Substance-related problems in patients visiting an urban Canadian emergency department

ABSTRACTObjective:For many patients with addiction and other substance problems, the emergency department (ED) is the sole provider of medical care. This study sought to determine the prevalence and characteristics of substance-related medical problems in ED patients, as defined by documentation in the medical record. We also sought to compare the ED resource use (length of ED stay and number of revisits) of patients with and without substance problems.Methods:Trained evaluators using explicit criteria reviewed all ED charts during a 6-week period at a Canadian tertiary care teaching centre. Data was collected on demographics, documentation of problematic substance use and whether the ED visit was due to substance problems. Using a computerized database, we determined how many patients with and without substance problems had 1 or more subsequent ED visits during the 1-year period from Sept. 1, 2002, to Aug. 31, 2003.Results:Of 6064 visits made by 5194 patients, 6026 visits (99.4%) representing 5188 patients (99.9%) were captured for review. Of those visits, 674 (11.2%, 95% confidence interval [CI] 10.4%–12.0%), made by 600 patients, had documentation of problematic substance use and 521 visits (8.6%, 95% CI 7.9%–9.4%) by 469 patients were caused by substance problems. The mean age of patients with a visit due to a substance problem was 39.2 years, compared with 48.5 years for those with other visits (p< 0.001). The admission rate for substance-related visits was 25.3%, compared with 17.6% for other visits (p< 0.001). For discharged patients, the median length of the ED visit owing to substance-related problems lasted 232 minutes (IQR [interquartile range] 267 min), compared with 164 minutes (IQR 167 min) for other visits (p< 0.001). In 1 year of follow-up, 161 of 600 patients (26.8%) with a substance problem made 466 revisits (mean 0.78 revisits/patient), compared with 975 of 4588 patients (21.3%) without a substance problem who made a total of 2150 revisits (mean 0.47 revisits/patient,p< 0.001).Conclusion:Substance problems contribute significantly to ED visits, hospital admissions and duration of ED stay at a tertiary centre. It is likely that our methodology underestimates the scope of the problem and that a universal screening program would find a higher prevalence. The magnitude of this problem supports the need for an interdisciplinary identification and intervention program for ED patients with substance-related issues.

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What are kids getting into these days? A retrospective chart review of substance use presentations to a Canadian pediatric emergency department

CJEM ◽

10.1017/cem.2015.13 ◽

2015 ◽

Vol 17 (4) ◽

pp. 345-352 ◽

Cited By ~ 1

Author(s):

G. Emmi Driedger ◽

Kathryn A. Dong ◽

Amanda S. Newton ◽

Rhonda J. Rosychuk ◽

Samina Ali

Keyword(s):

Emergency Department ◽

Substance Use ◽

Chart Review ◽

Social Issues ◽

Admission Rate ◽

Retrospective Chart Review ◽

Pediatric Emergency ◽

Problematic Substance Use ◽

Level Of Consciousness ◽

Problematic Substance

AbstractObjectivesGoals for this study were to characterize the substances being used by youth who presented to an emergency department (ED), their demographic descriptors, and to describe the associated acute morbidity and mortality.MethodsWe conducted a retrospective review of all youth, ages 10–16 years, who presented to a pediatric ED with complaints related to recreational drug use (n=641) for 2 years ending on December 31, 2009.ResultsThe median age of patients was 15 years; 56% were female. Six percent of patients were homeless, and 21% were wards of the state. The most frequent ingestions included ethanol (74%), marijuana (20%), ecstasy (19%), and medications (15%). Over one third of patients had ingested two or more substances. Ninety percent of patients were brought to the ED by the emergency medical services; 63% of these activations were by non-acquaintances. Of the 47% of youth who presented with a decreased level of consciousness, half had a Glasgow Coma Scale less than 13. The Canadian Triage and Acuity Scale score was 1 or 2 for 44% of patients. Sixty-eight percent received IV fluids, 42% received medication, and 4% were intubated. The admission rate was 9%.ConclusionsYouth who presented to the ED for substance use represented a socially vulnerable population whose use of recreational substances resulted in high medical acuity and significant morbidity. Improved clinical identification of such high-risk youth and subsequent design of interventions to address problematic substance use and social issues are urgently needed to complement the acute medical care that youth receive.

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Recurrent Emergency Department Users: Two Categories with Different Risk Profiles

Journal of Clinical Medicine ◽

10.3390/jcm8030333 ◽

2019 ◽

Vol 8 (3) ◽

pp. 333 ◽

Cited By ~ 4

Author(s):

Ksenija Slankamenac ◽

Meret Zehnder ◽

Tim Langner ◽

Kathrin Krähenmann ◽

Dagmar Keller

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Emergency Services ◽

Hospital Admissions ◽

Tertiary Care ◽

Chronic Obstructive ◽

Care Hospital ◽

Co Morbidity ◽

Ed Visits ◽

Morbidity Index

Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Repeated ED users had more ED visits (p < 0.001) and needed more hospital admissions (p < 0.010) compared to frequent ED users. Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases (p < 0.001) and mental disorders (p < 0.001). In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled (p = 0.001), had an increased Charlson co-morbidity index (p = 0.004) or suffering from rheumatic diseases (p < 0.001). A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services.

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P008: Addressing chronic pain and problematic substance use of opioids in the emergency department: can a comprehensive framework for care work?

