What determines diagnostic resource consumption in emergency medicine: patients, physicians or context?

ObjectivesA major cause for concern about increasing ED visits is that ED care is expensive. Recent research suggests that ED resource consumption is affected by patients’ health status, varies between physicians and is context dependent. The aim of this study is to determine the relative proportion of characteristics of the patient, the physician and the context that contribute to ED resource consumption.MethodsData on patients, physicians and the context were obtained in a prospective observational cohort study of patients hospitalised to an internal medicine ward through the ED of the University Hospital Bern, Switzerland, between August and December 2015. Diagnostic resource consumption in the ED was modelled through a multilevel mixed effects linear regression.ResultsIn total, 473 eligible patients seen by one of 38 physicians were included in the study. Diagnostic resource consumption heavily depends on physicians’ ratings of case difficulty (p<0.001, z-standardised regression coefficient: 147.5, 95% CI 87.3 to 207.7) and—less surprising—on patients’ acuity (p<0.001, 126.0, 95% CI 65.5 to 186.6). Neither the physician per se, nor their experience, the patients’ chronic health status or the context seems to have a measurable impact (all p>0.05).ConclusionsDiagnostic resource consumption in the ED is heavily affected by physicians’ situational confidence. Whether we should aim at altering physician confidence ultimately depends on its calibration with accuracy.

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Patterns and Results of Triage Advice Before Emergency Department Visits Made by Patients With Cancer

JCO Oncology Practice ◽

10.1200/op.20.00617 ◽

2021 ◽

pp. OP.20.00617

Author(s):

Arthur S. Hong ◽

Hannah Chang ◽

D. Mark Courtney ◽

Hannah Fullington ◽

Simon J. Craddock Lee ◽

...

Keyword(s):

Emergency Department ◽

Acute Care ◽

Emergency Department Visits ◽

University Hospital ◽

Urgent Care ◽

Telephone Triage ◽

Patients With Cancer ◽

Oncology Care ◽

Ed Visits ◽

The University

PURPOSE: Patients with cancer undergoing treatment frequently visit the emergency department (ED) for commonly anticipated complaints (eg, pain, nausea, and vomiting). Nearly all Medicare Oncology Care Model (OCM) participants prioritized ED use reduction, and the OCM requires that patients have 24-hour telephone access to a clinician, but actual reductions in ED visits have been mixed. Little is known about the use of telephone triage for acute care. METHODS: We identified adults aged 18+ years newly diagnosed with cancer, linked to ED visits from a single institution within 6 months after diagnosis, and then analyzed the telephone and secure electronic messages in the preceding 24 hours. We coded interactions to classify the reason for the call, the main ED referrer, and other attempted management. We compared the acuity of patient self-referred versus clinician-referred ED visits by modeling hospitalization and ED visit severity. RESULTS: From 2011 to 2018, 3,247 adults made 5,371 ED visits to the university hospital and self-referred to the ED 58.5% of the time. Clinicians referred to outpatient or oncology urgent care for 10.3% of calls but referred to the ED for 61.3%. Patient self-referred ED visits were likely to be hospitalized (adjusted Odds Ratio [aOR], 0.89, 95% CI, 0.64 to 1.22) and were not more severe (aOR, 0.75, 95% CI, 0.55 to 1.02) than clinician referred. CONCLUSION: Although patients self-referred for six of every 10 ED visits, self-referred visits were not more severe. When patients called for advice, clinicians regularly recommended the ED. More should be done to understand barriers that patients and clinicians experience when trying to access non-ED acute care.

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Severe Sepsis in the Emergency Department – An Observational Cohort Study from the University Hospital of the West Indies

West Indian Medical Journal ◽

10.7727/wimj.2012.194 ◽

2018 ◽

Cited By ~ 1

Author(s):

R Edwards ◽

R Hutson ◽

J Johnson ◽

R Sherwin ◽

G Gordon-Strachan ◽

...

