Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

2020 ◽  
Vol 27 (10) ◽  
pp. 995-1001
Author(s):  
Avi Baehr ◽  
Caroline Ledbetter ◽  
Kelly J. Bookman ◽  
Yang Wang ◽  
Adit A. Ginde ◽  
...  
Keyword(s):  
Emergency Departments ◽  
High Acuity ◽  
Timeliness Of Care

scholarly journals Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Barbara Y. DiPietro ◽  
Dana Kindermann ◽  
Stephen M. Schenkel
Keyword(s):  
Emergency Departments ◽  
Social Factor ◽  
Homeless People ◽  
Chronic Illnesses ◽  
Limb Pain ◽  
Baltimore City ◽  
Administrative Records ◽  
Immunodeficiency Virus ◽  
High Acuity ◽  
Alteration Of Consciousness

The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs) in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86%) were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9), lack of housing (n=6), alteration of consciousness (n=6), infection with human immunodeficiency virus (HIV) (n=5), and nausea/vomiting (n=5). Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.

Timeliness of Care for Injured Patients Initially Seen at Freestanding Emergency Departments

2020 ◽  
Vol 29 (2) ◽  
pp. 95-99
Author(s):  
Lauren E. Birmingham ◽  
Gwendolyn Richner ◽  
Mary Moran ◽  
Kindra M. Hatridge ◽  
Richard L. George
Keyword(s):  
Emergency Departments ◽  
Timeliness Of Care ◽  
Injured Patients

scholarly journals Analyzing Main and Interaction Effects of Length of Stay Determinants in Emergency Departments

2019 ◽  
Author(s):  
Gorkem Sarıyer ◽  
Mustafa Gökalp Ataman ◽  
İlker Kızıloğlu
Keyword(s):  
Length Of Stay ◽  
Emergency Departments ◽  
Secondary Data ◽  
The Elderly ◽  
Interaction Effects ◽  
Urban Hospital ◽  
Main Effect ◽  
High Acuity ◽  
Main Determinants ◽  
Ed Operations

Background: Measuring and understanding main determinants of length of stay (LOS) in emergency departments (EDs) is critical from an operations perspective, since LOS is one of the main performance indicators of ED operations. Therefore, this study analyzes both the main and interaction effects of four widely-used independent determinants of ED-LOS. Methods: The analysis was conducted using secondary data from an ED of a large urban hospital in Izmir, Turkey. Between-subject factorial analysis of variance (ANOVA) was used to test the main and interaction effects of the corresponding factors. P values <.05 were considered statistically significant. Results: While the main effect of gender was insignificant, age, mode of arrival, and clinical acuity had significant effects, whereby ED-LOS was significantly higher for the elderly, those arriving by ambulance, and clinically-categorized high-acuity patients. Additionally, there was an interaction between the age and clinical acuity in that, while ED-LOS increased with age for high acuity patients, the opposite trend occurred for low acuity patients. When ED-LOS was modeled using gender, age, and mode of arrival, there was a significant interaction between age and mode of arrival. However, this interaction was not significant when the model included age, mode of arrival, and clinical acuity. Conclusion: Significant interactions exist between commonly used ED-LOS determinants. Therefore, interaction effects should be considered in analyzing and modelling ED-LOS.

scholarly journals Timeliness of Care in US Emergency Departments

2014 ◽  
Vol 174 (11) ◽  
pp. 1847 ◽  
Author(s):  
Sidney T. Le ◽  
Renee Y. Hsia
Keyword(s):  
Emergency Departments ◽  
Timeliness Of Care

scholarly journals P109: Education innovation: pediatric emergencies curriculum for emergency physicians

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S95-S95
Author(s):  
K. Pardhan ◽  
R. Clark ◽  
C. Filipowska ◽  
W. Thomas-Boaz ◽  
M. Hillier ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Pediatric Patients ◽  
Comfort Level ◽  
Emergency Physicians ◽  
Childrens Hospital ◽  
Pediatric Emergencies ◽  
Large Community ◽  
High Acuity ◽  
Low Volume ◽  
Simulation Centre

Introduction: Tertiary care emergency departments (EDs) in large urban environments may have a low volume of high acuity pediatric presentations due to their proximity to dedicated childrens hospitals or large community centres. This may lead to discomfort among emergency physicians (EPs) and registered nurses (RNs) in managing these patients and a waning of knowledge and skills for this unique population. Among the EP group at our institution, 68% indicated they managed pediatric patients in less than 25% of their shifts, 68% also indicated they were uncomfortable managing an undifferentiated critically unwell neonate and only 32% indicated they would be comfortable teaching pediatric topics to emergency medicine residents. At our institution, our innovation was to create a useful curriculum for certified EPs and RNs to improve the interdisciplinary teams comfort level, knowledge and skill set when managing pediatric emergencies. Methods: A needs assessment was undertaken of the EPs and RNs working in our centre. This information was used to develop intended learning outcomes in a collaborative manner with the clinical nursing educator and physician curriculum leads. The team further collaborated with the local simulation centre and a pediatric emergency physician from the local childrens hospital. Results: A one-year, three-module curriculum was developed to cover the areas felt to be highest yield by the EP group: febrile illness, respiratory disease and critically ill neonates and infants. Each module contains three components: an in person interactive lecture delivered by an EP who routinely manages pediatric patients, either at a childrens hospital or large community centre; an online component with e-mail blasts of high yield pediatric content; and, culminating in an interdisciplinary interdepartmental simulation held in situ. This latter is particularly important so that all members of the interdisciplinary team can practice finding and using equipment based on its actual location within the ED. Each component of each module is then evaluated by the participants to ensure improvement for subsequent delivery. Conclusion: Well delivered continuing professional development (CPD) will become increasingly important as competence by design becomes the model for maintenance of certification. Maintaining skills for pediatric patients is an important component of CPD for physicians working in general emergency departments that see a low volume of high acuity pediatric presentations. Our curriculum seeks to address this identified need in an innovative manner using a modular and interdisciplinary approach with a diversity of teaching methods to appeal to the learning styles among our health care team.

Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽  
2010 ◽  
Vol 31 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Gregory Luke Larkin ◽  
Annette L. Beautrais
Keyword(s):  
Suicide Prevention ◽  
Emergency Departments

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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