scholarly journals Acute cannabis intoxication in the emergency department: the effect of legalization

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Robert Baraniecki ◽  
Puru Panchal ◽  
Danya Deepsee Malhotra ◽  
Alexandra Aliferis ◽  
Zaka Zia
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Primary Outcome ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Before And After ◽  
Icd 10 ◽  
Ed Visits ◽  
October 17 ◽  
Recreational Use

Abstract Background On October 17, 2018, the Cannabis Act decriminalized the recreational use of cannabis in Canada. This study seeks to determine how legalization of cannabis has impacted emergency department (ED) visits for acute cannabis intoxication. Methods We conducted a retrospective chart review at an academic ED in Hamilton, Ontario. We assessed all visits with a cannabis-related ICD-10 discharge code 6 months before and after legalization (October 17, 2018) to determine cases of acute cannabis intoxication. The primary outcome was the rate of ED visits. Secondary outcomes included number of visits distributed by age, length of stay, co-ingestions, and clinical course in the emergency department (investigations and treatment). Results There was no difference in the overall rate of ED visits following legalization (2.44 vs. 2.94 visits/1000, p = 0.27). However, we noted a 56% increase in visits among adults aged 18–29 (p = 0.03). Following legalization, a larger portion of patients required observation without interventions (25% vs 48%, p < 0.05). Bloodwork and imaging studies decreased (53% vs. 12%, p < 0.05; 29% vs. 2%, p < 0.05); however, treatment with benzodiazepines increased (24% vs. 51%, p < 0.05). Conclusions Legalization was not associated with a change in the rate of cannabis-related ED visits in our study. More research is needed regarding changing methods of cannabis ingestion and trends among specific age groups.

scholarly journals (A86) Emergency Department Patient Presentations during the 2009 Heatwave in Adelaide

2011 ◽  
Vol 26 (S1) ◽  
pp. s24-s25 ◽  
Author(s):  
L. Mayner ◽  
P. Arbon
Keyword(s):  
Emergency Department ◽  
Media Coverage ◽  
Human Life ◽  
Age Groups ◽  
Emergency Department Patient ◽  
Public Hospitals ◽  
Global Media ◽  
Before And After ◽  
Icd 10 ◽  
Icd Codes

BackgroundRecordings of heatwaves date back to the early 1900s and usually are associated with high mortality. In Australia, heatwaves have been the major cause of natural hazard-related deaths. Heatwaves usually do not carry the global media coverage associated with other disasters, and frequently, are referred to as silent disasters. The main impact of heatwaves is on health and human life.ObjectivesPreliminary results are presented for the 2009 heatwave, investigating the emergency department patient presentations from three public hospitals in Adelaide, a city in the central southern area of Australia.MethodsDemographic and syndromic data were obtained from emergency department records. Ethics permission was obtained prior to data collection. Heatwave conditions occurred from 26 January–07 February 2009. Two non-heatwave periods were day-matched approximately two weeks before and after the heatwave. Data were analyzed by age groups, gender, and ICD codes for chronic conditions.ResultsThe two largest groups of people presenting were between 15 and 64 years of age and > 75 years of age during the heatwave and non-heatwave periods. During the heatwave period, both groups had significant increases in patient presentation related to renal problems (ICD 10: N000-N3999) and dehydration and hyperthermia (ICD10: E86, T67). The latter syndrome was far more accentuated during the heatwave, with emergency department patient presentations rising from 2 (non heatwave) to 62 presentations for the 15 and 64 years cohort and from 4 (non heatwave) to 91 for the > 75 years cohort. Cardiovascular- and respiratory-related presentations showed slight increases during the heatwave, while mental health had high presentations for the 15–64 year cohort throughout heatwave and non heatwave periods.ConclusionsBoth young and older people were affected by heatwave, and precautionary warning should be used throughout the community to alert people of the dangers underlying extreme heat conditions.

scholarly journals Inappropriateness of Repeated Laboratory and Radiological Tests for Transferred Emergency Department Patients

2019 ◽  
Vol 8 (9) ◽  
pp. 1342 ◽  
Author(s):  
Jérôme Bertrand ◽  
Christophe Fehlmann ◽  
Olivier Grosgurin ◽  
François Sarasin ◽  
Omar Kherad
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Laboratory Tests ◽  
Chart Review ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Emergency Department Patients ◽  
Radiological Procedures

