3 Reducing frequent attenders to the emergency department at west suffolk hospital

2020 ◽  
Vol 96 (1132) ◽  
pp. 119.3-120
Author(s):  
Fiona Huang ◽  
Yusef Kiberu ◽  
Sreejib Das
Keyword(s):  
Emergency Department ◽  
Care Plan ◽  
Liaison Psychiatry ◽  
Post Intervention ◽  
Significance Level ◽  
Frequent Attenders ◽  
Number Of Patients ◽  
Wide Range ◽  
The Impact ◽  
Multi Disciplinary Team

IntroductionPatients who repeatedly attend the emergency department (ED) often have underlying complex social, psychological and chronic medical issues which are difficult to address in the emergency/acute medicine environment alone. Their attendances not only present a burden to the ED, but also can be a sign that the patient’s primary issue has been insufficiently addressed. At West Suffolk Hospital, we are trialling an approach to reduce frequency of ED attendances in a specific cohort of patients identified as being frequent attenders. In order to do this, we are using a multi-disciplinary approach including psychiatry services and ED clinicians.MethodsOur cohort of frequent attenders were identified as patients presenting more than 4 times to ED between March 2017 to April 2018. Exclusion criteria was if the patient is under 18 years old, has known long term medical conditions and known safeguarding concerns. With collaborative working by the emergency medicine clinician and liaison psychiatry, a letter was sent to 38 patients in May 2018, identifying them as frequent attenders and inviting them to a tailored multi-disciplinary team meeting. Initially we are assessing the impact of the letter, so 6 months after the letters were sent out, we assessed patient attendances again. 2 patients were excluded due to moving out of area and being in prison. Paired sample for means t-test was used to compare attendances pre- and post-intervention.ResultsThere were a wide range of presenting complaints to ED, most of which were psychiatric related – overdose, deliberate self harm, alcohol/drug related. The intervention letter improved the attendance rate the most in this cohort, whereas it had a negligible effect on attendances with physical complaints. The average fall in attendance was 33% in the 6 months post patients receiving the intervention letter. This reached significance level with p=0.039.ConclusionsSending frequent attender patients a letter and putting in place a care plan could significantly reduce Emergency Department attendances. However there were a small number of patients, making it difficult to assess the efficacy of our intervention especially when adjusting for patient relocation.We are hoping to disseminate the locally trialed strategy region wide across East Anglia, providing many more data points. We can also implement the model not just in patients with psychiatric background, but also patients with chronic medical problems too with additions to the multi-disciplinary team as per the needs of the patient.

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

scholarly journals Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Kaehne ◽  
Paula Keating
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Emergency Department Visits ◽  
Service Utilisation ◽  
Specific Patient ◽  
Access Points ◽  
Latent Demand ◽  
Frequent Attenders ◽  
Cohort Design ◽  
The Impact

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

The impact of frequent attenders on a UK emergency department

2010 ◽  
Vol 17 (6) ◽  
pp. 332-336 ◽  
Author(s):  
Alexandra Dent ◽  
Glenys Hunter ◽  
Andrew Philip Webster
Keyword(s):  
Emergency Department ◽  
Frequent Attenders ◽  
The Impact

The Impact of Implementing a “Pain, Agitation, and Delirium Bundle” in a Pediatric Intensive Care Unit: Improved Delirium Diagnosis

2021 ◽  
Author(s):  
Lise D. Cloedt ◽  
Kenza Benbouzid ◽  
Annie Lavoie ◽  
Marie-Élaine Metras ◽  
Marie-Christine Lavoie ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Post Intervention ◽  
Number Of Patients ◽  
Implementation Period ◽  
Short And Long Term ◽  
The Impact

