scholarly journals P029: Requesting prescriptions in the emergency department: the patient, the request and the response

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S74-S75
Author(s):  
L. Shepherd ◽  
M. Mucciaccio ◽  
K. VanAarsen
Keyword(s):  
Emergency Department ◽  
Family Doctor ◽  
Wait Time ◽  
Primary Objective ◽  
Urgent Care ◽  
Care Centre ◽  
Medication Prescription ◽  
Physician Decision Making ◽  
Service Gap ◽  
Urgent Care Centre

Introduction: Patients presenting to the Emergency Department (ED) for the sole purpose of requesting prescriptions are problematic. Problematic for the patient, who may have a long wait to be seen and may leave dissatisfied. Problematic for the ED physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misappropriation of medications. The primary objective of this study was to determine the characteristics of patients who present to the ED or Urgent Care Centre (UCC) requesting a prescription, the nature of these requests and the resulting action by the attending physician. The secondary objective was to determine the proportion of medication requests and responses that have potential street value. With this knowledge we may be better positioned to serve these patients and support physician decision-making. Methods: This was a single-centre, retrospective electronic chart review looking at all adult patients with a presenting complaint of medication request who attended a two-site tertiary ED or an Urgent Care Centre (UCC) in London, Ontario between April 1, 2014 and June 30, 2017. Data was tested for normality and analyzed using descriptive statistics. Results: A total of 1923 cases met the inclusion criteria. Cases were removed (n = 421) if it was unclear which prescription was requested or if a non-medication prescription or injection was requested. The patient median (IQR) age was 44 (32-54) with 58% being male and 55% having a family doctor. There were a total of 2261 prescriptions requested by 1502 patients. The top 3 most commonly requested classes of medications were opioids 433/1502 (28.8%), antidepressants/antipsychotics 371/1502 (24.7%) and benzodiazepines 252/1502 (16.8%). The median (IQR) wait time was 73 minutes (35-128). 298/1502 (19.8%) of patients received their requested prescription (opioids 12.7%; antidepressant/antipsychotic 55.3% and benzodiazepines 16.3%). 740/1502 (49.3%) of patients requested a medication that had street value. Of those, 118/740 (15.9%) received the requested medication. Conclusion: There is no “one size fits all” solution for the patient who presents to the ED requesting a prescription. The large number of requests for psychiatric medications suggests a service gap for mental health patients in the community. This data supports the need for comprehensive electronic medication records to guide physicians’ decisions.

scholarly journals Outcomes of Establishing an Urgent Care Centre in the Same Location as an Emergency Department

2020 ◽  
Vol 12 (19) ◽  
pp. 8190
Author(s):  
Annelie Raidla ◽  
Katrin Darro ◽  
Tobias Carlson ◽  
Amir Khorram-Manesh ◽  
Johan Berlin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Times ◽  
Urgent Care ◽  
Care Centre ◽  
Close Collaboration ◽  
Surge Capacity ◽  
Close Proximity ◽  
Major Incidents ◽  
Use Of Medical Services ◽  
Urgent Care Centre

The emergency department (ED) is one of the busiest facilities in a hospital, and it is frequently described as a bottleneck that limits space and structures, jeopardising surge capacity during Major Incidents and Disasters (MIDs) and pandemics such as the COVID 19 outbreak. One remedy to facilitate surge capacity is to establish an Urgent Care Centre (UCC), i.e., a secondary ED, co-located and in close collaboration with an ED. This study investigates the outcome of treatment in an ED versus a UCC in terms of length of stay (LOS), time to physician (TTP) and use of medical services. If it was possible to make these parameters equal to or even less than the ED, UCCs could be used as supplementary units to the ED, improving sustainability. The results show reduced waiting times at the UCC, both in terms of TTP and LOS. In conclusion, creating a primary care-like facility in close proximity to the hospitals may not only relieve overcrowding of the hospital’s ED in peacetime, but it may also provide an opportunity for use during MIDs and pandemics to facilitate the victims of the incident and society as a whole.

