scholarly journals P.100 A Retrospective Study of Alberta Emergency Room Utilization by Pediatric Epilepsy Patients

2021 ◽  
Vol 48 (s3) ◽  
pp. S48-S48
Author(s):  
J Kassiri ◽  
J Mailo ◽  
T Rajapakse ◽  
GT Wang ◽  
N Liu ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hospital Admissions ◽  
Medical Laboratory ◽  
Administrative Databases ◽  
Pediatric Epilepsy ◽  
Developmentally Delayed ◽  
Discharge Abstract Database ◽  
Normal Children ◽  
Younger Age ◽  
Utilization Patterns

Background: Epilepsy, a common neurologic condition, instigates a large number of emergency room (ER) visits annually. This project aims to retrospectively review the patterns and characteristics of Alberta ER visits by pediatric epilepsy patients. Methods: Methods: Alberta Health administrative databases, including the Inpatient Discharge Abstract Database, the National Ambulatory Care Reporting System, Diagnostic Imaging and Medical Laboratory, were used to identify ER utilization patterns among children with epilepsy in Alberta, Canada between 2012–2018. Results: Results: Of 5,419 pediatric epilepsy ER patients between 2012–2018 in Alberta, 59% were developmentally delayed children. Children in this particular group, when compared to developmentally normal children with epilepsy, had the following characteristics: they were significantly more likely to utilize ERs in children’s hospitals versus other hospitals; they presented at a significantly younger age; they had a significantly longer length of stay; they had higher triage scores; they were subjected to significantly more investigations; and they had significantly more hospital admissions for epilepsy. Conclusions: Discussion: This novel Alberta-wide study of resource utilization of pediatric epilepsy patients shows that developmentally delayed children with epilepsy use significantly higher resources compared to developmentally normal children with epilepsy. Whether this is justified or not requires further study.

scholarly journals The volume of general surgery emergency cases in a government hospital during the COVID-19 pandemic and two other periods: a comparative, retrospective study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ibrahim Abu Shakra ◽  
Maxim Bez ◽  
Samer Ganam ◽  
Rola Francis ◽  
Amir Muati ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Control Period ◽  
Medical Laboratory ◽  
Government Hospital ◽  
Analog Scale ◽  
Surgical Interventions ◽  
Medical Emergencies ◽  
The Mean ◽  
Surgery Department ◽  
Second Lebanon War

Abstract Background During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed. Objective To compare the characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. Methods Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We retrospectively compared the characteristics of patients who were admitted with various conditions during three periods. Results Patients’ mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0, respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P < 0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. Conclusions Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.

Abstract O.02: Validation of Kawasaki Disease Incidence Assessment as Derived from Health System Administrative Databases vs. Active Retrospective Surveillance in Ontario, Canada

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Cedric Manlhiot ◽  
Sunita O’Shea ◽  
Bailey Bernknopf ◽  
Michael Labelle ◽  
Mathew Mathew ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Disease Incidence ◽  
Administrative Databases ◽  
Canadian Hospital ◽  
Hospital Discharge Database ◽  
Incident Cases ◽  
Discharge Database

Introduction: Historically, 2 methods have been used to determine the incidence of Kawasaki disease (KD): active or passive surveillance, or the use of administrative databases. Given the increasing regulatory requirements, mainly around patient privacy, periodic retrospective surveillances have become increasingly challenging. Administrative databases are not curated datasets and doubts have been cast on their accuracy. Methods: The Hospital for Sick Children has been conducting retrospective triennial surveillances of KD since 1995 by contacting all hospitals in Ontario and manually reviewing all cases through chart review, reconciling inter-hospital transfers and multiple readmissions. We queried the Canadian hospital discharge database (Canadian Institute for Health Information) for hospitalizations associated with a diagnosis of KD between 2004-9. The administrative dataset was manually reviewed; patient national health number, institution and dates of admission/discharge were used to identify inter-hospital transfers, readmission and follow-up episodes. Results: The Canadian hospital discharge database reported 1,685 admissions during the study period (281±44 per year) for Ontario. Manual review of the dataset identified 219 (13%) as inter-hospital transfers (56, 26%), readmissions (122, 56%), admissions for follow-up of coronary artery aneurysms (14, 6%) or hospital admissions not related to KD (27, 12%). When these admissions were removed, the total number of incident cases for the study period was 1,466 (244±45 per year). The retrospective triennial surveillance identified 1,373 KD cases during the same period (229±33 per year). The Canadian hospital discharge database overestimated the number of cases in all 6 years by an average of 6.7±5.9%. The overestimation likely comes from patients who were originally diagnosed with KD but in whom the diagnosis of KD was subsequently excluded (historically ~5-6%). Conclusions: Reliance on administrative data to determine incidence of KD is possible and accurate; data should be manually reviewed to remove non-incident cases and estimates should be adjusted to reflect the expected proportion of patients in whom the diagnosis of KD will be subsequently excluded.

