Abstract P1: Limitations of Self-Reported Readmission Data After Acute Myocardial Infarction: Insights from the TRIUMPH Registry

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Philip G Jones ◽  
Adam C Salisbury ◽  
Carole Decker ◽  
Harlan M Krumholz ◽  
John A Spertus
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Coronary Intervention ◽  
Self Report ◽  
Readmission Rates ◽  
Hospital Records ◽  
Outpatient Visits ◽  
Patient Reported ◽  
Reason For Admission

Background: Self-reported readmission rates are frequently reported in the medical literature, yet the validity of these data is controversial. Few studies describe the accuracy of self-report of readmission following an AMI in comparison with physician-adjudicated data. Methods: We studied 4,340 AMI patients enrolled in the 24-US center TRIUMPH registry. Patients were interviewed at 1, 6 and 12 months after their AMI, and were asked to report all hospitalizations since their last contact, including the hospital name, date and reason. After obtaining consent from the patient and each hospital, all hospitalization records within the first year after the patient's index MI were requested and adjudicated by a physician panel. Accuracy of patients’ report of hospitalization and reason for admission (sensitivity, specificity) were assessed. Results: Of 4,340 patients, 3,633 (84%) completed follow-up interviews, reporting a total of 2,016 readmissions. Of these, hospital records were successfully obtained on 1,373. Record review revealed that 501 (36%) were not actual rehospitalizations (e.g., emergency department only, outpatient visits, admissions prior to study enrollment). Interestingly, when obtaining hospital records, we identified another 394 readmissions that were not reported by patients. Sensitivity of self-reported reason for admission was modest to poor for cardiac-cause rehospitalization, AMI and percutaneous coronary intervention (Table). Conclusions: We identified several limitations of self-reported readmission rates in this multi-center AMI cohort. Emergency department and outpatient visits were frequently reported as hospital admissions, nearly 400 hospitalizations were not reported to study personnel at the time of the follow-up interview, and accuracy of patient-reported reason for admission was modest at best. These data underscore the importance of verifying self-reported follow-up outcomes data. Accuracy of Patient Self-Reported Reason for Admission Adjudicated Reason for Admission Sensitivity Specificity Any cardiac 37% 88% AMI 43% 94% PCI 66% 93%

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L Dunnell ◽  
A Shrestha ◽  
E Li ◽  
Z Khan ◽  
N Hashemi
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Community Services ◽  
Service Improvement ◽  
Specialist Nurse ◽  
Front Door ◽  
Medication Changes ◽  
Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

scholarly journals Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study

2020 ◽  
Vol 19 (5) ◽  
pp. 433-439
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Tom Wilsgaard ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Employment Status ◽  
Smoking Status ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Self Report ◽  
Percutaneous Coronary ◽  
Working Age ◽  
Vocational Support

Background: Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI). Aims: The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment. Methods: We included first-time PCI patients from the NorStent trial, who were of working age (<63 years; n = 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants. Results: Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up. Conclusion: Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.

scholarly journals A systematic review of intensive outpatient care programs for high-need, high-cost patients

2020 ◽  
Vol 10 (5) ◽  
pp. 1187-1199
Author(s):  
Rebecca K Delaney ◽  
Brittany Sisco-Taylor ◽  
Angela Fagerlin ◽  
Peter Weir ◽  
Elissa M Ozanne
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Outpatient Care ◽  
Program Effectiveness ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Multidisciplinary Teams ◽  
Patient Reported ◽  
Intensive Outpatient