Background: Laboratory and radiographic tests are often repeated during inter-hospital transfers from secondary to tertiary emergency departments (ED), despite available data from the sending structure. The aim of this study was to identify the proportion of repeated tests in patients transferred to a tertiary care ED, and to estimate their inappropriateness and their costs. Methods: A retrospective chart review of all adult patients transferred from one secondary care ED to a tertiary care ED during the year 2016 was carried out. The primary outcome was the redundancy (proportion of procedure repeated in the 8 h following the transfer, despite the availability of the previous results). Factors predicting the repetition of procedures were identified through a logistic regression analysis. Two authors independently assessed inappropriateness. Results: In 2016, 432 patients were transferred from the secondary to the tertiary ED, and 251 procedures were repeated: 179 patients (77.2%) had a repeated laboratory test, 34 (14.7%) a repeated radiological procedure and 19 (8.2%) both. Repeated procedures were judged as inappropriate for 197 (99.5%) laboratory tests and for 39 (73.6%) radiological procedures. Conclusion: Over half of the patients transferred from another emergency department had a repeated procedure. In most cases, these repeated procedures were considered inappropriate.

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.

scholarly journals National rates of non-fatal emergency department visits and hospitalisations due to fall-related injuries in older adults 2010–2014 and 2016: transitioning from ICD-9-CM to ICD-10-CM

2021 ◽  
Vol 27 (S1) ◽  
pp. i75-i78
Author(s):  
Briana L Moreland ◽  
Elizabeth R Burns ◽  
Yara K Haddad
Keyword(s):  
Emergency Department ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Injury Rates ◽  
Fall Injury ◽  
The Us ◽  
Before And After ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Ed Visits

BackgroundThis study describes rates of non-fatal fall-injury emergency department (ED) visits and hospitalisations before and after the US 2015 transition from the 9th to 10th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM to ICD-10-CM).MethodsED visit and hospitalisation data for adults aged 65+ years were obtained from the 2010–2016 Healthcare Cost and Utilisation Project. Differences in fall injury rates between 2010 and 2014 (before transition), and 2014 and 2016 (before and after transition) were analysed using t-tests.ResultsFor ED visits, rates did not differ significantly between 2014 and 2016 (4288 vs 4318 per 100 000, respectively). Hospitalisation rates were lower in 2014 (1232 per 100 000) compared with 2016 (1281 per 100 000).ConclusionIncreased rates of fall-related hospitalisations could be an artefact of the transition or may reflect an increase in the rate of fall-related hospitalisations. Analyses of fall-related hospitalisations across the transition should be interpreted cautiously.

scholarly journals Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

2021 ◽  
Vol 22 (6) ◽  
pp. 1270-1275
Author(s):  
Tinh Le ◽  
Parker Cordial ◽  
Mackenzie Sankoe ◽  
Charlotte Purnode ◽  
Ankur Parekh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Similar Time ◽  
Initiation Point ◽  
Medication Assisted Treatment ◽  
Icd 10 ◽  
Ed Visits

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.

scholarly journals Evaluation of a clinical protocol using intranasal fentanyl for treatment of vaso-occlusive crisis in sickle cell patients in the emergency department

2019 ◽  
Vol 25 (5) ◽  
pp. 293-299
Author(s):  
Hugo Paquin ◽  
Evelyne D Trottier ◽  
Yves Pastore ◽  
Nancy Robitaille ◽  
Marie-Joelle Dore Bergeron ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Hospitalization Rates ◽  
Number Of Patients ◽  
Implementation Period ◽  
Administration Time ◽  
Opiate Administration

Abstract Background Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visits and admission in children with sickle cell disease (SCD). Objectives This study aims to evaluate whether the use of a new pain management pathway using intranasal (IN) fentanyl from triage leads to improved care, translated by a decrease in time to first opiate dose. Methods We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) with VOC, in the period pre- (52 patients) and post- (44 patients) implementation period of the protocol. Time to first opiate was the primary outcome and was evaluated pre- and postimplementation. Patients received a first opiate dose within 52.3 minutes of registration (interquantile range [IQR] 30.6, 74.6), corresponding to a 41.4-minute reduction in the opiate administration time (95% confidence interval [CI] −56.1, −27.9). There was also a 43% increase in the number of patients treated with a nonintravenous (IV) opiate as first opiate dose (95% CI 26, 57). In patients who were discharged from the ED, there was a 49% decrease in the number of IV line insertions (95% CI −67, −22). There was no difference in the hospitalization rates (difference of 6 [95% CI −13, 25]). Conclusions This study validates the use of our protocol using IN fentanyl as first treatment of VOC in the ED by significantly reducing the time to first opiate dose and the number of IVs.

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.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

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