Patient-Reported Adverse Drug Related Events from Emergency Department Discharge Prescriptions

AbstractObjectivesThe National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.MethodsWe deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.ResultsOf those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.ConclusionsPatient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.

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Patient-reported adverse drug-related events from emergency department discharge prescriptions

CJEM ◽

10.1017/s1481803500012422 ◽

2010 ◽

Vol 12 (04) ◽

pp. 331-338 ◽

Cited By ~ 5

Author(s):

Corinne M. Hohl ◽

Riyad B. Abu-Laban ◽

Peter J. Zed ◽

Jeffrey R. Brubacher ◽

Gina Tsai ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Time Frame ◽

Tertiary Care Centre ◽

Crude Odds Ratio ◽

Patient Reported ◽

Scale Scores ◽

Emergency Department Triage ◽

Emergency Department Discharge ◽

Research Assistants

ABSTRACTObjective:The tolerability of drugs prescribed on emergency department (ED) discharge is unknown. Our objectives were to quantify and describe adverse drug-related events (ADREs) as reported by patients triaged as Canadian Emergency Department Triage and Acuity Scale scores 3, 4 or 5, discharged from the ED with prescriptions.Methods:This prospective observational study was a planned substudy of a larger study on adherence to discharge prescriptions. This study was conducted in a tertiary care centre with an annual ED census of 69 000 visits. The primary outcome was the frequency of ADREs reported during a structured telephone questionnaire 2 weeks after ED discharge. An ADRE was deemed to have occurred if the patient reported a symptom consistent with a known ADRE that began and resolved within a plausible time frame after starting and stopping the drug, and if no alternative diagnosis was probable.Results:Research assistants contacted 258/301 (85.7%) patients discharged from the ED with a prescription. An ADRE was reported by 54/258 patients (20.9%, 95% confidence interval [CI] 16.4%–26.3%). The most commonly reported ADREs were nausea, constipation and drowsiness. None required hospital admission or caused death. Participants reporting ADREs were not more likely to make an unplanned ED or clinic revisit (crude odds ratio [OR] 1.1, 95% CI 0.6–2.2; adjusted OR 1.2, 95% CI 0.6–2.4).Conclusion:Approximately one-fifth of low-acuity patients prescribed medication on discharge from the ED report ADREs, but most of these are neither severe nor associated with an increase in use of health services. Attention to common preventable ADREs, such as opioid-associated constipation, could reduce the rate of ADREs in this population.

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4021 Learning from Patient Experience to Improve Diagnosis: a Pilot Study

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.409 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 138-139

Author(s):

Kelly Gleason ◽

Cheryl Dennison Himmelfarb ◽

Susan Peterson ◽

Taylor Wynn ◽

Mariel Villanueva ◽

...

Keyword(s):

Emergency Department ◽

Health Status ◽

Administrative Data ◽

Health Problem ◽

Chronic Obstructive Lung Disease ◽

Diagnostic Error ◽

Chronic Obstructive ◽

Study Results ◽

Patient Reported ◽

Emergency Department Discharge

OBJECTIVES/GOALS: Leveraging Patient’s Experience to improve Diagnosis (LEAPED) is our proposed method of measuring diagnostic error through seeking patient feedback on their understanding of their diagnosis and health status following emergency department discharge. To pilot test LEAPED’s feasibility, we deployed and determined patient uptake of LEAPED. METHODS/STUDY POPULATION: To test LEAPED, we employed a longitudinal cohort study design at emergency departments across one academic health system in the Mid-Atlantic region. Patients consented to complete questionnaires regarding their understanding of their diagnosis and/or follow-up steps and their health status at 2 weeks, 1 month, and 3 months following emergency department discharge. People aged 18 and older who were seen at the emergency department within the past 7 days with at least one chronic condition (hypertension, diabetes, history of stroke, arthritis, cancer, heart disease, osteoporosis, depression, and/or chronic obstructive lung disease) and one or more of the following common chief complaints: chest pain, upper back pain, abdominal pain, shortness of breath/cough, dizziness, and headache were eligible to join the study. RESULTS/ANTICIPATED RESULTS: Of those enrolled (n = 59), 95% (n = 53) responded to the two week post-ED discharge questionnaire (1 and 3-month ongoing). Of the 6 non-responders, 1 had died and 3 were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female. Over half of participants (53%) were white and 41% were black. Almost one-third (27%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a third did not have an understanding of what steps to take after leaving the ED. Participants reported a new health problem was identified after ED discharge (19%), worsening health status (12%), and health status stayed the same (16%). DISCUSSION/SIGNIFICANCE OF IMPACT: Patient uptake of LEAPED was high, which suggests that patient-report is a feasible method of evaluating diagnostic decision making and delivery to patients and yields insightful information beyond administrative data. The next steps are to validate the accuracy of patient-reported diagnostic error by comparing with administrative data.

