1371 “The Nosebleed Effect”: Advice Given to Epistaxis Patients Discharged from The Emergency Department

Abstract Introduction Many patients with epistaxis are seen in the A&E department. A significant number are discharged without need for inpatient admission due to minor bleeds. Many are given limited information on management of further bleeds and even fewer are advised on the prevention of bleeds. Aim To evaluate the advice given to patients with epistaxis who are seen and discharged from A+E, to instigate an improvement in advice and to examine the subsequent effect on re-attendance rates Method Epistaxis patients discharged from A+E were audited over a 6-week period looking at advice given on discharge. A questionnaire was distributed to all A&E and ENT doctors probing current practice. A presentation on the management and prevention of epistaxis and the appropriate verbal/written advice to give was delivered and epistaxis advice sheets were made available. The practice regarding advice and the re-attendance rates were re-audited. Results 53 patients presented to the A&E department with epistaxis. 31 patients presenting with epistaxis were seen and discharged by A&E doctors. The remaining seen by ENT. Only 9 patients received verbal advice and 1 received written advice. There were 13 re-attenders. After re-audit showed a significant increase in the proportion of patients receiving advice by A&E doctors. Verbal and written advice increased from 18% to 61% and 1% to 60% respectively. The number of re-attenders was reduced to 13 to 6.

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G36(P) Evaluation of current practice guidelines and follow-up of outcomes among emergency department visits for head injuries in a cohort of infants less than 6 months of age

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-306237.36 ◽

2014 ◽

Vol 99 (Suppl 1) ◽

pp. A16-A16

Author(s):

E. Rutledge ◽

F. Doherty ◽

S. Deiratany ◽

R. McNamara ◽

I. Okafor

Keyword(s):

Emergency Department ◽

Practice Guidelines ◽

Current Practice ◽

Head Injuries ◽

Emergency Department Visits

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Hypercoagulability in Septic Shock Patients With Thrombocytopenia

Journal of Intensive Care Medicine ◽

10.1177/08850666211024188 ◽

2021 ◽

pp. 088506662110241

Author(s):

Sang-Min Kim ◽

Sang-Il Kim ◽

Gina Yu ◽

June-Sung Kim ◽

Seok In Hong ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Multivariate Analysis ◽

Platelet Count ◽

Mortality Rate ◽

Confidence Interval ◽

Sofa Score ◽

Odds Ratio ◽

Fibrinogen Level ◽

Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

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Impact of cancer on emergency department outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18618 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18618-e18618

Author(s):

Alexander S. Qian ◽

Edmund M. Qiao ◽

Vinit Nalawade ◽

Rohith S. Voora ◽

Nikhil V. Kotha ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Hospital Mortality ◽

Hospital Admission ◽

Cancer Patients ◽

Metastatic Cancer ◽

Inpatient Admission ◽

Cancer Site ◽

Patients With Cancer ◽

Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

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Implementation of the Western Australian Osteoporosis Model of Care: a fracture liaison service utilising emergency department information systems to identify patients with fragility fracture to improve current practice and reduce re-fracture rates: a 12-month analysis

Osteoporosis International ◽

10.1007/s00198-018-4526-5 ◽

2018 ◽

Vol 29 (8) ◽

pp. 1759-1770 ◽

Cited By ~ 4

Author(s):

C. A. Inderjeeth ◽

W. D. Raymond ◽

A. M. Briggs ◽

E. Geelhoed ◽

D. Oldham ◽

...

