scholarly journals Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael E. Reschen ◽  
Jordan Bowen ◽  
Alex Novak ◽  
Matthew Giles ◽  
Sudhir Singh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Admission Rate ◽  
Deterrent Effect ◽  
Chronic Obstructive ◽  
Electronic Patient Records ◽  
Bed Occupancy ◽  
Acute Medicine ◽  
Obesity And Diabetes ◽  
Co Morbidity ◽  
The Impact

Abstract Background To better understand the impact of the COVID-19 pandemic on hospital healthcare, we studied activity in the emergency department (ED) and acute medicine department of a major UK hospital. Methods Electronic patient records for all adult patients attending ED (n = 243,667) or acute medicine (n = 82,899) during the pandemic (2020–2021) and prior year (2019) were analysed and compared. We studied parameters including severity, primary diagnoses, co-morbidity, admission rate, length of stay, bed occupancy, and mortality, with a focus on non-COVID-19 diseases. Results During the first wave of the pandemic, daily ED attendance fell by 37%, medical admissions by 30% and medical bed occupancy by 27%, but all returned to normal within a year. ED attendances and medical admissions fell across all age ranges; the greatest reductions were seen for younger adults in ED attendances, but in older adults for medical admissions. Compared to non-COVID-19 pandemic admissions, COVID-19 admissions were enriched for minority ethnic groups, for dementia, obesity and diabetes, but had lower rates of malignancy. Compared to the pre-pandemic period, non-COVID-19 pandemic admissions had more hypertension, cerebrovascular disease, liver disease, and obesity. There were fewer low severity ED attendances during the pandemic and fewer medical admissions across all severity categories. There were fewer ED attendances with common non-respiratory illnesses including cardiac diagnoses, but no change in cardiac arrests. COVID-19 was the commonest diagnosis amongst medical admissions during the first wave and there were fewer diagnoses of pneumonia, myocardial infarction, heart failure, cellulitis, chronic obstructive pulmonary disease, urinary tract infection and other sepsis, but not stroke. Levels had rebounded by a year later with a trend to higher levels of stroke than before the pandemic. During the pandemic first wave, 7-day mortality was increased for ED attendances, but not for non-COVID-19 medical admissions. Conclusions Reduced ED attendances in the first wave of the pandemic suggest opportunities for reducing low severity presentations to ED in the future, but also raise the possibility of harm from delayed or missed care. Reassuringly, recent rises in attendance and admissions indicate that any deterrent effect of the pandemic on attendance is diminishing.

scholarly journals Impact Prognostic of Delayed Reperfusion Time in Patients With Stemi of ≤24 Hours Treated in the Emergency Department of a General Hospital

2020 ◽  
Author(s):  
Lorenzo Socias ◽  
Guillem Frontera ◽  
Catalina Rubert ◽  
Joan Torres ◽  
Tomas Ripoll ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Reperfusion Therapy ◽  
Cardiovascular Complications ◽  
Primary Angioplasty ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Killip Class ◽  
Coronary Syndrome ◽  
The Impact

Abstract Background. The patients who attend a hospital without a hemodynamic laboratory may have differences in health outcomes, treatment, reperfusion times, the rate of cardiovascular complications, hospital stay, mortality or costs may be affected. The study aimed to analyze the prognostic of patients with STEMI treated in the Emergency Department (ED) and the impact prognostic of the delayed reperfusion time in a Hospital General without hemodynamic laboratory. Methods. After ethics review board approval, this retrospective observational cohort study of patients included acute coronary syndrome with ST elevation of ≤ 24 h in the Illes Balears infarction code registry (CI-IB) between May 2008 and December 2018. The information recorded were age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty (PA). Cardiovascular Event (CE) was defined the combined variable: Killip class progression, malignant arrhythmias, Re-infarction, cerebrovascular disease and mortality. Results.605 patients were analyzed. The reperfusion treatment was 83,1% (80,8% with PA). 19% presented some CE. Hospital and monthly mortality was 6.8% and 7.8% respectively. The main differences between patients with and without CE were: age (66 vs 59 years); Chronic obstructive pulmonary disease (COPD); previous infarction; anterior location; Door-To-Needle Time and FPC-PA time. The risk factors of CE were: age, COPD, anterior location, fibrinolysis and patients without reperfusion treatment. In the group with PA, the risk of mortality was higher in COPD (p=0.012), Symptom start –FPC time with (p = 0,084) and FPC-PA time > 90 minutes (p= 0.107). FCM-AP> 90 minutes had a higher mortality (10 vs 4.4%;HR 1,79; IC 95% 1,15-2,78; log-rank:p=0,013)Conclussions. In our cohort, most patients received reperfusion treatment and were performed within the recommended time. In ED, the pacients with a FCM-PA time longer than recommended in the guidelines and COPD had higher CE y mortality.

