The analysis of the geographical distribution of emergency departments’ frequent users: a tool to prioritize public health policies?

Abstract Background The individual factors associated to Frequent Users (FUs) in Emergency Departments are well known. However, the characteristics of their geographical distribution and how territorial specificities are associated and intertwined with ED use are limited. Investigating healthcare use and territorial factors would help targeting local health policies. We aim at describing the geographical distribution of ED’s FUs within the Paris region. Methods We performed a retrospective analysis of all ED visits in the Paris region in 2015. Data were collected from the universal health insurance’s claims database. Frequent Users (FUs) were defined as having visited ≥3 times any ED of the region over the period. We assessed the FUs rate in each geographical unit (GU) and assessed correlations between FUs rate and socio-demographics and economic characteristics of GUs. We also performed a multidimensional analysis and a principal component analysis to identify a typology of territories to describe and target the FUs phenomenon. Results FUs accounted for 278,687 (11.7%) of the 2,382,802 patients who visited the ED, living in 232 GUs. In the region, median FUs rate in each GU was 11.0% [interquartile range: 9.5–12.5]. High FUs rate was correlated to the territorial markers of social deprivation. Three different categories of GU were identified with different profiles of healthcare providers densities. Conclusion FUs rate varies between territories and is correlated to territorial markers of social deprivation. Targeted public policies should focus on disadvantaged territories.

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Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data

Emergency Medicine Journal ◽

10.1136/emermed-2019-209122 ◽

2020 ◽

pp. emermed-2019-209122

Author(s):

Geva Greenfield ◽

Mitch Blair ◽

Paul P Aylin ◽

Sonia Saxena ◽

Azeem Majeed ◽

...

Keyword(s):

Ethnic Groups ◽

Emergency Departments ◽

National Data ◽

Frequent User ◽

Frequent Users ◽

Frequent Attender ◽

Random Intercept ◽

Frequent Attendance ◽

Lower Likelihood ◽

Deprived Areas

BackgroundFrequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs.AimTo describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals.MethodWe analysed the Hospital Episode Statistics dataset for April 2014–March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups.ResultsOne in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively).ConclusionOne in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.

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Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211028173 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110281

Author(s):

Patrick Bodenmann ◽

Miriam Kasztura ◽

Madison Graells ◽

Elodie Schmutz ◽

Oriane Chastonay ◽

...

Keyword(s):

Online Survey ◽

Emergency Services ◽

Healthcare Providers ◽

Negative Consequences ◽

Emergency Department Care ◽

Frequent Users ◽

Complex Needs ◽

Wide Range ◽

Ed Overcrowding ◽

Ed Visits

Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.

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Men and sexual and reproductive healthcare in the Nordic countries: a scoping review

10.1101/2021.04.20.21255777 ◽

2021 ◽

Author(s):

Mazen Baroudi ◽

Jon Petter Stoor ◽

Hanna Blåhed ◽

Kerstin Edin ◽

Anna-Karin Hurtig

Keyword(s):

Medical Education ◽

Healthcare Providers ◽

Nordic Countries ◽

Health Policies ◽

Sexually Transmitted ◽

Pregnancy And Childbirth ◽

Knowledge And Attitudes ◽

Factors Influencing ◽

Reproductive Healthcare ◽

The Impact

AbstractContextMen generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries.MethodsWe searched PubMed and SveMed+ for peer-reviewed articles published between 2010 and 2020. The analyses identified factors influencing men’s experiences of and access to SRHC.ResultsThe majority of the 68 articles included focused on pregnancy, birth, infertility, and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organizational obstacles, such as women-centred SRHC and no assigned profession, hindered men’s access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men’s access to SRHC.ConclusionsThe identified knowledge gap indicates the necessity of the improved health and medical education of healthcare providers, as well as of health system interventions.

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A qualitative study of workplace violence among healthcare providers in emergency departments in India

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00290-0 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Kevin Davey ◽

Veda Ravishankar ◽

Nikita Mehta ◽

Tania Ahluwalia ◽

Janice Blanchard ◽

...

Keyword(s):

Qualitative Study ◽

Workplace Violence ◽

Emergency Departments ◽

Healthcare Providers

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Best Paper Selection

Yearbook of Medical Informatics ◽

10.1055/s-0040-1702000 ◽

2020 ◽

Vol 29 (01) ◽

pp. 091-092

Keyword(s):

Respiratory Diseases ◽

Social Care ◽

Healthcare Providers ◽

Health Department ◽

Mixed Methods Study ◽

Local Health ◽

Health Records ◽

Health And Social Care ◽

Perceived Workload ◽

Data Collections

Hosseini M , Faiola A, Jones J, Vreeman DJ, Wu H, Dixon BE. Impact of document consolidation on healthcare providers’ perceived workload and information reconciliation tasks: a mixed methods study. J Am Med Inform Assoc 2019;26(2):134-42 https://academic.oup.com/jamia/article/26/2/134/5253582 Yeung T. Local health department adoption of electronic health records and health information exchanges and its impact on population health. Int J Med Inform 2019;128:1-6 https://www.sciencedirect.com/science/article/abs/pii/S1386505618310426?via%3Dihub Souza J, Santos JV, Canedo VB, Betanzos A, Alves D, Freitas A. Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases. Health Inf Manag 2020;49(1):47-57 https://journals.sagepub.com/doi/full/10.1177/1833358319840575?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed Hannigan A, Villarroel N, Roura M, LeMaster J, Basogomba A, Bradley C, MacFarlane A. Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for?. Int J Equity Health 2019;19(1):2 https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1107-y

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Healthcare providers’ perspectives on family presence during resuscitation in the emergency departments of the Kingdom of Bahrain

BMC Emergency Medicine ◽

10.1186/s12873-020-00365-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Feras H. Abuzeyad ◽

Ahmed Elhobi ◽

Wael Kamkoum ◽

Luma Bashmi ◽

Ghada Al-Qasim ◽

...