Abstract Five percent of the patient population accounts for 50% of U.S. healthcare expenditures. High-need, high-cost patients are medically complex for numerous reasons, often including behavioral health needs. Intensive outpatient care programs (IOCPs) are emerging, innovative clinics which provide patient-centered care leveraging multidisciplinary teams. The overarching goals of IOCPs are to reduce emergency department visits and hospitalizations (and related costs), and improve care continuity and patient outcomes. The purpose of this review was to examine the effectiveness of IOCPs on multiple outcomes to inform clinical care. A systematic search of the literature was conducted to identify articles. Six studies were included that varied in rigor of research design, analysis, and measurement of outcomes. Most studies reported results on healthcare utilization (n = 4) and costs (n = 3), with fewer reporting results on patient-reported and health-related outcomes (n = 2). Overall, there were decreasing trends in emergency department visits and hospitalizations. However, results on healthcare utilization varied based on time of follow-up, with shorter follow-up times yielding more significant results. Two of the three studies that evaluated costs found significant reductions associated with IOCPs, and the third was cost-neutral. Two studies reported improvements in patient-reported outcomes (e.g., satisfaction, depression, and anxiety). Overall, these programs reported positive impacts on healthcare utilization and costs; however, few studies evaluated patient characteristics and behaviors (e.g., engagement in care) which may serve as key mechanisms of program effectiveness. Future research should examine patient characteristics, behaviors, and clinic engagement metrics to inform clinical practice.

scholarly journals LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S11-S12
Author(s):  
I. Stiell ◽  
M. Taljaard ◽  
A. Forster ◽  
L. Mielniczuk ◽  
G. Wells ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Control Period ◽  
Care Hospital ◽  
Index Visit ◽  
Rapid Access

Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.

Abstract WMP93: Efficacy of a Comprehensive Stroke Clinic Model on Reducing Readmissions after Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anna Glaser ◽  
Lisa Kotzen ◽  
Holly Weissman ◽  
Lauren Singer ◽  
Rebbeca Grysiewicz
Keyword(s):  
Ischemic Stroke ◽  
Hospital Admissions ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Reperfusion Therapy ◽  
Phone Call ◽  
Stroke Event ◽  
Readmission Rates ◽  
Clinic Group

Background: Stroke is a leading cause of hospital admissions among the elderly, and reducing readmission rates has become a primary goal of healthcare reform. Hospitals are now being held financially responsible for 30 day readmission rates exceeding their expected rate [1]. Our aim was to determine if patients seen in the comprehensive stroke discharge clinic had reduced 30 day readmissions compared to standard hospital follow up after ischemic stroke. Methods: Patients with a discharge diagnosis of ischemic stroke receive a phone call from the neurology office staff within 3 business days of hospital discharge to schedule an appointment with a mid-level provider in the comprehensive stroke discharge clinic within 1-3 weeks. Eligibility for the clinic includes patients ≥ 18 years of age that are either discharged to home directly or discharged to home from inpatient rehabilitation. We performed a retrospective stroke database search of patients meeting this criteria from May 2015 to June 2016. Patients were excluded from the search if they had an inpatient stroke event. Results: Of the 526 patients reviewed, 116 patients (22.1%) were seen in the comprehensive stroke discharge clinic. The average age of patients seen in clinic was 67 years and the average age of patients in the non-clinic group was 69 years. Approximately 12% of patients in each group received acute reperfusion therapy. There was only one 30 day related readmission in the clinic group, and fourteen 30 day related readmissions in the non-clinic group (0.86% versus 3.41%; 95% CI 0.12-4.99%). There were eight 30 day all cause readmissions in the clinic group, and forty-two 30 day all cause readmissions in the non-clinic group (6.90% versus 10.24%; 95% CI -2.12-8.81%). Conclusion: The comprehensive stroke clinic model may reduce 30 day related readmissions for patients discharged to home. However, there were limitations to this study. The percentage of patients seen in the comprehensive stroke clinic was low. The goal is to improve the clinic follow up rate over the course of the next year. In addition, patients were excluded from the clinic if they were discharged to a skilled nursing facility, which is often associated with a higher readmission rate.

Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation

Crisis ◽  
2021 ◽  
Author(s):  
Hannah Y. Rosebrock ◽  
Philip J. Batterham ◽  
Nicola A. Chen ◽  
Lauren McGillivray ◽  
Demee Rheinberger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Self Report ◽  
Local Health ◽  
Cross Sectional ◽  
South Wales ◽  
Patients Experience ◽  
Suicidal Crisis

Abstract. Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

scholarly journals 2481 A collaborative neurology-emergency medicine rapid outpatient clinic for the management of TIA and minor stroke in the emergency department

2018 ◽  
Vol 2 (S1) ◽  
pp. 37-37
Author(s):  
Bernard P. Chang ◽  
Rachel Mehendale ◽  
Eliza Miller ◽  
Benjamin Kummer ◽  
Joshua Willey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Low Risk ◽  
Minor Stroke ◽  
Decision Tool ◽  
Inpatient Hospitalization ◽  
Rapid Access ◽  
Rapid Access Clinic

OBJECTIVES/SPECIFIC AIMS: Current practice frequently dictates hospitalization for TIA and minor stroke (TIAMS) in order to obtain comprehensive evaluation of stroke risk factors and mechanism. Inpatient hospitalization is often done to expedite workup and to coordinate care although may be associated with nosocomial risks and increased healthcare cost. However, a subset of these patients who do not have debilitating deficits may not require inpatient hospitalization. We conducted a pilot study to assess the feasibility of conducting rapid outpatient stroke evaluations in low risk patients with TIAMS without disabling deficits. METHODS/STUDY POPULATION: The rapid access clinic was initiated at a single-site urban tertiary care facility for outpatient evaluation of TIAMS within 24 hours of emergency department (ED) evaluation. Patients were selected using a decision tool identifying presumed low-risk TIAMS seen in the ED. Criteria included medical (e.g., no disabling deficit, no thrombolytic agent given, negative CT for hemorrhagic stroke) as well as social criteria (e.g., patient ability to follow-up as an outpatient). We evaluated rates of noncompliance with post-ED follow-up, need for hospitalization from clinic, and 90 day stroke and health outcome data. RESULTS/ANTICIPATED RESULTS: Between December 2016 and December 2017 a total of 93 TIAMS patients seen in the ED were recommended for the rapid access clinic utilizing the decision tool. Of these patients, 94.5% (86) were evaluated within 24 hours of ED discharge. Only 2 patients (2.4%) who received outpatient evaluation required hospitalization; 61 (71.8%) patients had TIAMS on final evaluation in clinic. DISCUSSION/SIGNIFICANCE OF IMPACT: Our pilot data suggests that for a subset of patients, rapid outpatient evaluation may be a feasible and safe strategy for TIAMS management. Future work exploring such strategies may help improve TIAMS outcomes and reduce ED crowding and unnecessary hospital admissions.

scholarly journals Heart Failure in the Time of COVID-19

Cardiology ◽  
2020 ◽  
Vol 145 (8) ◽  
pp. 481-484 ◽  
Author(s):  
Marta Jiménez-Blanco Bravo ◽  
David Cordero Pereda ◽  
Diego Sánchez Vega ◽  
Susana del Prado Díaz ◽  
Juan Manuel Monteagudo Ruiz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Decompensated Heart Failure ◽  
Healthcare Systems ◽  
Advanced Heart Failure ◽  
Heart Failure Unit ◽  
Acutely Decompensated Heart Failure ◽  
Outpatient Visits ◽  
Vulnerable Patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a new threat to healthcare systems. In this setting, heart failure units have faced an enormous challenge: taking care of their patients while at the same time avoiding patients’ visits to the hospital. Objective: The aim of this study was to evaluate the results of a follow-up protocol established in an advanced heart failure unit at a single center in Spain during the coronavirus disease 2019 (COVID-19) pandemic. Methods: During March and April 2020, a protocolized approach was implemented in our unit to reduce the number of outpatient visits and hospital admissions throughout the maximum COVID-19 spread period. We compared emergency room (ER) visits, hospital admissions, and mortality with those of January and February 2020. Results: When compared to the preceding months, during the COVID pandemic there was a 56.5% reduction in the ER visits and a 46.9% reduction in hospital admissions, without an increase in mortality (9 patients died in both time periods). A total of 18 patients required a visit to the outpatient clinic for decompensation of heart failure or others. Conclusion: Our study suggests that implementing an active-surveillance protocol in acutely decompensated heart failure units during the SARS-CoV-2 pandemic can reduce hospital admissions, ER visits and, potentially, viral transmission, in a cohort of especially vulnerable patients.

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