scholarly journals The financial burden of imaging tests conducted in the emergency department of a teaching hospital: a brief report

2019 ◽  
Vol 6 (1) ◽  
pp. 43-46
Author(s):  
Sahar Mirbaha ◽  
Mohammadmehdi Forouzanfar ◽  
Amin Saberinia ◽  
Amir Salimi ◽  
Hamid Kariman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Imaging Technique ◽  
Financial Burden ◽  
Imaging Method ◽  
Total Cost ◽  
Imaging Methods ◽  
Number Of Patients ◽  
Different Types ◽  
One Year

Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.

scholarly journals LO68: Patterns and predictors of emergency physician productivity

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S31
Author(s):  
S. Campbell ◽  
S. Weerasinghe
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Ct Scan ◽  
Resource Utilization ◽  
Emergency Physician ◽  
X Ray ◽  
Workload Measurement ◽  
Number Of Patients ◽  
Return Visits

Introduction: Emergency Physician (EP) performance comprises both quality of care and quantity of patients seen in a set time. Emergency Department (ED) overcrowding increases the importance of the ability of EPs to see patients as rapidly as is safely possible. Maximizing efficiency requires an understanding of variables that are associated with individual physician performance. While using the incidence of return visits within 48 hours as a quality measure is controversial, repeat visits do consume ED resources. Methods: We analysed the practice variables of 85 EPs working at a single academic ED, for the period from June 1, 2013 to May 31, 2017, using data from an emergency department information system (EDIS). Variables analysed included: number of shifts worked, number of patients seen per hour (pt/hr), an adjusted workload measurement (assigning a higher score to CTAS 1-3 patients), percentage of patients whose care involved an ED learner, and the percentage of patients who returned to the ED within 48 hours of ED discharge. Resource utilization was measured by percentage of diagnostic imaging (ultra sound (US), CT scan (CT), x-ray (XR)) ordered and percentage of patients referred to consulting services. We performed principal component analyses to identify bench marks of resource use, demographic (age, EM qualification, gender) and other practice related predictors of performances. Results: Mean pt/hr differed significantly by EM Qualification for CTAS 2-4, with 1.71/hr (95% Confidence Interval=1.63-1.77) by FRCPS physicians, compared to 1.89/hr by CCFP(EM) (CI=1.81-1.97). There were no differences for CTAS 1 and 5. Other variables associated with a significantly lower pt/hr, included a greater use of imaging, (CT: p=0.0003, XR: p=0.0008) although this was did not reach statistical significance with US (p=0.06%). Female gender, older age, number of patient consultations for CTAS 3 and more patients seen by a learner were all associated with lower pt/hr. Pt/hr was a better predictor (R2=45%) for EP resource utilization than adjusted workload measurement (R2 =35%). Higher use of CT was associated with fewer return visits in <48 hrs (0.13% lower). Male gender, younger age, number of patient consultation for CTAS 3 and fewer patients seen by a learner were all associated with an increase in return visits. Conclusion: We found a significant difference in pt/hr rates and return visits within 48 hours between EPs with different age ranges, gender, and EM certification. Increased use of CT scan and x-ray, and consultation for patients CTAS 3 were associated with lower pt/hr. Return visit rates also varied in association with diagnostic imagine use, age, gender and number of patients seen by a learner. Further research is needed to assess the association with these variables on quality of care.

scholarly journals SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
S Davidson ◽  
L Cornett ◽  
K McElvanna
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Ct Scan ◽  
Surgical Patients ◽  
Lessons Learnt ◽  
Retrospective Audit ◽  
Time Period ◽  
Number Of Patients ◽  
Scan Data ◽  
Surgical Admission

Abstract Aim With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions. Methods A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed. Results In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p &lt; 0.001). Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p &lt; 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014). 2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07). Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019. Conclusions There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.

scholarly journals A new denoising strategy and the X-shaped supplement denoising operator targeting time-reversed mirror imaging technique

2021 ◽  
Vol 18 (4) ◽  
pp. 503-514
Author(s):  
Lingli Zhang ◽  
Yuxiao Ren ◽  
Lei Chen ◽  
Kai Wang ◽  
Xinji Xu ◽  
...  
Keyword(s):  
Reference Model ◽  
Imaging Technique ◽  
Velocity Model ◽  
Laplacian Operator ◽  
Imaging Method ◽  
Geometric Features ◽  
Conventional Imaging ◽  
Imaging Methods ◽  
Seismic Wavelet ◽  
Residual Noise

Abstract Imaging of vertical structures is a challenge in the seismic imaging field. The conventional imaging methods for vertical structures are highly dependent on the reference model or boreholes. Time-reversed mirror imaging can effectively image the vertical structures based on the multiples and a smoothed velocity model without the need of accurate seismic wavelet estimation. Although the Laplacian operator is applied in time-reversed mirror imaging, there still exists severe residual noise. In this study, we developed a new imaging denoising strategy and an X-shaped supplement denoising operator for time-reversed mirror imaging based on the geometric features of the image and the causes of imaging noise. Synthetic results for the single- and double-staircase model prove the powerful denoising capacity of the X-shaped supplement denoising operator. In addition, the results of a Marmousi model prove that the X-shaped denoising operator can also effectively suppress the noise when applying time-reversed mirror imaging method to image complex inclined structures. However, the X-shaped denoising operator still contains some limitations, such as non-amplitude-preserving.

scholarly journals Patient profile of patients attending to emergency department of a tertiary neurological and neurosurgical hospital of Nepal: One year experience

