Preventing emergency department visits and hospitalizations for asthma by use of oral corticosteroids at home: Are we adhering to national guidelines?

2010 ◽  
pp. 100913044943042-5
Author(s):  
Timothy H. Self ◽  
Cary R. Chrisman ◽  
Anna R. Jacobs ◽  
Ngan H. Vo ◽  
John C. Winton
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
National Guidelines ◽  
Oral Corticosteroids ◽  
At Home

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

scholarly journals P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Thomas Ferguson ◽  
Paul Komenda ◽  
Gerard Harper ◽  
John Milad
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Self Care ◽  
Emergency Department Visits ◽  
Weekend Effect ◽  
Care At Home ◽  
The Uk ◽  
Care System ◽  
At Home

Abstract Background and Aims The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system. Method Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP. Results Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits. Conclusion In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.

scholarly journals A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015

2020 ◽  
pp. 155982762094218
Author(s):  
Briana L. Moreland ◽  
Ramakrishna Kakara ◽  
Yara K. Haddad ◽  
Iju Shakya ◽  
Gwen Bergen
Keyword(s):  
United States ◽  
Older Adults ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Targeted Prevention ◽  
Injury Surveillance System ◽  
Injurious Falls ◽  
Ed Visits ◽  
At Home

Introduction. Falls among older adults (age ≥65) are a common and costly health issue. Knowing where falls occur and whether this location differs by sex and age can inform prevention strategies. Objective. To determine where injurious falls that result in emergency department (ED) visits commonly occur among older adults in the United States, and whether these locations differ by sex and age. Methods. Using 2015 National Electronic Injury Surveillance System-All Injury Program data we reviewed narratives for ED patients aged ≥65 who had an unintentional fall as the primary cause of injury. Results. More fall-related ED visits (71.6%) resulted from falls that occurred indoors. A higher percentage of men’s falls occurred outside (38.3%) compared to women’s (28.4%). More fall-related ED visits were due to falls at home (79.2%) compared to falls not at home (20.8%). The most common locations for a fall at home were the bedroom, bathroom, and stairs. Conclusion. The majority of falls resulting in ED visits among older adults occurred indoors and varied by sex and age. Knowing common locations of injurious falls can help older adults and caregivers prioritize home modifications. Understanding sex and age differences related to fall location can be used to develop targeted prevention messages.

scholarly journals Home Care of Acute Leukemia Patients: From Active Therapy to End-of-Life and Palliative Care. a Three-Year Experience of a Single Centre

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5867-5867
Author(s):  
Isabella Capodanno ◽  
Pierluigi Alfieri ◽  
Enrica Tamagnini ◽  
Katia Codeluppi ◽  
Stefano Luminari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Acute Leukaemia ◽  
Emergency Department Visits ◽  
Place Of Death ◽  
Terminal Phase ◽  
Number Of Patients ◽  
Historical Group ◽  
Study Population ◽  
At Home

Abstract Purpose: Since July 2012, the Haematological Home Care (HHC) program was activated in our Institution to improve quality of assistance of patients with haematological malignancies, both in the terminal phase of disease and during active chemotherapy. Methods: We conducted a retrospective study to describe the 3-year experience of our HHC program; its efficacy was measured for acute leukaemia patients only analysing number of hospitalizations, number of accesses to the Emergency department and place of death. Our study population was also compared with historical data from a small group of 17 patients with acute leukaemia assisted at home, by their general practitioner, in the previous 3 years, when the HHC program was not available. Results: The study group consisted of 44 patients, 36 of whom (82%) needed a palliative treatment, while 8 (18%) had an ongoing active chemotherapy. The mean number of hospitalizations was 0.64 (range 0-7) per patient and the number of emergency department visits was 0.82 (range 0-4) per patient. Place of death was home environment in 51.4% and hospital in 40.5% of patients. When compared to data of the historical group, HCC program significantly reduced the number of hospitalizations (0.64 vs 2.53 per patient, range 0-9; P 0.001), significantly increased the number of patients who died at home (51.5% vs 6%; P=0.003) and reduced those who died in hospital (40.5% vs 65%; P 0.003). Conclusions: Home care for patients with acute leukaemia is feasible, decreases the number of hospitalizations, and increases the number of patients who die in their own home. Figure. Figure. Disclosures Luminari: Servier: Consultancy; Gilead: Consultancy; Celgene: Consultancy; Roche: Consultancy; Sandoz: Consultancy.

