Hypercalcemia in the Emergency Department: A Missed Opportunity

2014 ◽  
Vol 80 (8) ◽  
pp. 732-735 ◽  
Author(s):  
Anna Marie Royer ◽  
Reid A. Maclellan ◽  
J. Daniel Stanley ◽  
Trent B. Willingham ◽  
W. Heath Giles
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Physician ◽  
Definitive Diagnosis ◽  
Chief Complaint ◽  
Delay In Diagnosis ◽  
Discharge Disposition ◽  
Discharge Plan ◽  
Acute Condition ◽  
Missed Opportunity

Primary hyperparathyroidism is surgically correctable and frequently presents with mild hypercalcemia. The symptoms of hyperparathyroidism are nonspecific often leading to a delay in diagnosis until patients present with an acute condition. Literature suggests that up to 20 per cent of patients presenting to the emergency department (ED) found to have hypercalcemia are ultimately diagnosed with hyperparathyroidism. We performed a retrospective review from 2012 to 2013 of patients with hypercalcemia in our ED and analyzed their characteristics. One hundred sixty-eight patients were identified with hypercalcemia. Patient medical history, chief complaint, review of symptoms, discharge disposition, and primary care physician (PCP) status were evaluated. Eighty-four per cent were classified as mild (10.8 to 11.9 mg/dL), 11 per cent as moderate (12 to 14 mg/dL), and five per cent as severe (greater than 14 mg/dL). A definitive diagnosis of hyperparathyroidism was identified in 3.5 per cent (six of 168). Documentation of hypercalcemia as a diagnosis was present in all patients in the severe and 78 per cent in the moderate categories. However, only 21 per cent of patients with mild hypercalcemia had documentation addressing this diagnosis. Of concern, 24 per cent (41 of 168) of patients were identified with mild hypercalcemia and discharged from the ED with no definitive plan based on lack of a PCP. Additionally, 81 per cent of these patients had symptoms referable to hypercalcemia. Mild hypercalcemia found during ED workup rarely requires immediate medical treatment. However, a significant number of those patients will have hyperparathyroidism amendable to surgical correction. Therefore, an appropriate mechanism for outpatient hypercalcemia workup should be integrated into the patient's ED discharge plan.

scholarly journals Inguinoscrotal pathology

2017 ◽  
Vol 11 (1-2S) ◽  
pp. 41 ◽  
Author(s):  
Luis Guerra ◽  
Michael Leonard
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Significant Proportion ◽  
Care Physician ◽  
Imaging Studies ◽  
Undescended Testes ◽  
Scrotal Pain ◽  
Outpatient Visits ◽  
Insight Into

Infants, children, and adolescents with inguinoscrotal pathology comprise a significant proportion of emergency department and outpatient visits. Visits to the emergency department primarily comprise individuals presenting with scrotal pain due to testicular torsion or torsion of the testicular appendages. At such time, immediate urological consultation is sought. Outpatient visits comprise those individuals with undescended testes, hydroceles, and varicoceles. Rare, but important problems, such as pediatric testicular tumours, may also present in the office setting. Many of these outpatient visits are to primary care physicians, who should have an appreciation of the timing and need for referral.The purpose of this review is to familiarize the general urologist and primary care physician with these varied pathologies and give insight into their assessment and management. Some of these same conditions are seen in adult patients, but there are some significant differences in their management in the pediatric group. In addition, the utility of imaging studies, such as ultrasound, are discussed within each pathological entity. It is hoped that this overview will assist our general urology and primary care colleagues in patient management for diverse inguinoscrotal pathologies.