Pharmacist-Led Transition of Care Pilot Targeting Older People After Emergency Department Discharge

2020 ◽  
Vol 35 (6) ◽  
pp. 273-282
Author(s):  
Scott M. Pearson ◽  
Anushka Tandon ◽  
Danielle R. Fixen ◽  
Sunny A. Linnebur ◽  
Gretchen M. Orosz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Primary Outcome ◽  
Transitional Care ◽  
Intervention Group ◽  
Chronic Obstructive ◽  
P Value ◽  
Historical Cohort ◽  
Obstructive Pulmonary Disease ◽  
The Impact

OBJECTIVE: To evaluate the impact of a pharmacist-led transitional care intervention targeting high-risk older people after an emergency department (ED) visit.<br/> DESIGN: Retrospective cohort study of older people with ED visits prior to and during a pharmacist-led intervention.<br/> SETTING: Patients receiving primary care from the University of Colorado Health Seniors Clinic.<br/> PARTICIPANTS: The intervention cohort comprised 170 patients with an ED visit between August 18, 2018, and February 19, 2019, and the historical cohort included 166 patients with an ED visit between August 18, 2017, and February 19, 2018. All included patients either had a historical diagnosis of heart failure or chronic obstructive pulmonary disease, or they had an additional ED visit in the previous six months.<br/> INTERVENTIONS: The pilot intervention involved postED discharge telephonic outreach and assessment by a clinical pharmacist, with triaging to other staff if necessary.<br/> MAIN OUTCOME MEASURE: The primary outcome was the proportion of patients with at least one repeat ED visit, hospitalization, or death within 30 days of ED discharge. Outcome rates were also assessed at 90 days postdischarge.<br/> RESULTS: The primary outcome occurred in 21% of the historical cohort and 25% of the intervention cohort (adjusted P-value = 0.48). The incidence of the composite outcome within 90 days of ED discharge was 43% in the historical group compared with 38% in the intervention group (adjusted P-value = 0.29).<br/> CONCLUSION: A pharmacist-led telephonic intervention pilot targeting older people did not appear to have a significant effect on the composite of repeat ED visit, hospitalization, or death within 30 or 90 days of ED discharge. A limited sample size may hinder the ability to make definitive conclusions based on these findings.

scholarly journals Recurrent Emergency Department Users: Two Categories with Different Risk Profiles

2019 ◽  
Vol 8 (3) ◽  
pp. 333 ◽  
Author(s):  
Ksenija Slankamenac ◽  
Meret Zehnder ◽  
Tim Langner ◽  
Kathrin Krähenmann ◽  
Dagmar Keller
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Emergency Services ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Co Morbidity ◽  
Ed Visits ◽  
Morbidity Index

Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Repeated ED users had more ED visits (p < 0.001) and needed more hospital admissions (p < 0.010) compared to frequent ED users. Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases (p < 0.001) and mental disorders (p < 0.001). In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled (p = 0.001), had an increased Charlson co-morbidity index (p = 0.004) or suffering from rheumatic diseases (p < 0.001). A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P &lt; 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Impact of clinical guidance and rapid molecular pathogen detection on evaluation and outcomes of febrile or hypothermic infants

2020 ◽  
Vol 41 (11) ◽  
pp. 1285-1291
Author(s):  
Jennifer Crook ◽  
Meng Xu ◽  
James C. Slaughter ◽  
Jeremy Willis ◽  
Whitney Browning ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Guideline ◽  
Young Infant ◽  
Tertiary Care ◽  
Admission Rate ◽  
Entire Study ◽  
Clinical Guidance ◽  
Period 2 ◽  
Ancillary Test ◽  
The Impact

AbstractObjective:To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants.Design:Before-and-after intervention study.Setting:Tertiary-care children’s hospital.Patients:Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED).Methods:The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis.Results:Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29–60 days old being managed without antibiotics.Conclusions:Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.

scholarly journals 152 Implementation of Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Comfort Adedokun ◽  
Rosa McNamara ◽  
Nessa O’Herlihy
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Older People ◽  
Rapid Assessment ◽  
Admission Rate ◽  
Clinical Decision ◽  
Admission Rates ◽  
Clinical Decision Unit ◽  
Medical Referral ◽  
The Impact

Abstract Background The Emergency Department (ED) is where most people, including older adults in crises, seek care. OPRAH was introduced in order to meet the needs of our changing population. The unit was developed out of existing resources within the ED and cohorts both older patients and staff to an area more suitable to carry out assessments. Methods We used a quality improvement framework to develop our service. OPRAH is led by an ED GEM (Geriatric Emergency Medicine) consultant, staffed using the existing ED team, housed within footprint of the ED as part of the Clinical Decision Unit (CDU) with the addition of an HCA (healthcare assistant) as required. To determine the impact of the service on admissions of older adults, we collated patient records prospectively. These were reviewed and coded by senior ED professionals blinded to outcomes, to determine medical-referral rate for admission in these cohort. Results In the first 3 weeks of implementation, 76 patients were assessed. Four were admitted and 2 transferred to other hospitals. Mean age was 83 years ranging 66-103 years with an average of 262 minutes in the ED prior to OPRAH admission. Blinded coders review determined 53 (76%) of these patients would have been referred for admission. The majority of the remainder would have completed their care in the ED, as they were not eligible for admission to CDU. Conclusion Introduction of OPRAH to the ED has improved access for older people to short-stay ED led care and reduced admission rates. We have identified a trend towards fewer episodes where care by in-house teams is completed within the ED. We are in an early phase of this project. Nonetheless, it is evident that by redesigning how we assess older people in the ED and using available outpatient resources, we could impact on admission rate and length of stay in the ED without compromising patient care. Implementation has increased the use of the integrated care team, hospital and community MDT (multidisciplinary team).

