Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study

ObjectivesTo examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years.DesignThis is a retrospective observational study that used a large administrative dataset.SettingThe study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive.ParticipantsChildren aged 0–15 years who attended CUH ED during the study period of 6 years (2012–2018) were included in this study (n=76 831).InterventionsFree GP care was expanded to all children aged 0–5 years in July 2015.Main outcome measuresPaediatric attendances to CUH ED were examined before (Time Period 1: July 2012–June 2015) and after (Time Period 2: July 2015–June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated.ResultsPaediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0–5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%.ConclusionThe expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.

Download Full-text

Emergency department visits for dental problems among adults with private dental insurance: A national observational study

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.02.001 ◽

2021 ◽

Vol 44 ◽

pp. 166-170

Author(s):

Troy B. Amen ◽

Inkyu Kim ◽

Gregory Peters ◽

Alba Gutiérrez-Sacristán ◽

Nathan Palmer ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Emergency Department Visits ◽

Dental Insurance

Download Full-text

LO028: Prospective validation of an iOS app to evaluate tremor in patients with alcohol withdrawal syndrome

CJEM ◽

10.1017/cem.2016.65 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S39-S39 ◽

Cited By ~ 1

Author(s):

B. Borgundvaag ◽

S.L. McLeod ◽

T.E. Dear ◽

S.M. Carver ◽

N. Norouzi ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Alcohol Withdrawal ◽

Withdrawal Syndrome ◽

Prospective Observational Study ◽

Alcohol Withdrawal Syndrome ◽

Research Assistant ◽

Rater Agreement ◽

Objective Indicator ◽

Expert Assessments

Introduction: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom driven approach, whereby patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised; CIWA-Ar) and treated according to severity. Among the domains assessed by the CIWA-Ar, tremor is the most objective indicator of withdrawal severity, however, the ability of clinicians to reliably quantify tremor is highly dependent on experience. The objective of this study was to prospectively validate an objective, reliable tool to standardize and quantify the severity of alcohol withdrawal tremor using the built-in accelerometer of an iOS application. Methods: A prospective observational study of patients ≥18 years presenting to an academic emergency department in alcohol withdrawal was conducted from Oct 2014 to Aug 2015. Assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Accelerometer derived results were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 76 patients with 78 tremor recordings were included. Accelerometer derived tremor scores matched exactly with expert assessor scores in 36 (46.2%) cases, within 1 point for 73 (93.6%) cases and differed by ≥ 2 points in 5 (6.4%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘very good’ 0.92 (95% CI: 0.86, 0.99). Conclusion: iOS accelerometer based assessment of the tremor component of the CIWA-Ar score is reliable and has potential to more accurately assess the severity of patients in alcohol withdrawal. We anticipate this resource will be easily disseminated and will impact and improve the care of patients with alcohol withdrawal.

Download Full-text