The Influence of Having an Assigned Medicaid Primary Care Physician on Utilization of Otitis Media–related Services

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_6) ◽  
pp. 1192-1197
Author(s):  
Stephen Berman ◽  
Jessica Bondy ◽  
Dennis Lezotte ◽  
Barbara Stone ◽  
Patricia J. Byrns
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Retrospective Study ◽  
Primary Care Physician ◽  
Otitis Media ◽  
Odds Ratio ◽  
Care Physician ◽  
Administrative Database ◽  
Related Services ◽  
Utilization Patterns

Objective. This study documents the influence of having an assigned Medicaid primary care physician (PCP) on the utilization of otitis media–related services. Design/Methods. This is a retrospective study using the 1991 Colorado Medicaid administrative database that followed 28 844 children <13 years who had at least 1 visit for otitis media. Results. Children continuously enrolled in Medicaid throughout the entire year were >4 times (odds ratio: 4.2 and 4.89, respectively) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the emergency department for an otitis media–related visit was increased by 26% and 50%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever filling an antibiotic for otitis media was reduced by 23% and 34%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever having otitis media–related surgery was not affected by PCP status, but young children, 13 to 18 months of age, had higher referral rates when they had an assigned PCP. Conclusions. These findings suggest that having an assigned Medicaid PCP influences the utilization patterns of some otitis media–related medical services.

scholarly journals LO078: The immigrant effect: a barrier to accessing primary and emergency department care - a Canadian population cross-sectional study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S57-S57
Author(s):  
R. Ohle ◽  
H. Bleeker ◽  
J.J. Perry
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physician ◽  
Odds Ratio ◽  
Care Physician ◽  
Model Parameters ◽  
Emergency Department Care ◽  
Canadian Population ◽  
Study Population ◽  
Immigrant Effect

Introduction: In 2011, Canada had a foreign-born population of about 6,775,800 people. They represented 20.6% of the total population, the highest proportion among the G8 countries. Immigrants encounter significant barriers to accessing primary healthcare. This is thought to be due to lower education level, employment status and the healthy immigrant effect. Our objective was to assess in an immigrant population without a primary care physician, would similar socioeconomic barriers also prevent access to the emergency department. Methods: Data regarding individuals’ ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008 were analyzed (N=134,073, response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who used emergency department care. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Prevalence estimates and confidence intervals for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Model parameters were estimated by the method of maximum likelihood. The Wald statistic was employed to test the significance of individual variables or interaction terms in relation to ED choice. Results: Our study population included 1,767 immigrants and 13,787 Canadian born respondents from across Canada without a primary care physician (57.3% male). Immigrants were less likely to use the emergency department then Canadian born respondents (Odds Ratio 0.4759 (95%CI 0.396-0.572). Adjusting for health, education or employment had no effect on this reduced access (Odds Ratio 0.468 (95%CI 0.378-0.579). Conclusion: In a Canadian population without a primary care physician, immigrants access the emergency department less then Canadian born respondents. However this effect is independent of previously reported social and economic barriers. Immigration status is an important but complex component of racial and ethnic disparity in access to care. Specific policy and system development targeting this at risk population are required to allow for equal access to healthcare.

The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment

2014 ◽  
Vol 168 (3) ◽  
pp. 289-295 ◽  
Author(s):  
Andrew Czarnecki ◽  
Julie T. Wang ◽  
Jack V. Tu ◽  
Douglas S. Lee ◽  
Michael J. Schull ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Chest Pain ◽  
Primary Care Physician ◽  
Care Physician ◽  
Low Risk ◽  
Risk Patients

scholarly journals Exploring emergency department visits: factors influencing individuals’ decisions, knowledge of triage systems and waiting times, and experiences during visits to a tertiary hospital in Saudi Arabia

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Nawaf Alhabdan ◽  
Faisal Alhusain ◽  
Abdulkareem Alharbi ◽  
Muatassem Alsadhan ◽  
Moath Hakami ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Care Physician ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Validated Questionnaire