CJEM ◽

10.1017/cem.2016.185 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S81-S81

Author(s):

M.A. Allen

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Substance Use ◽

Best Practice ◽

Electronic Record ◽

Emergency Department Visits ◽

Direct Result ◽

Complex Needs ◽

Problematic Substance Use ◽

Problematic Substance

Introduction: Chronic pain and substance misuse are complex chronic illness that are subject to prejudice, misinterpretation and cultural biases. They require a broad, multi-disciplined approach if they are to be effectively managed. Barrier’s to effective care in the emergency department include our reliance on pain scales alone to effectively triage and manage chronic pain, differing philosophy’s and attitudes regarding the appropriate use of high risk pain pharmacology including opioids and confusing classifications systems used to describe pain and problematic substance use which can often lead to further stigmatization and over medicating. Methods: The charts of thirteen patients with complex pain and problematic substance use who had more than 360 visits to a regional emergency department in one year were reviewed retrospectively and data collected regarding frequency of visits and disposition after the implementation of a comprehensive pain and addiction strategy from April 2011 to August 2015. Results: In the first year of implementation there was a 70% drop in the frequency of emergency department visits. Five patients (38%) required a comprehensive pain plan. Six agreed (46%) to a direct referral to our mental health, addiction and chronic pain services. Two patients (15%) were lost to follow-up. Review of the electronic record to track patient visits to provincial emergency departments did not show an increase in visits to other facilities within the province. Review of visits in 2015 show a 97% drop in the frequency of visits. Family Physicians in the community did not report an increase in the frequency of patient visits as a direct result of the implementation of this strategy nor was there an increase in complaints to administration regarding ineffective pain management. Conclusion: Although survey numbers are low it suggests that a framework for the management of complex pain and substance use disorders can be successfully implemented in the emergency department improving timely access to appropriate management and resources for patients based on best practice to address their complex needs.

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Frequent users of an inner-city emergency department

CJEM ◽

10.2310/8000.2012.120670 ◽

2012 ◽

Vol 14 (05) ◽

pp. 306-313 ◽

Cited By ~ 11

Author(s):

Jill Geurts ◽

Wes Palatnick ◽

Trevor Strome ◽

Erin Weldon

Keyword(s):

Emergency Department ◽

Substance Use ◽

General Population ◽

Tertiary Care ◽

Vital Signs ◽

Female Gender ◽

Tertiary Care Centre ◽

Lengths Of Stay ◽

Ed Visits ◽

Marginally Housed

ABSTRACTBackground:Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits.Methods:Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit—demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay—were analyzed and compared to data from the entire ED population for the same period.Results:Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (p< 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (p< 0.05). Patients left without being seen in 15.8% of visits.Conclusions:High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.

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Screening procedures to identify problematic substance use in medical emergency department patients

Addiction Science & Clinical Practice ◽

10.1186/1940-0640-7-s1-a79 ◽

2012 ◽

Vol 7 (S1) ◽

Author(s):

Michael Bogenschutz ◽

Dennis Donovan ◽

Cameron Crandall ◽

Robert Lindblad ◽

Raul Mandler ◽

...

Keyword(s):

Emergency Department ◽

Substance Use ◽

Medical Emergency ◽

Problematic Substance Use ◽

Problematic Substance ◽

Screening Procedures ◽

Emergency Department Patients

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Epidemiological profile of non-urgent patient visits to emergency department in a tertiary care hospital in South India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195841 ◽

2019 ◽

Vol 7 (1) ◽

pp. 128

Author(s):

Arun Anbumani ◽

Moses Kirubairaj Amos Jegaraj ◽

Reka Karruppusami

Keyword(s):

Emergency Department ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Significant Proportion ◽

Admission Rate ◽

Urgent Care ◽

Minor Trauma ◽

Care Hospital ◽

Ed Visits ◽

Epidemiological Profile

Background: Non-urgent visits to emergency department (ED) form a significant proportion of ED visits. The reasons vary from minor injuries, fever of short duration, parental anxiety, and even serious conditions like myocardial infarctions presenting atypically. Non-urgent visits stress the ED services while prolonged waiting affects the patients. The aim was to study the profile of non-urgent visits to emergency department of a tertiary care hospital in South India.Methods: Prospective and descriptive study of patients aged 15 years and above categorized as non-urgent after triage was conducted. Data such as age, gender, reason for visit, time of presentation during the day, duration of ED stay and need for referral were recorded. Quantitative variables were presented as Mean±SD and frequency with percentage for qualitative variables.Results: Non-urgent visits contributed to 47.1% of total ED visits. Reasons for non-urgent visits were fever (15.4%), vomiting (13.9%), breathlessness (7.6%), minor trauma (7.3%), giddiness (7.0%) and dysuria (5.5%). 80.8% of all non- urgent visits were seen by ED doctor within two hours of being triaged. Most patients were treated for their immediate symptoms and 64.8% needed follow-up out-patient appointments. Admission rate was 1.2%. Majority of non-urgent visits (55.7%) were daytime visits and 13% were after-hours.Conclusions: Non-urgent visits contribute to about half of all ED visits and can stress ED. A local triage guideline is necessary to run these services in ED. Extended general practice or family physician run urgent care can relieve the stress on ED while rendering to patients accessible and affordable care.

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