Examining Canada's return visits to the emergency department after a concussion

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 784-788 ◽  
Author(s):  
Laura Morrison ◽  
Rachel Taylor ◽  
Mathew Mercuri ◽  
Jennifer Thompson
Keyword(s):  
Emergency Department ◽  
Clinical Characteristics ◽  
Hospital Setting ◽  
Urgent Care ◽  
Care Centre ◽  
Canadian Hospital ◽  
Discharge Instructions ◽  
Health Records ◽  
Return Visits ◽  
Urgent Care Centre

ABSTRACTObjectivesThe purpose of this study was to identify 1) the proportion of patients discharged from the emergency department (ED) with a diagnosis of concussion and return within 14 days, and 2) the characteristics that prompt a return.MethodsA health records review was conducted on adult patients with a discharge diagnosis of a concussion who accessed care through Hamilton Health Sciences EDs and Urgent Care Centre in 2016. Subsequent data were collected from those who returned to the ED within 14 days. Clinical characteristics of returners were compared to those of non-returners.ResultsOf the 389 patients included in the study, 38 (10%) returned within 14 days. Patients who sustained a concussion in a sport-related context or were referred to a specialized clinic were less likely to return (p = 0.03). Those who suffered an assault-related concussion were more likely to return (p = 0.01). Of those who did return, 42% received a CT scan with normal results, and 42% were given new discharge instructions.ConclusionsApproximately 10% of patients diagnosed with a concussion in a Canadian hospital setting returned to the ED within 14 days of their index visit. Our study suggests the opportunity to reduce this burden to both the healthcare system and the patient through careful discharge instructions outlining anticipated symptoms following a concussion (specifically, headache) or referral to a concussion clinic.

scholarly journals Describing team development within a novel GP-led urgent care centre model: a qualitative study

BMJ Open ◽  
2016 ◽  
Vol 6 (6) ◽  
pp. e010224 ◽  
Author(s):  
Sarah Morton ◽  
Agnieszka Igantowicz ◽  
Shamini Gnani ◽  
Azeem Majeed ◽  
Geva Greenfield
Keyword(s):  
Qualitative Study ◽  
Team Development ◽  
Urgent Care ◽  
Care Centre ◽  
Urgent Care Centre

Urgent care centre in Sweden — the integration of teams and perceived effects

2019 ◽  
Vol 34 (4) ◽  
pp. 1205-1216 ◽  
Author(s):  
Ingela Wennman ◽  
Malin Wittholt ◽  
Eric Carlström ◽  
Tobias Carlsson ◽  
Amir Khorram‐Manesh
Keyword(s):  
Urgent Care ◽  
Care Centre ◽  
Perceived Effects ◽  
Urgent Care Centre

Patterns of healthcare use among adolescents attending an urban general practitioner-led urgent care centre

2013 ◽  
Vol 31 (8) ◽  
pp. 630-636 ◽  
Author(s):  
Shamini Gnani ◽  
Helen McDonald ◽  
Saiful Islam ◽  
Farzan Ramzan ◽  
Michele Davison ◽  
...  
Keyword(s):  
General Practitioner ◽  
Urgent Care ◽  
Care Centre ◽  
Healthcare Use ◽  
Urgent Care Centre

Reasons for attending an urban urgent care centre with minor illness: a questionnaire study

2014 ◽  
Vol 31 (e1) ◽  
pp. e71-e75 ◽  
Author(s):  
C Amiel ◽  
B Williams ◽  
F Ramzan ◽  
S Islam ◽  
T Ladbrooke ◽  
...  
Keyword(s):  
Urgent Care ◽  
Questionnaire Study ◽  
Care Centre ◽  
Minor Illness ◽  
Urgent Care Centre

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

scholarly journals Urgent care centre redirection: evaluation of a nurse-led intervention

2018 ◽  
Vol 25 (09) ◽  
pp. 25-30
Author(s):  
Nicola Groom ◽  
Tara Kidd ◽  
Nicola Carey
Keyword(s):  
Urgent Care ◽  
Care Centre ◽  
Urgent Care Centre
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