Identification of emergency department patients for referral to rapid-access addiction services

ABSTRACTObjectivesSubstance-related emergency department (ED) visits are rapidly increasing. Despite this finding, many EDs do not have access to on-site addiction services. This study characterized substance-related ED presentations and assessed the ED health care team's perceived need for an on-site rapid-access addiction clinic for direct patient referral from the ED.MethodsThis prospectively enrolled cohort study was conducted at an urban tertiary care ED from June to August 2018. Adult ED patients with problematic or high-risk substance use were enrolled by ED staff using a one-page form. The electronic and paper records from the index ED visit were reviewed. The primary outcome evaluated whether the ED health care team would have referred the patient to an on-site rapid-access addiction clinic, if one were available.ResultsWe received 557 enrolment forms and 458 were included in the analysis. Median age was 35 years, and 64% of included patients were male. Alcohol was the most commonly reported substance of problematic or high-risk use (60%). Previous ED visits within 7 days of the index visit were made by 28% of patients. The ED health care team indicated “Yes” for rapid-access addiction clinic referral from the ED for 66% of patients, with a mean of 4.3 patients referred per day during the study period.ConclusionsAt least four patients per day would have been referred to an on-site rapid-access addiction clinic from the ED, had one been available. This indicates a gap in care and collaborating with other sites that have successfully implemented this clinic model is an important next step.

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Neonatal Ethics: Development of a Consultative Group

PEDIATRICS ◽

10.1542/peds.86.6.944 ◽

1990 ◽

Vol 86 (6) ◽

pp. 944-949

Author(s):

Myra J. Edens ◽

Fonda D. Eyler ◽

James T. Wagner ◽

Donald V. Eitzman

Keyword(s):

Health Care ◽

Care Setting ◽

Ethical Issues ◽

Tertiary Care ◽

Health Care Team ◽

Care Team ◽

Advisory Group ◽

Neonatal Ethics ◽

Tertiary Care Setting ◽

Consultative Group

Experience of a neonatal ethics advisory group in a tertiary care setting was reviewed to identify which aspects of the experience have been most valuable in the development of a consultative group. Consultations were requested for 31 patients seen from August 1984 through December 1988. Review of these patients indicated that 21 of 31 infants were born after full-term gestations, 11 of 31 infants were seen beyond the neonatal period, and some type of congenital anomaly was the principal diagnosis for 64.7% of the patients. The reasons for seeking consultation primarily involved decisions regarding withdrawal or withholding of treatment. For 22 of the 31 patients, the consensus of the group supported the decision of the health care team. In the remaining consultations, the recommendation of the group was that more information and/or communication was needed. In the analysis of the neonatal ethics advisory group's experience with consultations the characteristics of neonatal patients were identified and the value of having a forum for discussing the difficult ethical issues facing members of the health care team were validated.

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P085: Remember that patient you saw last week – Characteristics of patients experiencing unanticipated death following emergency department discharge

CJEM ◽

10.1017/cem.2020.291 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S95-S95

Author(s):

R. Hoang ◽

K. Sampsel ◽

A. Willmore ◽

K. Yelle-Labre ◽

V. Thiruganasambandamoorthy ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Medical Errors ◽

Medical Error ◽

Tertiary Care ◽

Vital Signs ◽

Diagnostic Error ◽

Sufficient Information ◽

Risk Area ◽

Ed Visits

Background: The emergency department (ED) is an at-risk area for medical error. We measured the frequency and characteristics of patients with unanticipated death within 7 days of ED discharge and whether medical error contributed. Aim Statement: This study aimed to calculate the frequency of patients experiencing death within 7 days after ED discharge and determine whether these deaths were related to their index ED visit, were unanticipated, and whether possible medical error occurred. Measures & Design: We performed a single-centre health records review of 200 consecutive cases from an eligible 458,634 ED visits from 2014-2017 in two urban, academic, tertiary care EDs. We included patients evaluated by an emergency physician who were discharged and died within 7 days. Three trained and blinded reviewers determined if deaths were related to the index visit, anticipated or unanticipated, or due to potential medical error. Reviewers performed content analysis to identify themes. Evaluation/Results: Of the 200 cases, 129 had sufficient information for analysis, translating to 44 deaths per 100,000 ED discharges. We found 13 cases per 100,000 ED discharges were related and unanticipated deaths and 18 of these were due to potential medical errors. Over half (52.7%) of 129 patients displayed abnormal vital signs at discharge. Patients experienced pneumonia (27.1%) as their most common cause of death. Patient characteristic themes were: difficult historian, multiple complaints, multiple comorbidities, acute progression of chronic disease, recurrent falls. Provider themes were: failure to consider infectious etiology, failure to admit high-risk elderly patient, missed diagnosis. System themes included multiple ED visits or recent admission, no repeat vital signs recorded. Discussion/Impact: Though the frequency of related and unanticipated deaths and those due to medical error was low, these results highlight opportunities to potentially enhance ED discharge decisions. These data add to the growing body of ED diagnostic error literature and emphasize the importance of identifying potentially high risk patients as well as being cognizant of the common medical errors leading to patient harm.