Characteristics of Readmitted Psychiatric Inpatients

2003 ◽  
Vol 93 (1) ◽  
pp. 235-238 ◽  
Author(s):  
Kaye Baron ◽  
J. Ray Hays
Keyword(s):  
Clinical Utility ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Prediction Equation ◽  
Short Length ◽  
Cognitive Resources ◽  
Common Variance ◽  
Younger Age ◽  
The Common ◽  
Initial Hospitalization

This study examined sociodemographic, diagnostic, psychological, and episode-based variables in a sample of 130 psychiatric patients admitted to treatment at least twice in a 6-yr. period. Short length of initial hospitalization ( r = -.30, p <.01) and younger age on initial admission ( r = -.20, p <.05) were significantly correlated with frequent hospital admissions. Scores on four of the subscales of the WAIS-R were significantly correlated with readmission, confirming that patients who have fewer cognitive resources are at risk of frequent admissions. A multiple regression analysis combining variables to predict readmission accounted for only 12% of the common variance ( r128 = .34, p <.01), however, indicating that a prediction equation with these variables has limited clinical utility.

scholarly journals Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions

2005 ◽  
Vol 38 (2) ◽  
pp. 227-235 ◽  
Author(s):  
S.C.L. Farhat ◽  
R.L.P. Paulo ◽  
T.M. Shimoda ◽  
G.M.S. Conceição ◽  
C.A. Lin ◽  
...  
Keyword(s):  
Air Pollution ◽  
Emergency Room ◽  
Hospital Admissions ◽  
Emergency Room Visits

scholarly journals First Nations Pneumonia Admissions: Different Patients or Different Attitudes?

2004 ◽  
Vol 11 (5) ◽  
pp. 328-329
Author(s):  
NR Anthonisen
Keyword(s):  
First Nations ◽  
Hospital Admissions ◽  
Artificial Ventilation ◽  
Administrative Databases ◽  
Control Group ◽  
Severity Assessment ◽  
X Rays ◽  
Pneumonia Severity ◽  
System 1 ◽  
Age And Sex

In this issue of theCanadian Respiratory Journal, Marrie et al (pages 336-342) present a database study of hospital admissions among First Nation Aboriginals (FNAs) in Alberta that is fascinating, at least to me. They captured all hospital admissions for "status" FNAs from 1997 to 1999, along with data on where and how long they were hospitalized, the severity of the pneumonia, the number of comorbidities present, whether they were readmitted and the costs involved. They compared these finding with a group of age- and sex-matched non-FNAs who were also hospitalized for pneumonia. There are, of course, weaknesses in the study that commonly occur in most exercises using administrative databases. Pneumonia is a hospital record diagnosis (there is no information about chest x-rays, sputum cultures, etc). Pneumonia severity assessment relies on information regarding hospital transfers, intensive care unit admissions and events such as shock, artificial ventilation and death (there is no information available to apply an accepted grading system) (1). Further, "status" FNAs were probably not entirely representative of FNAs in general; indeed, some nonstatus FNAs may well have been included in the control group. However, I strongly doubt that these or similar objections are substantial enough to greatly influence the findings of Marrie et al.

Abstract 18655: Efficacy of Cardiac Computerized Tomographic Angiography in the Evaluation of Patients with Cocaine-Induced Chest Pain: A Pilot Randomized Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Richard Peralta ◽  
Andrew Yoon ◽  
Moustapha Atoui ◽  
Karomibal Mejia ◽  
Maryam Afshar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Length Of Stay ◽  
Emergency Room ◽  
Randomized Trial ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Major Adverse Cardiovascular Events ◽  
Emergency Room Visits ◽  
Tomographic Angiography

Background: Cocaine-induced chest pain (CICP) is reported in 40% of patients using cocaine and is associated with frequent emergency room visits and hospital admissions. Hypothesis: Coronary computed tomographic angiography (CCTA) has better outcomes than standard-of-care (SOC) for the evaluation of patients with CICP. Method: CICP patients were randomized to CCTA protocol or SOC. The primary outcome of the study was a composite of recurrent emergency room visits and hospital admissions. Secondary outcomes included length of stay, major adverse cardiovascular events and all-cause mortality. Results: The study population consisted of 202 patients with CICP (CCTA=23 and SOC=179). As compared to SOC, the number of emergency room visits in the CCTA group were lower at 30 days (1.04±0.1 vs. 1.24±0.5, p=0.012) and 1 year (2.43±0.9 vs. 2.61±2.1, p=0.008), but not at 3 years (5.04±3.3 vs. 4.87±1, p=0.112) findings that were independent of CCTA results. Mean admission rates for the CCTA group were slightly but not significantly lower than the SOC group at 30 days (0.91±0.1 vs.1.10±0.2 p=0.438) and 1 year (1.52±0.3 vs. 1.82±0.3 p=0.187), but not at 3 years (3.22±0.6 vs. 2.95±0.5, p=0.111). Hospital length of stay was also lower in CCTA patients than in SOC patients (2.61±0.5 vs. 3.34 ± 0.5 p<0.001). After 3 year follow-up, there was 1 major adverse cardiovascular event in the CCTA group compared to 22 in the SOC group (p=0.024). No patient died in the CCTA while 3 patients died from any cause in the SOC group (p=0.776) after 3 years of follow-up. Conclusion: In this prospective randomized trial, CCTA reduced near and intermediate-term but not long-term rates of emergency room visits and hospitalizations. When compared to SOC, the use of CCTA was associated with a reduction of major adverse cardiovascular events. Larger randomized controlled trials to further assess the efficacy of a CCTA-based strategy for CICP appear warranted.

