Urgent Care and the Emergency Department: Providing the Right Ambulatory Care Settings

Abstract Background Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system to prioritize antibiotic stewardship efforts. Methods We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly selected days from 2017 to 2018. For inpatients and perioperative patients, administrations of antibiotics were recorded, whereas prescriptions were recorded for outpatients. Results On the study days, 10.9% (95% confidence interval [CI], 10.6%–11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95% CI, 52.6%–55.7%), 38.0% were from the hospital (95% CI, 36.6%–39.5%), and 7.8% (95% CI, 7.1%–8.7%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult non–critical care inpatient wards accounted for 26.4% (95% CI, 25.0%–27.7%), 23.8% (95% CI, 22.6%–25.2%), and 23.9% (95% CI, 22.7%–25.3%) of antibiotic use, respectively. Only 9.2% (95% CI, 8.3%–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of gram-negative activity accounted for 30.4% (95% CI, 29.0%–31.9%) of antibiotics. Infections of the respiratory tract were the leading indication for antibiotics. Conclusions In an integrated healthcare system, more than half of antibiotic use occurred in the emergency department/urgent care centers and outpatient clinics. Antibiotics with a broad spectrum of gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.

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Effective safety netting in acute childhood illness: an important contribution to avoiding preventable deaths

British Journal of General Practice ◽

10.3399/bjgp18x696893 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696893

Author(s):

Sarah Neill ◽

Damian Roland ◽

Matthew Thompson ◽

Sue Palmer-Hill ◽

Natasha Bayes ◽

...

Keyword(s):

Research Programme ◽

Safety Net ◽

Childhood Illness ◽

Urgent Care ◽

Video Capture ◽

Delivery Modes ◽

Care Services ◽

The Right ◽

Qualitative Exploration ◽

Safety Netting

BackgroundChildren’s use of urgent care services continues to increase. If families are to access the right services at the right time they need access to information to inform their decision making. Providing a safety net of information has the potential to reduce morbidity and avoidable mortality and has been shown to reduce re-consultation safely.AimOur research programme aims to provide parents with information they can use to help them determine when to seek help for an acutely ill child.MethodOur programme includes: ASK SARA, a systematic review of existing interventions; ASK PIP, qualitative exploration of safety netting information used by parents and professionals; ASK SID, development of the content and delivery modes for the intervention; ASK ViC, video capture of children with acute illness; and ASK Petra, safety netting tool development using consensus methodology.ResultsThe ASK SNIFF programme findings demonstrate the need for professionally endorsed and co-produced safety netting resources focussing on symptoms of acute childhood illness. We now have consensus on the scripted content for a safety netting tool supported by video materials to enable parents to see symptoms for real.ConclusionSafety netting tools are a valuable aid to general practice enabling GPs to show parents what to look out for when their child is sick so that they know when to (re)consult. Recent reports of failure to recognise and appropriately safety net children with sepsis highlights the importance of such tools.

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The impact of urgent care centers on nonemergent emergency department visits

Health Services Research ◽

10.1111/1475-6773.13631 ◽

2021 ◽

Author(s):

Lindsay Allen ◽

Janet R. Cummings ◽

Jason M. Hockenberry

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Urgent Care ◽

Urgent Care Centers ◽

The Impact

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Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211024843 ◽

2021 ◽

pp. 1357633X2110248

Author(s):

Charlie M Wray ◽

Myla Junge ◽

Salomeh Keyhani ◽

Janeen E Smith

Keyword(s):

Emergency Department ◽

Emergency Department Visit ◽

Care Program ◽

Urgent Care ◽

Emergency Department Utilization ◽

Emergency Department Care ◽

Referral Rates ◽

Care Assessment ◽

The Impact ◽

Care Evaluation

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

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Use of Ophthalmic Sonography to Evaluate for Intraocular Foreign Body in Both Outpatient and Emergency Department/Urgent Care Patients

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211033232 ◽

2021 ◽

pp. 875647932110332

Author(s):

Patrick J. Fish

Keyword(s):

Emergency Department ◽

Foreign Body ◽

Foreign Bodies ◽

Outpatient Setting ◽

Intraocular Foreign Body ◽

Urgent Care ◽

Posterior Chamber ◽

Emergency Department Setting ◽

Before And After ◽

Glass Metal

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.