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GERIATRICS PREVENTABLE ADMISSIONS CARE TEAM (GERIPACT): A HIGH-RISK INTENSIVE AMBULATORY GERIATRICS PROGRAM

Innovation in Aging ◽

10.1093/geroni/igz038.529 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S147-S147

Author(s):

Stephanie W Chow ◽

Lizette Munoz ◽

Susana Lavayen ◽

Shamsi Fani ◽

Blair MacKenzie ◽

...

Keyword(s):

Health Care ◽

Social Work ◽

High Risk ◽

Emergency Room ◽

Older Patients ◽

Care Team ◽

Emergency Room Visits ◽

Telephone Hotline ◽

Ed Visits ◽

Preventable Admissions

Abstract The Geriatrics Preventable Admissions Care Team (GERIPACT) is an inter-professional team of 2 clinicians, 1 social worker, and 1 care coordinator, dedicated to offering temporary intensive ambulatory care services to complex older patients at high-risk for incurring expensive health care (ie. frequent emergency room visits or hospitalizations). GERIPACT services include frequent office visits for medical and social work needs, frequent telephone contact, home visits, specialty visit accompaniment, and a 24/7 telephone hotline. Use of this innovative model aims to serve communities lacking in geriatrician and geriatric social work providers, with a main goal of serving the highest risk older population. We reviewed the healthcare utilization of GERIPACT enrollees 6 months prior-to-enrollment and compared with 6 months following graduation from GERIPACT from 2016 to 2018. 78 patients were evaluated, with 49 total ED visits prior to enrollment and 35 post-graduation, saving 14 ED visits for a ratio of 18 saved ED visits per 100 GERIPACT patients. There were 45 hospitalizations prior to enrollment with 29 hospitalizations post-graduation, saving 16 hospitalizations, or 20 hospitalizations per 100 GERIPACT patients. Hospital days were reduced by 237 days post-graduation. An intensive ambulatory program for high risk geriatrics patients may be shown to be an efficient model of care for targeting those older patients who potentially incur greater expenses to the health care system. This focused team may be deployed to primary care communities with complex elderly patients in need of geriatricians and geriatric social workers, and may reduce unnecessary emergency room visits and inpatient stays.

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Gender analysis and training needs assessment of class 4 staff in a tertiary health care institute

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212161 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2275

Author(s):

Priyanka U. Honavar ◽

Padmaja Y. Samant ◽

Swati B. Bhosle

Keyword(s):

Health Care ◽

Tertiary Care ◽

Health Care Team ◽

Training Needs ◽

Support Staff ◽

Care Team ◽

Obstetrics And Gynecology ◽

Care Hospital ◽

Cross Sectional ◽

Trained Staff

Background: A health care team comprises of doctors, nurses, paramedical staff, medical assistants, administrators and support staff or class 4 workers. Each individual has a role in the execution of proper health care delivery to the patients. Obstetrics and gynecology is a dynamic branch requiring urgent attention in most cases right from admission to discharge. Delivery of prompt treatment is possible with better training and coordination of the health care team. In a tertiary care institute, referred patients have more critical health problems and need urgent assistance by well-trained staff. On the other hand, in a smaller set up with less human resource, agile and well-trained support staff would be an asset to overcome the limitations. Better-trained staff means less loss of man-hours from injuries and illnesses, less medico legal liabilities, reduced maintenance cost of equipment and less expenditure on health-related issues of staff. We conducted an interview based cross sectional observational cohort study of the situation and an assessment of needs for skill building of support staff in a tertiary care hospital. At the end, we propose a structured training program suitable to the local needs that can be conducted by experienced peers, technical staff and medical personnel. We studied unmet training needs of the staff and gender related issues.Methods: A questionnaire based cross sectional study involving 92 class 4 workers in the department of obstetrics and gynecology in a tertiary care hospital was conducted comprising questions regarding their demography, work profile, training, needs and problems faced. Key informants in the relevant area were also interviewed.Results: Graphical representation of the responses received has been made. Professional work profile, health issues, gender issues, training need of any specialized training has been highlighted.Conclusions: As an important part of the health care team, this study has brought out issues related to health especially occupational health, needs for training, hurdles faced at work amongst class 4 staff working in the department of obstetrics and gynecology.