AbstractDelirium is associated with significant negative outcomes, yet it remains underdiagnosed in children. We describe the impact of implementing a pain, agitation, and delirium (PAD) bundle on the rate of delirium detection in a pediatric intensive care unit (PICU). This represents a single-center, pre-/post-intervention retrospective and prospective cohort study. The study was conducted at a PICU in a quaternary university-affiliated pediatric hospital. All patients consecutively admitted to the PICU in October and November 2017 and 2018. Purpose of the study was describe the impact of the implementation of a PAD bundle. The rate of delirium detection and the utilization of sedative and analgesics in the pre- and post-implementation phases were measured. A total of 176 and 138 patients were admitted during the pre- and post-implementation phases, respectively. Of them, 7 (4%) and 44 (31.9%) were diagnosed with delirium (p < 0.001). Delirium was diagnosed in the first 48 hours of PICU admission and lasted for a median of 2 days (interquartile range [IQR]: 2–4). Delirium diagnosis was higher in patients receiving invasive ventilation (p < 0.001). Compliance with the PAD bundle scoring was 79% for the delirium scale. Score results were discussed during medical rounds for 68% of the patients in the post-implementation period. The number of patients who received opioids and benzodiazepines and the cumulative doses were not statistically different between the two cohorts. More patients received dexmedetomidine and the cumulative daily dose was higher in the post-implementation period (p < 0.001). The implementation of a PAD bundle in a PICU was associated with an increased recognition of delirium diagnosis. Further studies are needed to evaluate the impact of this increased diagnostic rate on short- and long-term outcomes.

scholarly journals 845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S513-S513
Author(s):  
Elizabeth A Aguilera ◽  
Gilhen Rodriguez ◽  
Gabriela P Del Bianco ◽  
Gloria Heresi ◽  
James Murphy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Screening Program ◽  
Medical Center ◽  
Hiv Infections ◽  
Hiv Screening ◽  
Opt Out ◽  
Number Of Patients ◽  
Confirmatory Tests ◽  
Routine Hiv Screening ◽  
The Impact

Abstract Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score &gt; 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

scholarly journals Evaluating alcohol intoxication management services: the EDARA mixed-methods study

2020 ◽  
Vol 8 (24) ◽  
pp. 1-214 ◽  
Author(s):  
Simon C Moore ◽  
Davina Allen ◽  
Yvette Amos ◽  
Joanne Blake ◽  
Alan Brennan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Alcohol Intoxication ◽  
Ethnographic Study ◽  
Acute Alcohol Intoxication ◽  
Front Line ◽  
Night Time ◽  
Number Of Patients ◽  
The Impact ◽  
Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

The impact of an education intervention on the approach of hospital staff to patients with dementia in a Danish general hospital setting: An explanatory sequential mixed-methods study

2021 ◽  
pp. 205715852110229
Author(s):  
Annemarie Toubøl ◽  
Lene Moestrup ◽  
Katja Thomsen ◽  
Jesper Ryg ◽  
Dennis Lund Hansen ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Collection ◽  
General Hospital ◽  
Hospital Staff ◽  
Education Intervention ◽  
Post Intervention ◽  
Sequential Mixed Methods ◽  
Number Of Patients ◽  
The Impact ◽  
Dementia Education

The number of patients with dementia admitted to hospitals is increasing. However, the care and treatment of these patients tends to be suboptimal. A response to this is a widespread implementation of educational initiatives. Nevertheless, the effect of such initiatives is questioned. The aim of this study was to investigate the impact of a dementia education intervention by examining the self-reported outcomes of general hospital staff and exploring the staff’s experiences of these outcomes. An explanatory sequential mixed-methods design framed the study method. The quantitative data collection included repeated questionnaires: pre-intervention ( n = 849), one month post-intervention ( n = 618), and five months post-intervention ( n = 468) followed by a qualitative data collection using interviews ( n = 16). The GRAMMS guideline was followed. The integration of the quantitative and qualitative results suggests that the impact of the education intervention can be ascribed to the interdisciplinary focus, which facilitated a comprehensive commitment to creating careful solutions for patients with dementia. A prioritization of person over task seems to be assisted by an improved interdisciplinary cooperation initiated by the inclusion of all employed staff at the hospital in a dementia education intervention.

scholarly journals Assessment of Reflex Urine Culture Criteria Changes and its Impact on Treatment of Asymptomatic Bacteriuria

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S346-S346 ◽  
Author(s):  
Kirre Wold ◽  
Jeff Brock ◽  
Kelly Percival ◽  
Lindsey Rearigh ◽  
Lucas Vocelka ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
Hospital Data ◽  
Post Intervention ◽  
Number Of Patients ◽  
Positive Urine ◽  
Before And After ◽  
Implementation Period ◽  
Inappropriate Antibiotics ◽  
The Impact