Trauma Visits to a Pediatric Emergency Department During the COVID-19 Quarantine and “Stay at Home” Period

2021 ◽  
pp. 000313482110474
Author(s):  
Usha Sethuraman ◽  
Nirupama Kannikeswaran ◽  
Adam Singer ◽  
Carolyn B Krouse ◽  
Dawn Cloutier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Physical Abuse ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Pediatric Emergency ◽  
Child Physical Abuse ◽  
Emergency Department Visits ◽  
Pediatric Emergency Department ◽  
Dog Bites ◽  
At Home

Background Impact of social distancing on pediatric injuries is unknown. Methods We retrospectively compared injury visits to a pediatric emergency department by individuals ≤21 years during “Stay at Home” (SHO) period to the same period in 2019 (non-SHO). Demographics, types, and outcomes of injuries were noted. Results Although, there was a 35.6% reduction in trauma-related emergency department visits during SHO period (1226 vs 1904), the proportion of injury visits increased (15.5% vs 8.1%, P < .001) and mean age was lower (5.8 yrs ±4.5 vs 8.4 yrs ± 5.2, P < .001). There were significant increases in visits related to child physical abuse (CPA), firearms, and dog bites. Further, significant increases in trauma alerts ( P < .01), injury severity ( P < .01), critical care admissions ( P < .001), and deaths ( P < .01) occurred during the SHO period. Conclusions Although overall trauma-related visits decreased during SHO, the proportion of these visits and their severity increased. Trauma visits related to child physical abuse, dog bites, and firearms increased. Further studies are required to assess the long-term impact of pandemic on pediatric trauma epidemiology.

scholarly journals Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030030
Author(s):  
Filipa Pereira ◽  
Pauline Roux ◽  
Marie Santiago-Delefosse ◽  
Armin von Gunten ◽  
Boris Wernli ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Chronic Conditions ◽  
Management Practices ◽  
Medication Management ◽  
Emergency Department Visits ◽  
Mixed Methods Study ◽  
Multiple Chronic Conditions ◽  
At Home

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

Abstract 045: Declines In Acute Myocardial Infarction And Stroke Emergency Department Visits Observed During Covid-19 Restrictions In North Carolina

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Eugenia Wong ◽  
Wayne D Rosamond ◽  
Mehul D Patel ◽  
Anna Waller
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
North Carolina ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Syndromic Surveillance System ◽  
Before And After ◽  
Ed Visits ◽  
At Home

Introduction: Efforts to control the COVID-19 pandemic brought sweeping social change, with stay-at-home orders and physical distancing mandates in 43 of 50 states by April 2020. Early on, isolated studies around the world described reduced hospital admissions. Reports from some US hospitals also described declines in catheterization laboratory activations, and acute myocardial infarction (AMI) and stroke admissions. However, there have been few population-based analyses of emergency department (ED) visits to verify these initial reports and describe longer term impacts of the pandemic on care seeking behavior. Hypothesis: We hypothesized that AMI and stroke ED visits in North Carolina (NC) would decrease substantially after a statewide stay-at-home order was announced on March 27, 2020. Methods: We analyzed all ED visits from January 5 to August 28, 2020 using data collected by the NC Disease Event Tracking and Epidemiologic Collection Tool, a syndromic surveillance system that automatically gathers ED data in near-real time for all EDs in NC. Counts of AMI and stroke/transient ischemic attack (TIA) were ascertained using ICD-10-CM diagnosis codes. We compared weekly 2020 ED visit data before and after NC’s stay-at-home order, and to 2019 ED visit data. Results: Overall ED volume declined by 44% in the weeks before and after the stay-at-home order ( Figure ) while the prior year’s ED volume stayed steady at ~100,000 visits per week. From January 5 to March 28, there were 593 AMI and 791 stroke/TIA visits per week on average. By April 11, ED visits reached a nadir at 426 AMI and 543 stroke/TIA visits per week, representing a 28% and 31% decrease, respectively. Since June, AMI and stroke/TIA ED visits have rebounded slightly but have yet to reach pre-pandemic levels. Conclusions: We observed swift declines in AMI and stroke/TIA ED visits following NC’s stay-at-home order. These findings potentially reflect the avoidance of medical care due to fears of COVID-19 exposure and may eventually result in higher associated case fatality.

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