Newborn Clinic: A Novel Model to Provide Timely, Comprehensive Care to Newborns Following Nursery Discharge

2020 ◽  
Vol 59 (14) ◽  
pp. 1233-1239
Author(s):  
Melissa E. Glassman ◽  
Rebekah Diamond ◽  
Sharon K. Won ◽  
Jasmyn Johal ◽  
Dana R. Sirota
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Risk Group ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
High Risk Group ◽  
Emergency Department Visits ◽  
Infant Morbidity ◽  
Novel Model

Ensuring safe and timely follow-up after well baby nursery (WBN) discharge is an ongoing challenge. This study demonstrates the efficacy of a novel model for follow-up, the Newborn Clinic (NBC), in reducing time to outpatient follow-up after WBN discharge. Our retrospective chart review of 17 952 newborns found that time to follow-up visit decreased significantly following NBC establishment. Emergency department visits, a marker of infant morbidity, were slightly increased in the post-establishment cohort. There was no difference, however, in hospital readmissions. Analysis within the post-establishment cohort showed that newborns with jaundice, a high-risk group, were much more likely to have early follow-up if their visit was scheduled with NBC. Our study demonstrates that NBC is an effective model for decreasing time from WBN discharge to follow-up visit. It should be considered as an initiative to run concurrently with expedited newborn discharge initiatives so that safe follow-up need not be sacrificed.

Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?

2021 ◽  
pp. 175045892110310
Author(s):  
Jessica Evans ◽  
James Chan ◽  
Delvina H Saraqini ◽  
Ranjeeta Mallick
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Medical Assessment ◽  
Risk Patients ◽  
Lost To Follow Up

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.

Documentation of Firearm Safety Screening During Emergency Department Visits for Assault-Related Injury

2021 ◽  
pp. 152483992110293
Author(s):  
Lauren B. Mulcahy ◽  
Monika K. Goyal ◽  
Joanna Cohen
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Risk Group ◽  
Emergency Department Visits ◽  
Washington Dc ◽  
Increased Risk ◽  
Icd 10 ◽  
Ed Visits ◽  
Firearm Safety

Assault-injured youth have an increased risk of future violence. Identifying firearm access among youth in the emergency department (ED) creates an opportunity for interventions aimed at reducing future violent events. We performed this study to determine the extent to which children with assault-related injuries are screened for access to firearms in the ED. We performed a retrospective chart review of all medical records from adolescent ED visits to an academic, tertiary care pediatric hospital in Washington DC with ICD-10 codes related to assault in a 3-month period. We found that among 252 assault-related encounters, none had any documentation of firearm access in the provider note, social work note, or psychiatry consultant note. Therefore, we concluded that firearm access screening is rarely documented in ED visits among patients who present for an assault, highlighting an important missed opportunity for firearm access screening among this high-risk group.

Retrospective analysis of 450 emergency department dermatology consultations: An analysis of in-person and teledermatology consultations from 2015 to 2019

2021 ◽  
pp. 1357633X2110248
Author(s):  
Alexander S Hines ◽  
Jacqueline Zayas ◽  
David A Wetter ◽  
Alina G Bridges ◽  
Michael J Camilleri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The United States ◽  
Emergency Department Visits ◽  
Treatment Plans ◽  
Diagnostic Concordance ◽  
N 93 ◽  
Valuable Role

Introduction Dermatologic complaints are a common reason for emergency department visits. Methods Retrospective chart review from 1 January 2015 to 31 December 2019. Patients in the Mayo Clinic Emergency Department receiving dermatology consultation were included. Results Dermatitis (24.7%, n = 113), infection (20.4%, n = 93), and drug reaction (10.3%, n = 47) accounted for the majority of diagnoses. Emergency department providers often provide no diagnosis (38%) or a differential diagnosis (22%), and dermatology consultation frequently alters diagnosis (46%) and treatment (83%). Patients receiving in-person consultations are admitted more frequently than those receiving teledermatology consultations (40% vs. 16%, p < 0.001). Primary diagnostic concordance with subsequent dermatology evaluation is high for in-person (94%) and teledermatology (88%) consultations. Discussion This is the largest study of emergency department dermatology consultations in the United States and the first to compare in-person and teledermatology emergency department consultation utilization in clinical practice. These modalities are utilized in a complementary fashion at our institution, with severe dermatologic diagnoses seen in-person. The valuable role of emergency department dermatologists is highlighted by frequent changes to diagnosis and treatment plans that result from dermatology consultation. Furthermore, our data suggest that teledermatology is an effective modality with the potential to expand access to dermatologic expertise in the emergency department setting.

The prevalence of pathological findings identified by next day abdominal ultrasound in patients discharged from the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 793-797
Author(s):  
Stephanie Cargnelli ◽  
Cameron Thompson ◽  
Taylor Dear ◽  
Aislinn Sandre ◽  
Bjug Borgundvaag ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Abdominal Ultrasound ◽  
Pathological Findings ◽  
Resonance Imaging ◽  
Patients Âgés ◽  
Common Strategy

ABSTRACTObjectiveA common strategy for managing emergency department (ED) patients with low-risk abdominal pain is to discharge them home and arrange for next day outpatient ultrasound for further assessment. The objective was to determine the proportion of outpatient ultrasounds with findings requiring intervention within 14 days.MethodsThis was a retrospective chart review of non-pregnant patients ages 18 to 40 years, presenting to an academic ED (annual census 65,000) with an abdominal complaint for whom the emergency physician arranged an outpatient (next day) abdominal ultrasound.ResultsOf the 299 included patients, 252 (84.3%) were female and mean (SD) age was 28.4 (6.0) years. Twenty-three (7.7%) patients had ultrasounds requiring intervention within 14 days of imaging. Of these, eight (34.8%) had appendicitis, five (21.7%) had cholecystitis, four (17.4%) had urological pathology, three (13.0%) had gynecological pathology, and three (13.0%) had gastrointestinal diagnoses. Of note, 14 (60.9%) patients requiring follow-up or intervention within 14 days had symptoms that improved or resolved at the time of the outpatient ultrasound. For the 277 (92.6%) patients not requiring intervention, 117 (42.2%) had improved, 89 (32.1%) were unchanged, 50 (18.1%) had resolved, and 5 (1.8%) had worsened symptoms at the time of the follow-up ultrasound. Of the non-intervention patients, 13 (4.7%) went on to have alternative imaging, including magnetic resonance imaging, computed tomography, and a sonohysterogram.ConclusionsNext-day ultrasound imaging remains a good way of identifying patients with serious pathology not appreciated at the time of their ED visit.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

Deliberate self-harm in young people: attendance at a paediatric emergency department

2009 ◽  
Vol 26 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Sophia Morgan ◽  
Sinead Byrne ◽  
Carole Boylan ◽  
Stephen McLearie ◽  
Carol Fitzpatrick
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Medical Records ◽  
Risk Group ◽  
High Risk Group ◽  
Deliberate Self Harm ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Appropriate Treatment ◽  
Self Harm

AbstractObjectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.

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