Abstract Background Asymptomatic bacteriuria (ASB) is a common clinical condition identified by the presence of bacteria in the urine of a patient without signs and symptoms of a urinary tract infection (UTI). Treatment of ASB leads to unnecessary antimicrobial use and can cause more harm than benefit in many patients. This study is to determine the impact of more stringent criteria for urinalysis with culture if indicated (UAC), implemented in September 2016, on the treatment of asymptomatic bacteriuria. Methods A pre-post descriptive study of patients was conducted with an order placed for UAC in the Emergency Department (ED) or hospital. Data was collected retrospectively via chart reviews. The data on ASB patients from November 2015 to April 2016 was compared with the post-implementation period October 2016 to January 2017. The number of UAC orders and cultures were averaged for 6 months pre and post implementation of the criteria change. Results A total of 580 patient charts were assessed post-implementation of the UAC criteria change. A majority of the orders originated from the ED, (N = 430, 72.8%). ASB was treated inappropriately at a rate of 60.4% (N = 64/106) pre-implementation and a rate of 65% (N = 41/63) post implementation, P = 0.542. The total number of UAC ordered before and after implementation did not change, (N = 2852 pre-intervention vs N = 2825 post-intervention, P = 0.744), as seen in Figure 1. However, the number of reflexed urine cultures did significantly decrease post criteria change,&#x2028; (N = 1056 pre-intervention vs. N = 603 post-intervention, P &lt; 0.0001). In addition, the number of positive urine cultures also significantly decreased, (N = 378 pre-intervention vs. N = 289 post-intervention, P = 0.0447). The impact the criteria change had on patient care is the number of potential antibiotic courses saved by reflexing fewer urine cultures off the UAC. Based on the decrease in positive urine cultures, it is estimated 702 courses of inappropriate antibiotics for ASB could be saved per year (59/month). Conclusion More stringent criteria for reflex urine cultures significantly decreases the number of urine cultures performed, therefore decreasing the number of patients treated with ASB. Additional stewardship measures are necessary to reduce the treatment of ASB for patients who have cultures performed. Disclosures All authors: No reported disclosures.

scholarly journals Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

2013 ◽  
Vol 3 (3) ◽  
pp. 17 ◽  
Author(s):  
Dan Brun Petersen ◽  
Thomas Andersen Schmidt
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
General Medicine ◽  
University Hospital ◽  
First Year ◽  
Special Focus ◽  
Diagnostic Study ◽  
Diagnostic Unit ◽  
Number Of Patients ◽  
The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

scholarly journals Comprehensive geriatric assessment in the emergency department

2020 ◽  
Vol 49 (6) ◽  
pp. 936-938 ◽  
Author(s):  
Siobhan Harding
Keyword(s):  
Emergency Department ◽  
Secondary Care ◽  
Evidence Base ◽  
Community Dwelling ◽  
Multiple Sources ◽  
National Guidelines ◽  
Post Discharge ◽  
Post Intervention ◽  
Quasi Experimental ◽  
The Impact

Abstract Completing comprehensive geriatric assessments (CGA) for frail patients admitted to acute hospitals has well-established benefits and is advocated by national guidelines. There is high-quality evidence demonstrating an association between inpatient CGAs and the patient being alive and community-dwelling at 12-month follow-up. However, less well-known is the effectiveness of CGAs conducted within the emergency department (ED), with the primary purpose of facilitating admission avoidance, on reducing 30-day reattendance or readmission. This commentary provides an overview of five studies that measure the impact of conducting an ED-CGA on subsequent secondary care attendance. Two randomised-controlled trials, one case-matched cohort study and two quasi-experimental pre- and post-intervention studies were reviewed. The studies reported variable success in preventing subsequent secondary care use. No studies meeting the criteria had been conducted within the UK, affecting generalisability of the findings. There is no clear evidence that conducting a CGA within ED reduced reattendances or admissions 30 days post-discharge. The existing evidence base is methodologically and clinically heterogeneous and is vulnerable to multiple sources of bias. Further research is needed to understand whether screening to identify target populations or whether increased intensity of interventions delivered improves outcomes. ED-CGA may not have a beneficial effect on cost improvement or service delivery metrics, but it may have positive outcomes that are of high importance to the patients. This warrants further study.

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