scholarly journals Necessity of trauma referrals to the emergency department

2020 ◽  
Vol 29 (3) ◽  
pp. 163-166
Author(s):  
Chengjie Lee ◽  
Paul Yugendra ◽  
Choon Peng Jeremy Wee ◽  
Jen Heng Pek
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Odds Ratio ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Smoke Inhalation ◽  
Traumatic Injuries ◽  
The Mean ◽  
Care Costs

Background: Patients with traumatic injuries presenting to the emergency department (ED) may be referred to another hospital for further management. Unnecessary referrals can inflate health-care costs and workload, as well as reduce provider and patient satisfaction. Objectives: In this study, we determined the proportion of unnecessary trauma referrals and described the characteristics of this patient population. Methods: A retrospective chart review was carried out between 1 January and 31 December 2016. Data regarding demographics, diagnosis and clinical course at the ED were collected in standardised forms. A referral was defined as unnecessary if the patient was discharged from the ED without a therapeutic procedure performed. Results: There were 121 trauma referrals. The mean age was 39.0±18.3 years old, and 94 (77.7%) patients were male. Seventy-eight (64.5%) of the referrals were from EDs in the same health-care cluster. Overall, 15 (12.3%) referrals were unnecessary, and of these, nine patients had sustained burns or were suffering from smoke inhalation. The length of stay of these unnecessary referrals was 197.0±96.2 minutes. Referring ED outside the health-care cluster was significantly associated with unnecessary referrals (odds ratio=4.42, 95% confidence interval 1.40–13.97, p=0.007). Conclusion: More than 1 in 10 trauma referrals were unnecessary. Further collaborative prospective studies with other EDs are needed to elucidate the underlying reasons for such unnecessary referrals so that targeted solutions can be implemented to reduce them in the future.

scholarly journals 24-hr observation unit is safe location for rapid glucose control in uncomplicated severe hyperglycaemia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. Ibrahim ◽  
R. Macatangay ◽  
C. Y. Chai ◽  
C. M. Khoo ◽  
M. Mahadevan
Keyword(s):  
Emergency Department ◽  
Glucose Control ◽  
Chart Review ◽  
Glucose Monitoring ◽  
Retrospective Chart Review ◽  
Effective Management ◽  
Observation Unit ◽  
Control Protocol ◽  
Sliding Scale ◽  
The Mean

Abstract Background Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU). Methods This is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4–6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days. Results We included 101 patients. The mean age was 53.5 years (95% CI 50.4–56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3–13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3–28.1) and 13.9 (95% CI 13.2–14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge. Conclusion ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.

Hospitalizations in elderly glioblastoma patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21529-e21529
Author(s):  
Claire Elizabeth Moroney ◽  
James R. Perry ◽  
Derek S Tsang ◽  
Denise Bilodeau ◽  
Christina Mueller ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Room ◽  
Acute Care ◽  
Health Care Costs ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Emergency Room Visits ◽  
The Mean ◽  
Care Costs

e21529 Background: Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. Methods: In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Results: Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median length of hospital stay per patient was 20.5 days and 14 days respectively. Forty-three percent of patients spent 0-4% of their survival as an inpatient. Only 3% spent 70% or more of their survival as an acute care inpatient. There was a mean of 79.7 days and a median of 43 days from the last emergency department visit to death. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162 479.78 (CAN) and $125 511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI 1.44, 3.7; p = 0.0005) and 2.19 (95% CI 1.28, 3.74; p = 0.0 04), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI 1.06, 2.77; p = 0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98, 2.26; p = 0.0623) for hospital admission as compared to patients with ECOG 4. Conclusions: A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.

scholarly journals Health Care Costs in Patients Treated with Ipilimumab for Advanced Melanoma Results of a Retrospective Chart Review

2014 ◽  
Vol 17 (7) ◽  
pp. A615 ◽  
Author(s):  
A. Tarhini ◽  
A.S. Rao ◽  
S. Corman ◽  
M. Botteman ◽  
X. Ji ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Advanced Melanoma ◽  
Care Costs

Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 31-35
Author(s):  
Trishna Shrestha ◽  
Sneha Pradhananga ◽  
Kabita Hada Batajoo ◽  
Manjita Bajracharya
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Costs ◽  
Medical Advice ◽  
Health Concern ◽  
Against Medical Advice ◽  
Factors Affecting ◽  
Tertiary Center ◽  
Care Costs ◽  
Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.  

scholarly journals Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

2021 ◽  
Author(s):  
Jonne T. H. Prins ◽  
Mathieu M. E. Wijffels ◽  
Sophie M. Wooldrik ◽  
Martien J. M. Panneman ◽  
Michael H. J. Verhofstad ◽  
...  
Keyword(s):  
Health Care ◽  
Incidence Rate ◽  
Health Care Costs ◽  
Indirect Costs ◽  
Rib Fractures ◽  
Work Absence ◽  
Lost Productivity ◽  
The Mean ◽  
Using Data ◽  
Care Costs

Abstract Purpose This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures. Methods A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire. Results In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age. Conclusion Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.

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.

scholarly journals 59. Persistence of Respiratory and Non-respiratory Symptoms Among COVID-19 Patients Seeking Care at an Ambulatory COVID-19 Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Aditi Ramakrishnan ◽  
Jennifer Zreloff ◽  
Miranda Moore ◽  
Sharon H Bergquist ◽  
Michele Cellai ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Illness Onset ◽  
Persistent Symptoms ◽  
Emory University ◽  
Ambulatory Patients ◽  
Three Stages ◽  
Taste Alteration

Abstract Background While hospitalized COVID-19 patients are well described in the literature, studies of the natural history and ambulatory cases are limited. We aim to describe the symptoms and clinical course of COVID-19 among ambulatory patients seen at the Emory University multidisciplinary Acute Respiratory Clinic (ARC) developed to care for patients with confirmed or suspected COVID-19. Methods PCR-confirmed COVID-19 cases seen at ARC from 4/3–5/16/2020 were included in a retrospective chart review. Encounters were classified as acute, subacute, or convalescent depending on the duration since illness onset (< 1, 1–4, or >4 weeks, respectively). Demographic, clinical, physical exam, diagnostic test, and disposition data were abstracted and analyzed with standard descriptive statistics. Results Among 404 visits at ARC, 127 (31.4%) were for confirmed COVID-19 illness (107 unique patients with 1–4 visits). The majority (75.7%) of patients were female, and the median age was 55 years (range 24–89). Patients presented during acute, subacute, and convalescent phases of illness (15.7%, 58.3%, and 26.0%, respectively; Table). Prevalent co-morbidities included hypertension (39.3%), obesity (27.1%), diabetes (20.6%), and asthma (21.5%). While measured or subjective fever was reported in the majority of acute visits (60.0%), it was less common in subacute and convalescent encounters (27.0% and 30.3%). Cough was commonly reported in acute, subacute, and convalescent visits (70.0%, 79.7%, 66.7%), as were dyspnea on exertion (45.0%, 70.3%, 66.7%) and chest tightness (40.0%, 40.5%, 60.6%). Although smell or taste alteration was present in almost half of acute and subacute patients, it was only reported in a quarter of convalescent patients. Among the three stages of illness, transfers from ARC to the ED or direct hospitalizations occurred in 15.0%, 23.0%, and 12.1% of acute, subacute and convalescent visits, respectively. Table Timecourse of Symptoms among COVID-19 Patients in the Ambulatory Context Conclusion Following acute illness, COVID-19 patients can experience persistent symptoms, primarily respiratory symptoms, which can be severe enough to warrant hospitalization. Clinics evaluating recovering patients should prepare to manage these symptoms. Further study of the pathophysiology and treatment of persistent pulmonary symptoms in COVID-19 is needed. Disclosures All Authors: No reported disclosures

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