Keyword(s):

Emergency Department ◽

Information Systems ◽

Fragility Fracture ◽

Current Practice ◽

Fracture Liaison Service ◽

Model Of Care ◽

Fracture Liaison ◽

Western Australian

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Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

Clinical Infectious Diseases ◽

10.1093/cid/ciz207 ◽

2019 ◽

Author(s):

Raghav Tripathi ◽

Konrad D Knusel ◽

Harib H Ezaldein ◽

Jeremy S Bordeaux ◽

Jeffrey F Scott

Keyword(s):

United States ◽

Emergency Department ◽

Retrospective Analysis ◽

The United States ◽

Cost Of Care ◽

Emergency Department Visits ◽

Limited Information ◽

Targeted Interventions ◽

Ed Visits ◽

Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

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The Unmet Need for Pharmacists as Important Members of the Emergency Department Team in Resource-Limited Settings: A Case of Nepal

Journal of Pharmacy Technology ◽

10.1177/8755122519850118 ◽

2019 ◽

Vol 35 (5) ◽

pp. 219-224 ◽

Cited By ~ 1

Author(s):

Sunil Shrestha ◽

Krisha Danekhu ◽

Santosh Thapa ◽

Saval Khanal ◽

P. Ravi Shankar

Keyword(s):

Emergency Department ◽

Patient Care ◽

Unmet Need ◽

Developed Countries ◽

Limited Information ◽

Limited Evidence ◽

Resource Limited Settings ◽

Traditional Practice ◽

Resource Limited

Background: The role of pharmacists in many developed countries has evolved from the traditional practice of dispensing medicines to contributing directly or indirectly to improve patient health outcomes. They are providing hospital services and patient care including services in the emergency department (ED). However, there is limited evidence for pharmacist involvement in the ED from resource-limited countries such as Nepal. Objective: The aim of this study is to discuss the role of pharmacists and highlight the unmet need of pharmacists in ED in Nepal. Methods: A narrative review of existing literature was conducted. Results: The status of ED services in Nepalese hospitals is not yet at a desirable level, and there is limited information about the role of pharmacists in EDs. Evidence obtained from developed nations on the role of pharmacists in EDs suggests that they help in improving patient outcomes by minimizing medication errors, adverse drug reactions, and enhance patient care. Conclusion: The study highlights the need for pharmacists in EDs in resource-limited settings. There is limited evidence of pharmacists’ role in EDs from Nepal. Therefore, this study suggests a need for further studies on the possible contribution of pharmacists to ED services in Nepal.

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Dermatology in the Emergency Department: Prescriptions, Rates of Inpatient Admission, and Predictors of High Utilization in the US from 1996-2012

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2020.07.055 ◽

2020 ◽

Author(s):

Jason J. Yang ◽

Nolan J. Maloney ◽

Daniel Q. Bach ◽

Kyle Cheng

Keyword(s):

Emergency Department ◽

Inpatient Admission ◽

The Us ◽

High Utilization

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A Survey of School Nurses’ Perceptions of Complementary, Alternative, and Integrative Therapies

The Journal of School Nursing ◽

10.1177/1059840518770521 ◽

2018 ◽

Vol 35 (4) ◽

pp. 256-261 ◽

Cited By ~ 1

Author(s):

Grace Lartey ◽

Lizbeth P. Sturgeon ◽

Dawn Garrett-Wright ◽

Umar Y. Kabir ◽

Susan Eagle

Keyword(s):

Current Practice ◽

Conventional Medicine ◽

School Setting ◽

School Nurses ◽

Survey Study ◽

Limited Information ◽

State School ◽

Cross Sectional ◽

Nurses Perceptions ◽

Integrative Therapies

Complementary, alternative, and integrative therapies (CAIs) involve the use of practices outside of mainstream, conventional medicine. Few studies have been conducted on nurses’ perception and knowledge of CAI therapies. There is limited information on the protocols school nurses must follow in their practice on CAI use. The purpose of this study is to assess school nurses’ perception and knowledge of CAI therapies. A cross-sectional, nonexperimental survey study design was used, and participants were sampled with a cross-sectional convenience method. Members of four state School Nurses Associations were invited to participate in the study. Of the 290 participants, 100% of certified school nurses and 63% of non-certified school nurses believed CAI therapies have a place in their current practice (χ2 = 1.83, df = 1, p < .05). The study found that school nurses believe CAI therapies have a role in the school setting; however, the participants were not comfortable with assessing and administering these therapies.

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