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Patient-Reported Symptoms Improve Performance of Risk Prediction Models for Emergency Department Visits Among Patients With Cancer: A Population-Wide Study in Ontario Using Administrative Data

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.07.007 ◽

2019 ◽

Vol 58 (5) ◽

pp. 745-755 ◽

Cited By ~ 6

Author(s):

Rinku Sutradhar ◽

Mehdi Rostami ◽

Lisa Barbera

Keyword(s):

Emergency Department ◽

Risk Prediction ◽

Administrative Data ◽

Prediction Models ◽

Emergency Department Visits ◽

Improve Performance ◽

Risk Prediction Models ◽

Patients With Cancer ◽

Patient Reported

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Dysuria, Rebound Tenderness, and a Palpable Mass—A Ticking Time Bomb

Military Medicine ◽

10.1093/milmed/usab180 ◽

2021 ◽

Author(s):

Tyler Miklovic ◽

Philip Davis

Keyword(s):

Emergency Department ◽

Case Reports ◽

Pubic Symphysis ◽

Subsequent Treatment ◽

Urachal Cyst ◽

Significant Morbidity ◽

Palpable Mass ◽

Rebound Tenderness ◽

Patient Reported ◽

Middle Aged Adult

ABSTRACT A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source.

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Older veterans and emergency department discharge information

BMJ Quality & Safety ◽

10.1136/bmjqs-2011-000538 ◽

2012 ◽

Vol 21 (10) ◽

pp. 835-842 ◽

Cited By ~ 5

Author(s):

Susan Hastings ◽

Karen Stechuchak ◽

Eugene Oddone ◽

Morris Weinberger ◽

Dana Tucker ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Discharge

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Follow-up trends after Emergency Department discharge for acutely symptomatic hernias

The American Journal of Surgery ◽

10.1016/j.amjsurg.2017.08.028 ◽

2017 ◽

Vol 214 (6) ◽

pp. 1018-1021 ◽

Cited By ~ 2

Author(s):

Lara Spence ◽

Eric Pillado ◽

Dennis Kim ◽

David Plurad

Keyword(s):

Emergency Department ◽

Emergency Department Discharge

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Multicentric investigation of survival after Spanish emergency department discharge for acute heart failure

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e3283496711 ◽

2012 ◽

Vol 19 (3) ◽

pp. 153-160 ◽

Cited By ~ 13

Author(s):

Òscar Miró ◽

Víctor Gil ◽

Pablo Herrero ◽

Francisco Javier Martín-Sánchez ◽

Javier Jacob ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Acute Heart Failure ◽

Emergency Department Discharge

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Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial

Journal of Medical Internet Research ◽

10.2196/19685 ◽

2020 ◽

Vol 22 (10) ◽

pp. e19685

Author(s):

Afaf Girgis ◽

Ivana Durcinoska ◽

Anthony Arnold ◽

Joseph Descallar ◽

Nasreen Kaadan ◽

...

Keyword(s):

Emergency Department ◽

Patient Reported Outcomes ◽

Well Being ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Self Management ◽

Diverse Population ◽

Web Based ◽

Patients With Cancer ◽

Patient Reported

Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3

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Patient-Reported Outcomes Improves the Prediction of In-patient and Emergency Department Readmission Risks in Coronary Artery Disease

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.716 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Danielle Southern ◽

Colleen Norris ◽

Hude Quan ◽

Maria Santana ◽

Matthew James ◽

...

Keyword(s):

Emergency Department ◽

Risk Prediction ◽

Prediction Models ◽

Policy Decision ◽

Patient Reported Outcome Measures ◽

Baseline Survey ◽

Post Discharge ◽

Risk Prediction Models ◽

Patient Reported ◽

Artery Disease

IntroductionCoronary Artery Disease (CAD) patients are known to report higher healthcare resource use, such as inpatient [IP] and emergency department [ED] readmissions, than the general population. We investigate if the patient reported outcome measures (PROMs) improve the accuracy of readmissions risk prediction models in CAD. Objectives and ApproachPatients enrolled in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry between 1995 and 2014 who received catheterization (CATH) and completed baseline PROMs were linked to discharge abstract data and national ambulatory data. Logistic regression (LR) was used to develop 30-day and 1-year readmissions risk prediction models adjusting for patients’ demographic, clinical, and self-reported characteristics. PROM was measured using the 19-item Seattle Angina Questionnaire (SAQ). The discriminatory performance of each prediction model was assessed using the Harrel’s c-statistic for LR. ResultsOf the 13,264 patients who completed baseline SAQ, 59 (0.3%) had IP readmissions or ED visits within 30 days, and up to 356 (1.9%) within 1 year of baseline survey. The C-statistics for one-year readmissions risk prediction models that only adjusted for demographic and clinical variables only ranged between 56.4% and 61.2%. The prognostic improvement in the discrimination of these models ranged between 2% to 10% when patient-reported SAQ was included as predictor. The addition of SAQ improves the model discrimination in all types of admission. Conclusion/ImplicationsThe addition of PROMs improves the moderate accuracy of readmissions risk prediction models. These findings highlight the need for routine collection of PROMs in clinical settings and their potential use for aiding clinical and policy decision-making and post-discharge outcomes monitoring in the management of cardiovascular diseases.

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