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A Surgical Safety Checklist for Performing Tracheotomy in Patients with Coronavirus Disease 19

Otolaryngology ◽

10.1177/0194599820922981 ◽

2020 ◽

Vol 163 (1) ◽

pp. 42-46 ◽

Cited By ~ 13

Author(s):

Louis G. Portugal ◽

Dara R. Adams ◽

Fuad M. Baroody ◽

Nishant Agrawal

Keyword(s):

Health Care ◽

Mechanical Ventilation ◽

High Risk ◽

Prolonged Mechanical Ventilation ◽

Health Care Team ◽

Care Team ◽

Surgical Team ◽

Surgical Safety Checklist ◽

Surgical Safety

Performance of tracheotomy is a potential necessary step in the patient with coronavirus disease 19 (COVID-19) and prolonged mechanical ventilation. Due to viral aerosolization, tracheotomy carries a high risk of transmission of COVID-19 to the health care team performing the procedure. We share our institution’s surgical safety checklist for performing tracheotomy in patients with COVID-19, including key modifications intended to mitigate risk to the surgical team.

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Communicating Effectively with Your Health Care Team

PsycEXTRA Dataset ◽

10.1037/e572372006-007 ◽

2006 ◽

Author(s):

Harriet Patterson

Keyword(s):

Health Care ◽

Health Care Team ◽

Care Team

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Legal and Financial Planning for the AD Patient: How the Health Care Team Can Help

PsycEXTRA Dataset ◽

10.1037/e661192007-002 ◽

2007 ◽

Keyword(s):

Health Care ◽

Financial Planning ◽

Health Care Team ◽

Care Team

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Identification of pathogens from the upper respiratory tract of adult emergency department patients at high risk for influenza complications in a pre-Sars-CoV-2 environment

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2021.115352 ◽

2021 ◽

Vol 100 (2) ◽

pp. 115352

Author(s):

Justin Hardick ◽

Kathryn Shaw-Saliba ◽

Breana McBryde ◽

Charlotte A. Gaydos ◽

Yu-Hsiang Hsieh ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Respiratory Tract ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Emergency Department Patients

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Identifying children at high risk for infection-related decompensation using a predictive emergency department-based electronic assessment tool

Diagnosis ◽

10.1515/dx-2020-0030 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Robert J. Sepanski ◽

Arno L. Zaritsky ◽

Sandip A. Godambe

Keyword(s):

Emergency Department ◽

High Risk ◽

Positive Predictive Value ◽

Firing Rate ◽

Predictive Value ◽

Assessment Tool ◽

Predictive Tool ◽

High Severity ◽

Electronic Assessment ◽

Ed Visits

AbstractObjectivesElectronic alert systems to identify potential sepsis in children presenting to the emergency department (ED) often either alert too frequently or fail to detect earlier stages of decompensation where timely treatment might prevent serious outcomes.MethodsWe created a predictive tool that continuously monitors our hospital’s electronic health record during ED visits. The tool incorporates new standards for normal/abnormal vital signs based on data from ∼1.2 million children at 169 hospitals. Eighty-two gold standard (GS) sepsis cases arising within 48 h were identified through retrospective chart review of cases sampled from 35,586 ED visits during 2012 and 2014–2015. An additional 1,027 cases with high severity of illness (SOI) based on 3 M’s All Patient Refined – Diagnosis-Related Groups (APR-DRG) were identified from these and 26,026 additional visits during 2017. An iterative process assigned weights to main factors and interactions significantly associated with GS cases, creating an overall “score” that maximized the sensitivity for GS cases and positive predictive value for high SOI outcomes.ResultsTool implementation began August 2017; subsequent improvements resulted in 77% sensitivity for identifying GS sepsis within 48 h, 22.5% positive predictive value for major/extreme SOI outcomes, and 2% overall firing rate of ED patients. The incidence of high-severity outcomes increased rapidly with tool score. Admitted alert positive patients were hospitalized nearly twice as long as alert negative patients.ConclusionsOur ED-based electronic tool combines high sensitivity in predicting GS sepsis, high predictive value for physiologic decompensation, and a low firing rate. The tool can help optimize critical treatments for these high-risk children.

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