scholarly journals The Impact of a Hospitalist Model in Perioperative Care of Elective Joint Replacement Patients: a 17 years-experience Report

2020 ◽  
Author(s):  
Matteo Carlo Ferrari ◽  
Elena Azzolini ◽  
Giuseppe Strangio ◽  
Salvatore Badalamenti ◽  
Michele Lagioia
Keyword(s):  
Customer Satisfaction ◽  
Joint Replacement ◽  
Indirect Costs ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Joint Infections ◽  
Co Morbidity ◽  
Tertiary Teaching ◽  
Prosthetic Joint Infections ◽  
The Impact

Abstract Background Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. The aim of this report is to describe a 17-year experience of a hospitalist model in peri-operative co-management in more than 25,000 elective joint replacement patients. Methods A retrospective observational study about surgical co-management with hospitalists in a tertiary teaching referral hospital in Milan in relation to hospital lengths of stay (LOS), 30-days readmission rate, incidence of prosthetic joint infections (PJI) and patient related co-morbidities, number of medico-legal disputes and related costs, and medical customer satisfaction. Results Over a 17-year period LOS has been reduced from 10 to 5 days; readmission rates for total hip arthroplasty are 1.7% vs 3.7% (Italy) at 30 days; total infection rates for total knee arthroplasty are recorded at 0.8% vs 1.4% (Italy); obesity, diabetes, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) and/or smoking result as the main co-morbidity in PJI; there have been only 113 medico-legal disputes out of approximately 19,000 surgeries and we report 95% overall medical customer satisfaction. Conclusions This is the first paper outside the US to highlight the impact of the hospitalists on patient satisfaction and the translation of the obtained benefits into savings. The evolution of the hospitalist model in surgical settings shows promising results in terms of patients’ safety and cut of health-related direct and indirect costs.

scholarly journals (A122) Using Focused Operations Management Tools to Analyze and Alleviate Emergency Department Overcrowding

2011 ◽  
Vol 26 (S1) ◽  
pp. s34-s35 ◽  
Author(s):  
D. Schwartz ◽  
B. Ronen ◽  
J.S. Pliskin ◽  
A. Goldberg
Keyword(s):  
Emergency Department ◽  
Operations Management ◽  
Medical Center ◽  
Patient Flow ◽  
Care Quality ◽  
Patient Comfort ◽  
Electronic Patient Records ◽  
Affecting Factors ◽  
Emergency Department Overcrowding ◽  
The Impact

IntroductionEmergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.MethodsEmergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.ResultsData collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.DiscussionThe implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.

The impact of GP referrals on overcrowding in emergency departments and acute medicine

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ayaz A Abbasi ◽  
Shams Khan ◽  
Victor Ameh ◽  
Ilyas Muhammad
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
General Medicine ◽  
Service Evaluation ◽  
Urgent Care ◽  
Ambulatory Assessment ◽  
Acute Medicine ◽  
Number Of Patients ◽  
The Impact

Background/Aims A long-standing issue common to most emergency departments worldwide is overcrowding, and the UK is no exception. Overcrowding can have many adverse consequences, such as increased medical errors, decreased quality of care and poor patient outcomes. This service evaluation aimed to review the number of patients referred to acute specialties by their GPs and to evaluate the impact of these referrals on the flow of patients in and out of the emergency department and acute medicine. Methods GP referral letters were collected at an emergency department in Greater Manchester, England, between 15 May 2019 and 28 May 2019. A proforma was used by a consultant in acute medicine and a consultant in emergency medicine to evaluate each letter. Result A total of 139 GP referrals were received by the emergency department, of which 43 were to general medicine and 96 to other specialties. Of the latter, 54 cases were directed to the emergency department, 20 were directed to a different specialty and 23 did not have a specialty clearly specified. The majority of referrals were for gastrointestinal conditions or abdominal pain, with the next largest category being chest infections. Most of these patients were eventually seen in the trust's ambulatory assessment area to relieve pressure on the emergency department. Conclusions Planned and specific use of urgent care centres and ambulatory assessment areas can help to relieve pressure on emergency departments, but appropriate intervention at the primary care level is also necessary to improve patient flow.

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