Everyday J.

2020 ◽  
pp. 141-146
Author(s):  
Chadd K. Kraus
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Services ◽  
Medical Emergency ◽  
State Laws ◽  
Admission Rates ◽  
Care Services ◽  
Ed Visits

Commonly defined as having greater than four emergency department (ED) visits in a year, patients who are frequent users of the ED make up an estimated 3.5% to 10% of all ED visits and have been reported to account for nearly a third of all ED use. Frequent ED users have higher mortality, higher hospital admission rates, and higher use of all health care services, both specialty and primary care, compared to other patients using the ED. These patients should have the autonomy to access ED evaluation and care if he or she believes he or she has a medical emergency. This principle has been codified into both federal and many state laws protecting the “prudent layperson standard.” These patients should not be coerced to not seek ED care if the person believes he or she has an emergent condition.

scholarly journals Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

2021 ◽  
Vol 8 (1) ◽  
pp. 18-28
Author(s):  
Paula Tanabe ◽  
Audrey L. Blewer ◽  
Emily Bonnabeau ◽  
Hayden B. Bosworth ◽  
Denise H. Clayton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
North Carolina ◽  
Sickle Cell Disease ◽  
Cost Benefit ◽  
Care Utilization ◽  
Evidence Based ◽  
Cell Disease ◽  
Ed Visits

Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.

Emergency Department Return Prediction System using Blood Samples with LightGBM for Smart Health Care Services

2020 ◽  
pp. 1-1
Author(s):  
Younghwan Shin ◽  
Sangdo Kim ◽  
Jong-Moon Chung ◽  
Hyun Soo Chung ◽  
Sang Gil Han ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Prediction System ◽  
Blood Samples ◽  
Care Services ◽  
Smart Health

Conscientious Refusals by Hospitals and Emergency Contraception

2011 ◽  
Vol 20 (1) ◽  
pp. 130-138 ◽  
Author(s):  
MARK R. WICCLAIR
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Sexual Assault ◽  
Emergency Contraception ◽  
Health Care Services ◽  
Goods And Services ◽  
Care Services ◽  
Catholic Health Care ◽  
Life Sustaining Treatment ◽  
Nutrition And Hydration

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.

A Model for the Management of Suicidal Behaviour in Primary Care

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
V. Voros ◽  
P. Osvath ◽  
S. Fekete
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Suicidal Behaviour ◽  
Suicide Risk ◽  
Health Care Services ◽  
Warning Signs ◽  
Health Concern ◽  
Care Services ◽  
Suicidal Patients ◽  
Primary Care Professionals

Introduction:Although suicide rates are decreasing in most European countries, suicide is still a major health concern. Despite of the fact, that the vast majority of suicidal patients contacted with health care services before the suicidal act, the doctor-patient meeting is a necessary, but sometimes not sufficient way enough to prevent suicide. Most patients, who commit or attempt suicide, are not regarded as being at high immediate risk at their final contact with health care services.Aims and methods:Based on reviewing the relevant literature and on our previous studies we developed a brief, practical, clinical guideline, which may aid general practitioners and primary care professionals to assess suicide risk and also to manage these patients.Results:We introduce a model for an integrated, regional suicide prevention strategy, which includes recognition, risk assessment and also intervention. The main steps of our model are to recognize warning signs, explore crisis situation and/or psychopathologic symptoms, assess protective and risk factors, estimate suicide risk, plan intervention strategies, and finally manage suicidal patients through the different levels of intervention.Conclusion:In the management of suicidal behaviour the complex stress-diathesis model has to be adjusted by considering biological markers (mental disorders, personality traits) and psycho-social factors (crisis, negative life events, interpersonal conflicts). Only after the assessment of these factors primary care professionals, as ‘gatekeepers’ can manage suicidal patients effectively by using adequate psychopharmacotherapeutic and psychotherapeutic facilities in the recognition, treatment and prevention of suicidal behaviour.

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