Keyword(s):

Emergency Departments ◽

Healthcare Providers ◽

Family Presence

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Managing the patient safety risks of bottom-up health information technology innovations: Recommendations for healthcare providers

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i1.952 ◽

2018 ◽

Vol 25 (1) ◽

pp. 7-13 ◽

Cited By ~ 4

Author(s):

Mark A. Sujan

Keyword(s):

Information Technology ◽

Risk Management ◽

Health Information Technology ◽

Health Information ◽

Management Strategies ◽

Healthcare Providers ◽

Local Health ◽

Health It ◽

Bottom Up ◽

Patients At Risk

Health information technology (IT) offers exciting opportunities for providing novel services to patients, and for improving the quality and safety of care. Many healthcare professionals are already improving services through the development of numerous bottom-up local health IT innovations. Such innovations from the ground up are to be welcomed, but healthcare providers are struggling to develop processes for managing the risks that come with the introduction of health IT into clinical processes. I argue that too often the main strategy appears to be one of organisational ignorance. This puts patients at risk, and it threatens the successful adoption of health IT. I recommend that healthcare providers focus on strengthening their processes for organisational learning, promoting proactive risk management strategies, and making risk management decisions transparent and explicit.

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Education of the medical profession to facilitate delivery of transgender health care in an Australian health district

Australian Journal of Primary Health ◽

10.1071/py19102 ◽

2020 ◽

Vol 26 (1) ◽

pp. 17

Author(s):

Maansi Arora ◽

Kaete Walker ◽

Judy Luu ◽

Robbert J. Duvivier ◽

Tinashe Dune ◽

...

Keyword(s):

Health Care ◽

New England ◽

Lived Experience ◽

Medical Profession ◽

Healthcare Providers ◽

Health District ◽

Easy Access ◽

Local Health ◽

Community Members ◽

Transgender Health

Transgender individuals who desire medical transition need to access care through their local healthcare system. This is the first study to explore the perceptions of the community and attitudes of healthcare providers towards the delivery of transgender health care in an Australian context. An anonymous survey was conducted of trans and gender-diverse community members; and physicians and trainees in the Hunter New England Local Health District of New South Wales, Australia. Community members were surveyed about their healthcare experiences. Medical students, GPs and hospital physicians were surveyed on their attitudes towards the delivery of transgender health care before and after a 1-h education session that included the lived experience of a community member. Community members expressed a need for increased education for healthcare providers in transgender medicine. Following the intervention, significantly more healthcare providers felt confident to facilitate transgender health care for adults, adolescents and children; and more healthcare providers agreed that medical and surgical treatment should be offered to transgender patients if desired. The positive safety profile of treatment was felt to be the most persuasive factor for the provision of care. Healthcare providers identified a need for health education in transgender medicine; easy access to evidence-based resources; and local referral pathways as key strategies to improving transgender health care.

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Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data

Emergency Medicine Journal ◽

10.1136/emermed-2019-208849 ◽

2020 ◽

pp. emermed-2019-208849

Author(s):

Steven Paling ◽

Jennifer Lambert ◽

Jasper Clouting ◽

Júlia González-Esquerré ◽

Toby Auterson

Keyword(s):

Emergency Departments ◽

Fixed Effects ◽

Patient Flow ◽

Waiting Times ◽

Healthcare Providers ◽

Ordinary Least Squares ◽

Hospital Length Of Stay ◽

Bed Occupancy ◽

Point Change ◽

Factors Associated

BackgroundLong lengths of stay (also called waiting times) in emergency departments (EDs) are associated with higher patient mortality and worse outcomes.ObjectiveTo add to the literature using high-frequency data from a large number of hospitals to analyse factors associated with long waiting times, including exploring non-linearities for 'tipping points'.MethodsMultivariate ordinary least squares regressions with fixed effects were used to analyse factors associated with the proportion of patients in EDs in England waiting more than 4 hours to be seen, treated and admitted or discharged. Daily situation reports (Sitrep), hospital episode statistics and electronic staffing records data over 90 days between December 2016 and February 2017 were used for all 138 English NHS healthcare providers with a major ED.ResultsHigher inpatient bed occupancy was correlated with longer ED waiting times, with a non-linear association. In a full hospital, with 100% bed occupancy, the proportion of patients who remained in the ED for more than 4 hours was 9 percentage points higher (95% CI 7.5% to 11.1%) than with an 85% occupancy level. For each percentage point change in the following factors, the proportion of ED stays over 4 hours also increased: more inpatients with hospital length of stay over 21 days (0.07%, 95% CI 0.008% to 0.13%); higher emergency admissions (0.08%, 95% CI 0.06% to 0.10%); and lower discharges relative to admissions on the same day (0.04%, 95% CI 0.02% to 0.06%), the following day (0.05%, 95% CI 0.03% to 0.06%) and at 2 days (0.05%, 95% CI 0.04% to 0.07%).ConclusionsThese results suggest that tackling patient flow and capacity in the wider hospital, particularly very high bed occupancy levels and patient discharge, is important to reduce ED waiting times and improve patient outcomes.

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