Keyword(s):

Emergency Department ◽

Severe Sepsis ◽

Cohort Study ◽

West Indies ◽

Observational Cohort Study ◽

University Hospital ◽

The West ◽

Observational Cohort ◽

The University

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The Impact of COVID-19 on Admissions and Management of Patients with Atrial Fibrillation Episodes in the Emergency Department

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116048 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6048

Author(s):

Łukasz Bilaszewski ◽

Wojciech Timler ◽

Katarzyna Budrewicz ◽

Michał Marczak ◽

Remigiusz Kozłowski ◽

...

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Sinus Rhythm ◽

Primary Diagnosis ◽

University Hospital ◽

Period 2 ◽

Ed Visits ◽

The University ◽

The Impact ◽

Second Wave

Background: During the COVID-19 pandemic, the number of admissions to the emergency department (ED) due to a primary diagnosis of atrial fibrillation (AF) has decreased when compared to pre-pandemic times. The principal aim of the study was to assess the frequency of SARS-CoV-2 infections and sinus rhythm restoration among patients who arrived at the ED with AF. Secondary aims included determining whether patients arriving at the ED principally due to AF delayed their presentations and whether the frequency of successful cardioversion for AF was decreased during the pandemic period. Materials and Methods: A retrospective analysis of medical records of patients admitted to two hospital EDs due to AF during July–December 2019 (pre-pandemic period) versus July–December 2020 (pandemic period) was performed. Results: During the study periods, 601 ED visits by 497 patients were made due to the primary diagnosis of AF. The patients were aged 71.2+/−13.5 years and 51.3% were male. The duration of an AF episode before the ED admission was 10 h (4.5–30 h) during the pandemic period vs. 5 h (3–24 h) during the non-pandemic period (p = 0.001). A shorter duration of the AF episode before ED admission was associated with the successful restoration of the sinus rhythm. During the pandemic period, among patients with short-lasting AF who were not treated with Phenazolinum, the restoration of the sinus rhythm was more frequent in the Copernicus Memorial Hospital than in the University Hospital (p = 0.026). A positive SARS-CoV-2 test was found in 5 (1%) patients, while 2 other patients (0.5%) had a prior diagnosis of COVID-19 disease noted in their medical history. Conclusions: 1. The number of AF episodes treated in these two EDs was lower during the pandemic than non-pandemic period. 2. The patients with AF appeared at the ED later after AF onset in the pandemic period. 3. Successful cardioversion of atrial fibrillation was more frequent during the pre-pandemic period in one of the two hospitals. 4. A difference of approaches to the treatment of short-lasting AF episodes between EDs during the pandemic period may exist between these two EDs. 5. The patients with SARS-CoV-2 infection during the second wave of the COVID-19 pandemic constituted a small percentage of the patients admitted to EDs due to an AF episode.

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The development and validation of a resource consumption score of an emergency department consultation

PLoS ONE ◽

10.1371/journal.pone.0247244 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247244

Author(s):

Martin Müller ◽

Clyde B. Schechter ◽

Wolf E. Hautz ◽

Thomas C. Sauter ◽

Aristomenis K. Exadaktylos ◽

...

Keyword(s):

Emergency Department ◽

External Validation ◽

Chief Complaint ◽

Resource Consumption ◽

University Hospital ◽

Contributing Factors ◽

Night Time ◽

Final Model ◽

Ed Visits ◽

The Impact

Background Emergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements. Methods Characteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable. Results In total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors. Conclusions More than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.

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Abstract #216: Knowledge About Inpatient Diabetes Management: Impact of an Educational Intervention in Nurses at the University Hospital of Puerto Rico

Endocrine Practice ◽

10.1016/s1530-891x(20)42522-4 ◽

2015 ◽

Vol 21 ◽

pp. 30-31

Author(s):

Anette Garces-Dominguez ◽

Loida Gonzalez-Rodriguez ◽

Monica Vega ◽

Myriam Allende-Vigo

Keyword(s):

Puerto Rico ◽

Educational Intervention ◽

Diabetes Management ◽

University Hospital ◽

Inpatient Diabetes ◽

Inpatient Diabetes Management ◽

The University

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Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽

10.1024/0301-1526.33.2.78 ◽

2004 ◽

Vol 33 (2) ◽

pp. 78-81 ◽

Cited By ~ 21

Author(s):

Thalhammer ◽

Aschwanden ◽

Jeanneret ◽

Labs ◽

Jäger

Keyword(s):

Current Literature ◽

Vascular Complications ◽

University Hospital ◽

Closure Device ◽

Ultrasound Guided ◽

Vascular Closure Device ◽

Device Use ◽

Arterial Stenoses ◽

The University ◽

Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

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User Evaluation of an Integrated Medical Workstation for Clinical Data Analysis

Methods of Information in Medicine ◽

10.1055/s-0038-1634954 ◽

1993 ◽

Vol 32 (05) ◽

pp. 365-372 ◽

Cited By ~ 2

Author(s):

T. Timmeis ◽

J. H. van Bemmel ◽

E. M. van Mulligen

Keyword(s):

Data Analysis ◽

Clinical Research ◽

Clinical Data ◽

University Hospital ◽

User Evaluation ◽

Scientific Staff ◽

Medical Institutions ◽

Clinical Data Analysis ◽

Research Problems ◽

The University

AbstractResults are presented of the user evaluation of an integrated medical workstation for support of clinical research. Twenty-seven users were recruited from medical and scientific staff of the University Hospital Dijkzigt, the Faculty of Medicine of the Erasmus University Rotterdam, and from other Dutch medical institutions; and all were given a written, self-contained tutorial. Subsequently, an experiment was done in which six clinical data analysis problems had to be solved and an evaluation form was filled out. The aim of this user evaluation was to obtain insight in the benefits of integration for support of clinical data analysis for clinicians and biomedical researchers. The problems were divided into two sets, with gradually more complex problems. In the first set users were guided in a stepwise fashion to solve the problems. In the second set each stepwise problem had an open counterpart. During the evaluation, the workstation continuously recorded the user’s actions. From these results significant differences became apparent between clinicians and non-clinicians for the correctness (means 54% and 81%, respectively, p = 0.04), completeness (means 64% and 88%, respectively, p = 0.01), and number of problems solved (means 67% and 90%, respectively, p = 0.02). These differences were absent for the stepwise problems. Physicians tend to skip more problems than biomedical researchers. No statistically significant differences were found between users with and without clinical data analysis experience, for correctness (means 74% and 72%, respectively, p = 0.95), and completeness (means 82% and 79%, respectively, p = 0.40). It appeared that various clinical research problems can be solved easily with support of the workstation; the results of this experiment can be used as guidance for the development of the successor of this prototype workstation and serve as a reference for the assessment of next versions.

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Sharing of Worldwide Spread Knowledge Using Hypermedia Facilities & Fast Communication Protocols (Mosaic and World Wide Web): The Example of ExPASy

Methods of Information in Medicine ◽

10.1055/s-0038-1634588 ◽

1995 ◽

Vol 34 (01/02) ◽

pp. 75-78 ◽

Cited By ~ 5

Author(s):

R. D. Appel ◽

O. Golaz ◽

Ch. Pasquali ◽

J.-C. Sanchez ◽

A. Bairoch ◽

...

Keyword(s):

World Wide Web ◽

World Wide ◽

Relevant Literature ◽

Communication Protocols ◽

Laboratory Data ◽

Central Element ◽

University Hospital ◽

New Information ◽

The University ◽

Link Information

Abstract:The sharing of knowledge worldwide using hypermedia facilities and fast communication protocols (i.e., Mosaic and World Wide Web) provides a growth capacity with tremendous versatility and efficacy. The example of ExPASy, a molecular biology server developed at the University Hospital of Geneva, is striking. ExPASy provides hypermedia facilities to browse through several up-to-date biological and medical databases around the world and to link information from protein maps to genome information and diseases. Its extensive access is open through World Wide Web. Its concept could be extended to patient data including texts, laboratory data, relevant literature findings, sounds, images and movies. A new hypermedia culture is spreading very rapidly where the international fast transmission of documents is the central element. It is part of the emerging new “information society”.

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