature cartilage had generally the highest moduli and GAG depleted samples the lowest. Hydraulic permeability (KH) was estimated from the rheological data and decreased with applied load; GAG depleted cartilage exhibited higher hydraulic permeability than either immature or mature tissues. The rheometer-based methodology developed was validated by the close comparison of the rheometer-obtained cartilage characteristics (G*, G′, G″, KH) with results obtained with more complex testing techniques available in literature. Rheometry is relatively simpler and does not require highly capital intensive machinery and staff training is more accessible; thus the use of a rheometer would represent a cost-effective approach for the determination of frequency-dependent properties of cartilage for more comprehensive and impactful results for both healthcare professional and R&D.

scholarly journals P109: Does an elevated troponin ultimately matter? An assessment of outcomes in patients presenting to the emergency department with non-cardiac complaints

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S104-S104
Author(s):  
K. Endres ◽  
B. Chow ◽  
H. Garuba
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Preliminary Data ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Cardiac Events ◽  
Significant Difference ◽  
Chi Squared ◽  
Invaluable Tool ◽  
The Difference

Introduction: Acute myocardial infarction (MI) is one of the most time-sensitive diagnoses made in the emergency department (ED). Troponin (TNI) measurement is an invaluable tool; however, its utility depends on the clinical context and is highest where there is a strong pre-test probability. Studies show that most TNI elevations are due to non-cardiovascular causes; however, elevated TNI has been associated with increased morbidity and mortality, often prompting additional investigations. The aim of our study was to compare 1-year cardiac outcomes of patients who presented to the ED with non-cardiac complaints and elevated TNI who had further cardiac testing versus those who did not. Methods: We conducted a retrospective chart review of patients ≥18 seen in the ED for non-cardiac complaints with a high TNI from January-June 2016. Patients were stratified into two groups: 1) those who received diagnostic testing for ischemia and/or a cardiac consultation and 2) those without cardiac consultation or testing. Data was also collected on major adverse cardiac events within 1-year of ED presentation. Chi-squared analysis assessed the difference in proportions of outcomes between groups. We present our preliminary data. Results: In total, 1500 patients met inclusion criteria and 861 have been analyzed thus far. Of these 861, 209 went on to have either diagnostic testing for ischemia and/or a cardiology consult while 652 had no further investigations. There was no statistically significant difference in the proportion of patients who developed unstable angina (p = 0.9824), ST-elevation myocardial infarction (STEMI) (p = 0.9956), non-STEMI (p = 0.9008), stroke/TIA (p = 0.9657), revascularization (p = 0.8873), cardiac hospitalization (p = 0.9446) or died (p = 0.8972), within 1-year of their ED presentation. Conclusion: In patients with isolated elevated TNI and non-cardiac complaints, preliminary data showed no difference in mortality or cardiac event rates between those who had further testing/consultations and those who did not. TNI ordering could be cautiously limited to only presenting complaints/preliminary diagnoses likely to have cardiac etiology or sequelae or those in whom further testing would impact management/outcomes. Quality of care may be improved by reducing length of stay in the ED and potential risks of unnecessary tests. Future studies include determining cost implications and classifying what level of TNI elevation in non-ACS patients may predict a future cardiac outcome.

Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?

2018 ◽  
Vol 12 (5) ◽  
pp. 391-395
Author(s):  
Isabel E-Hui Chu ◽  
Weranja Ranasinghe ◽  
Madeleine Nina Jones ◽  
Philip McCahy
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Treatment Options ◽  
Cost Effective ◽  
Renal Stones ◽  
Level Of Evidence ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Chi Squared ◽  
Recovery Times ◽  
Operative Costs

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

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