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P029: Requesting prescriptions in the emergency department: the patient, the request and the response

CJEM ◽

10.1017/cem.2020.236 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S74-S75

Author(s):

L. Shepherd ◽

M. Mucciaccio ◽

K. VanAarsen

Keyword(s):

Emergency Department ◽

Family Doctor ◽

Wait Time ◽

Primary Objective ◽

Urgent Care ◽

Care Centre ◽

Medication Prescription ◽

Physician Decision Making ◽

Service Gap ◽

Urgent Care Centre

Introduction: Patients presenting to the Emergency Department (ED) for the sole purpose of requesting prescriptions are problematic. Problematic for the patient, who may have a long wait to be seen and may leave dissatisfied. Problematic for the ED physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misappropriation of medications. The primary objective of this study was to determine the characteristics of patients who present to the ED or Urgent Care Centre (UCC) requesting a prescription, the nature of these requests and the resulting action by the attending physician. The secondary objective was to determine the proportion of medication requests and responses that have potential street value. With this knowledge we may be better positioned to serve these patients and support physician decision-making. Methods: This was a single-centre, retrospective electronic chart review looking at all adult patients with a presenting complaint of medication request who attended a two-site tertiary ED or an Urgent Care Centre (UCC) in London, Ontario between April 1, 2014 and June 30, 2017. Data was tested for normality and analyzed using descriptive statistics. Results: A total of 1923 cases met the inclusion criteria. Cases were removed (n = 421) if it was unclear which prescription was requested or if a non-medication prescription or injection was requested. The patient median (IQR) age was 44 (32-54) with 58% being male and 55% having a family doctor. There were a total of 2261 prescriptions requested by 1502 patients. The top 3 most commonly requested classes of medications were opioids 433/1502 (28.8%), antidepressants/antipsychotics 371/1502 (24.7%) and benzodiazepines 252/1502 (16.8%). The median (IQR) wait time was 73 minutes (35-128). 298/1502 (19.8%) of patients received their requested prescription (opioids 12.7%; antidepressant/antipsychotic 55.3% and benzodiazepines 16.3%). 740/1502 (49.3%) of patients requested a medication that had street value. Of those, 118/740 (15.9%) received the requested medication. Conclusion: There is no “one size fits all” solution for the patient who presents to the ED requesting a prescription. The large number of requests for psychiatric medications suggests a service gap for mental health patients in the community. This data supports the need for comprehensive electronic medication records to guide physicians’ decisions.

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Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1394 ◽

2021 ◽

pp. 1-3

Author(s):

Joanne Huang ◽

Zahra Kassamali Escobar ◽

Todd S. Bouchard ◽

Jose Mari G. Lansang ◽

Rupali Jain ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Antimicrobial Stewardship ◽

Emergency Departments ◽

Urgent Care ◽

Complex Data ◽

University Of Washington ◽

Primary Care Clinics ◽

Urgent Care Centers ◽

The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

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A rare encounter of obstructed direct inguinal hernia

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i2.28745 ◽

2019 ◽

Vol 22 (2) ◽

pp. 41-43

Author(s):

Amit Kumar Singh ◽

Nripesh Rajbhandari ◽

Balaram Malla ◽

Gakul Bhatta

Keyword(s):

Emergency Department ◽

Inguinal Hernia ◽

Intestinal Obstruction ◽

Intestinal Resection ◽

Posterior Wall ◽

Acute Intestinal Obstruction ◽

University Hospital ◽

Direct Inguinal Hernia ◽

Direct Hernia ◽

The Right

The direct inguinal hernia has a wider neck and thus usually doesn’t present as strangulation or incarceration in comparison to the indirect component. When direct inguinal hernias are untreated for a longer duration, they may get strangulated and incarcerated. Hence such long-standing direct hernias with features of intestinal obstruction and /or peritonism should be promptly seen and diagnosed to prevent massive and unwanted intestinal resection. We are reporting a case of 83-year-old male presented to Surgical Emergency Department of Dhulikhel Hospital, Kathmandu University hospital with complaints of swelling in the right inguinoscrotal region for 12 years and progressed to become irreducible and painful for 12 hours. Clinically he had an acute intestinal obstruction. Intra-operatively we found a direct hernia containing congested small bowel loops and toxic fluids. The toxic fluid was suctioned and after confirming viability, modified Bassini’s repair was done with reinforcement of the posterior wall. Even direct inguinal hernia of longer duration can cause acute or sub-acute intestinal obstruction with or without features of peritonism. This complication is more common in elderly patients.

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