scholarly journals 3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

scholarly journals Ten-year trends in stroke admissions and outcomes in Canada

2015 ◽  
Vol 42 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Noreen Kamal ◽  
M. Patrice Lindsay ◽  
Robert Côté ◽  
Jiming Fang ◽  
Moira K. Kapral ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admissions ◽  
Age Groups ◽  
Population Based ◽  
Stroke Patients ◽  
Discharge Abstract Database ◽  
Absolute Increase ◽  
Admission Rates ◽  
Administrative Dataset ◽  
Hospital Administrative

AbstractBackgroundWe analyzed a 10-year stroke administrative dataset to examine trends in admissions, mortality, and discharge destination in Canada.MethodsWe conducted an analysis of hospital administrative data from April 1st 2003 to March 31st 2013 from the Canadian Institute of Health Information’s Discharge Abstract Database. Ten-year trends for population-based age- and sex-standardized admission rates were calculated. We reviewed 10-year trends in absolute stroke admissions for differences between provinces and age groups. Stroke 30-day in-hospital mortality rates were calculated and adjusted for sex, age, stroke type and comorbidities. We documented changes in discharge location for ischemic and hemorrhagic stroke patients discharged from acute care.ResultsThe rate of hospital admissions has declined from 140.2 to 117.5 (per 100,000 people). The number of absolute stroke admissions within provinces increased in Alberta and British Columbia (21.7% and 16.2% respectively). The proportion of stroke patients aged 40-69 years old increased by 4.8% (p<0.0001) over the 10 years, whereas the proportion aged over 70 decreased by 4.9% (p<0.0001). Risk-adjusted 30-day in-hospital mortality decreased from: 18.5% to 14.9% for all strokes; 15.2% to 12.1% for ischemic strokes; 35.6% to 29.7% for intracerebral hemorrhage; and 25.1% to 18.0% for subarachnoid hemorrhage. The absolute increase in patients requiring inpatient and outpatient support increased by 4% (p<0.0001).ConclusionThe rate of admissions for stroke is decreasing but there is an increase in stroke admissions for younger patients. In-hospital mortality is decreasing; fewer patients are going directly home without services and more are requiring support services.

Interdisciplinary care rounds in the community: Changing the paradigm of supportive service involvement in cancer care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 83-83
Author(s):  
Robert D. Siegel ◽  
Hal E. Crosswell ◽  
Terra Dillard ◽  
Jennifer Bayne ◽  
Tina Redenz ◽  
...  
Keyword(s):  
Emergency Room ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Academic Community ◽  
Adolescent And Young Adult ◽  
Cancer Center ◽  
Interdisciplinary Care ◽  
Supportive Services ◽  
Short Term ◽  
Tumor Boards

83 Background: Although cancer centers have focused on optimizing seamless Multidisciplinary Care (MDC) at tumor boards and/or clinics, there has been little published on effective ways to involve supportive services into the management of cancer patients. Historically, supportive services have been initiated when there is an active need rather than in anticipation of that need. As an alternative to pursuing such "crisis management" in our patients, Bon Secours St. Francis Cancer Center (BSSF) initiated Interdisciplinary Care (IDC) Rounds in an effort to anticipate patient needs, enhance quality of life (QoL), and potentially limit avoidable emergency room and hospital admissions. Methods: We initiated IDC Rounds with participants from the following disciplines: medical oncology, navigation, clinic nursing, palliative medicine, financial counseling, psychology, nutrition, clinical research, adolescent and young adult, and oncology rehabilitation/survivorship (ORS). A database was created to track new patients with malignancies within three weeks of presentation and the subsequent recommendations made by the IDC team. Those recommendations are then forwarded to the primary medical oncologist who has the ability to agree to those recommendations in full or in part before they are actuated. Results: BSSF is a non-academic, community-based cancer program and receives over 1,300 referrals annually from a referral population of 1.32 million in 10 counties. Short term metrics demonstrate a 57% and 100% increase in referrals to ORS and palliative care, respectively. Successes and challenges including sustainability, cost and measurable impact will be discussed. Conclusions: We have shown that it is feasible in the community setting to create a process that will allow early integration of supportive services into the full service care of cancer patients. Results demonstrate an increase in short-term metrics such as referrals to supportive services. Our ultimate goal is that formalized IDC results not only in earlier involvement by needed services but enhanced QoL for our patients with fewer emergency room and hospital admissions. Those data will be compiled as the program matures.

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