Abstract Background In recent years, there has been an increased utilization of emergency departments (EDs) in many countries. Additionally, it is reported that there are major delays in delivering care to ED patients. Longer waiting times are associated with poor patient satisfaction, whereas an understanding of the triage process increases satisfaction. This study aimed to assess ED visitor’s awareness of the triage procedure and their preferences regarding delayed communication. Methods Cross-sectional study of King Abdulaziz Medical City – Emergency Department visitors using a previously validated questionnaire (Seibert 2014) which was translated to Arabic, piloted, and then used for this study. Results A total of 334 questionnaires were returned. The mean age of respondents was 33 years. Regarding primary care physicians, only 16% of respondents said that they have one. About 21% of those tried to communicate with them before coming to the ED. Even though only 11% of respondents knew exactly what triage is, 51% were able to correctly explain why some patients are seen before others. Statistical analysis did not show any factors that are associated with increased knowledge of triage. Most respondents (75%) want to hear updates regarding delays with 69% of them preferring to be updated every 30 min. Conclusions This study showed that the majority of patients do not know what triage means and that most of them want to know how the ED works. Moreover, a lot of respondents said that they do not have a primary care physician. These results support increasing patient awareness by education and involving them if any delay happens.

scholarly journals 736. Delays in Malaria Recognition and Door to Anti-malarial Time in a South London Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S466-S466
Author(s):  
Nisha Patel ◽  
Tomasz Materski ◽  
Elisa Gonzalez ◽  
Solomon Russom ◽  
Gurjinder Sandhu
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Physician ◽  
African Countries ◽  
College Hospital ◽  
Travel History ◽  
Care Services ◽  
Primary Care Services ◽  
Sub Saharan ◽  
The Uk

Abstract Background The prompt recognition and treatment of Plasmodium falciparum is necessary to prevent death. We reviewed data from a cohort of patients presenting with malaria to Kings College Hospital NHS Trust, London. Methods Retrospective review of electronic records and drug charts of patients diagnosed with malaria from Jan 2019- March 2021. Results 109 cases of malaria were identified representing travellers from 11 Sub-Saharan African countries: Nigeria(38%), Sierra Leone(33%), Ivory Coast(10%). The age range varied from 4 to 76 years with a mean of 44, 66% of the cohort was male. 22 cases occurred during the COVID-19 Pandemic. The commonest symptoms were Fever (97%), Headache (92%) and malaise (72%). P. falciparum was present in 99% cases. A travel history was taken in 94% of cases. Malaria was considered by the first clinician in 82% of cases with the second highest differential being a viral illness. In 6 cases, it took 4 to 11 medical reviews before malaria was considered. 29 patients met the UK criteria for severe malaria. Door to antimalarial time varied from 1 to 128 hours, with a median of 7.4 hours. 46% of the cohort received intravenous Artesunate as their first antimalarial. Extreme delays occurred were clinicians did not consider malaria, patients had negative films or a patient did not declare a travel history when asked. 1 patient died of cerebral malaria with a door to needle time of 2hr 3min. Where a reason for delay is documented, drug availability represented the highest cause with mean delay from prescribing antimalarial to giving antimalarial of 2.7 hours. There was no difference in door to antimalarial administration during the COVID-19 Pandemic, but patients did have a delay in presentation to hospital from onset of symptoms, mean 6.2 days pre-pandemic, 10.5 days during pandemic, this was not statistically significant (P= 0.198). 3 patients presenting during the Pandemic had covid-19 swabs prior to admission and 10 had attended primary care services. Number of days between onset of malaria symptoms and presentation to the Emergency Department Box plot demonstrating that patients were waiting longer post symptom onset to access care in the Emergency Department. 3 patients had covid swabs in the community and 10 accessed care through their primary care physician. Conclusion Our data show that malaria is being considered early in the emergency department however there remain significant delays in administration of treatment. In 6 cases where malaria was not considered early there were delays in diagnosis of up to 5 days. An audit cycle will be completed with the aim of reducing door to antimalarial time. Disclosures All Authors: No reported disclosures

scholarly journals Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

CJEM ◽  
2016 ◽  
Vol 19 (04) ◽  
pp. 271-276
Author(s):  
Robert Ohle ◽  
Michelle Ohle ◽  
Jeffrey J. Perry
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Primary Care Physician ◽  
Low Socioeconomic Status ◽  
Access Point ◽  
Care Physician ◽  
Individual Risk ◽  
Factors Associated

Abstract Objective Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. Methods Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Results The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Conclusions Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.

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