2020 ◽  
Vol 1 (1) ◽  
pp. 20-24
Author(s):  
Rashmi Shrestha ◽  
Rachana Nakarmi ◽  
Ritesh Luitel ◽  
Subodh Sharma Paudel
Keyword(s):  
Emergency Department ◽  
Road Traffic ◽  
Neurological Diseases ◽  
Physical Assault ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
Patient Profile ◽  
Number Of Patients ◽  
One Year ◽  
Ischemic Attack

Introduction: Neurological emergencies are life threatening conditions that arise frequently and have devastating results if not diagnosed and treated quickly with high rates of neurological mortality and morbidity. Being a tertiary neurological center, Upendra Devkota Memorial National Institute of Neurological and Allied Science is a major referral center for neurological diseases. The objective of this study is to assess the types and number of diseases that present to the emergency department of a tertiary neurological center. Methods: This is a retrospective study conducted in emergency department of national neurosurgical/neurological referral hospital in Kathmandu, from Oct 2018 to Sept 2019. Clinico-epidemiological details of the patients were noted. Results: The total number of patients presenting to the emergency in one year period were 2995. 58.33% were males and 41.67% were females with male to female ratio of 1:1.4. Majority of the patients (24.91%) were above 60 years of age. Trauma (26.08%) was the major admissions followed by stroke (25.71%) and headache (11.79%). The majority of trauma were road traffic accident (43.02%) followed by fall injury (29.83%) and physical assault (18.96%). Out of the stroke cases, 51.68% were ischemic followed by hemorrhagic stroke 44.55% and transient ischemic attack (3.77%). One thousand eight hundred and ten people were admitted. Conclusion: The study presents an overview of the patients presenting as neurological emergency. It helps to better plan and devise resources and system in a neurosurgical emergency.

scholarly journals Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 986
Author(s):  
Byeong-Keon Moon ◽  
Ryeok Ahn ◽  
Deulle Min ◽  
JaeLan Shim
Keyword(s):  
Emergency Department ◽  
Healthcare Workers ◽  
Medical Center ◽  
Financial Burden ◽  
Foreign Worker ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Discharge Against Medical Advice

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

Editorial

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 91-91 ◽  
Author(s):  
Baer ◽  
Seiler ◽  
Büchler
Keyword(s):  
Liver Resection ◽  
Hepatic Resection ◽  
Ct Scan ◽  
Sub Saharan Africa ◽  
Preoperative Imaging ◽  
Term Survival ◽  
Liver Remnant ◽  
Mortality And Morbidity ◽  
Imaging Methods ◽  
Number Of Patients

Hepatocellular carcinoma (HCC) is a highly malignant tumor with a poor prognosis and an annual incidence of between 250,000 and 1.2 million cases in high risk areas, such as Southeast Asia, coastal areas of mainland China, and sub-Saharan Africa. Worldwide, it is the seventh most common cancer with the highest incidence of adult malignancy in areas endemic for then hepatitis B virus. From a clinical point of view, the number of HCC cases in Switzerland is expected to possibly increase, due to the increasing number of patients with chronic hepatitis C. The only established treatment to cure the HCC involves hepatic resection or, in selected cases, transplantation. However, the success of these operations is frequently limited due to the often-advanced stage of the tumor at the time of diagnosis. Recent advances in techniques of liver surgery, better preoperative imaging methods and therefore better patient selection have helped to lower mortality and morbidity after hepatic resection. The most frequently used imaging methods today, CT-scan and dynamic CT-scan, may be replaced by the MRI in the near future because of it's more detailed and more sensitive image of liver tumours. A still unresolved problem is the possibly life-threatening postoperative liver insufficiency caused by poor or insufficient liver remnant tissue which may occur after even limited liver resection especially in cirrhotic livers. A prevention of this problem would require a reliable preoperative assessment of the functional capacity of the liver remnant. But these functional assessments are still not satisfactory although the aminopyrin breathing test and galactose eliminating capacity test achieve remarkably good results. The clinical experience of important series of liver resection reported in this issue of Swiss Surgery for HCC from Switzerland, liver resection for HCC in cirrhotic patients from China as well as liver resection for cholangiocellular carcinomas demonstrate that the surgical procedures performed by experts today have a low mortality and morbidity rate and achieve quite remarkable long term survival results. As surgeons and physicians alike we are therefore encouraged today to resect these HCC whenever technically possible and whenever the clinical condition of the patients allow these operations.

scholarly journals The Costs of Medical Care for Covid-19 Patients: A case study in Turkey

2021 ◽  
Vol 16 (4) ◽  
pp. 186-195
Author(s):  
Cenk Teker ◽  
Dogancan Cavmak ◽  
Hakan Avci
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Care ◽  
Unit Cost ◽  
Total Cost ◽  
Historical Cost ◽  
Different Types ◽  
One Year ◽  
The Cost

Objective: This study aims to calculate the medical costs of Covid-19 patients for hospitals based on the severity of clinical care. Design: The study was conducted in a hospital in Istanbul/Turkey. A micro-costing approach was performed using historical cost data for one year. All direct and indirect medical inputs were determined in quantities and monetary values for four types of Covid-19 patients in the hospital. Results: The analysis calculated the unit cost of an outpatient to be 459,99 ₺, while the cost per day for inpatient to be 1.184,63 ₺, for non-intubated in intensive care unit to be 1.938,11, for intubated in the intensive unit to be 2.393,99₺. The study also indicates that the total cost of a non-intubated patient in intensive care units is 1,54 times higher than the total cost per inpatient. An intubated patient’s cost is 2,08 times higher than an inpatient’s cost. Conclusion: This study indicates that Covid-19 patients incur significantly high costs for hospitals. The findings of the study provide empirical data for different types of patients which can be used in clinical management and can help all related governing bodies to plan their actions and make the decisions

scholarly journals P010: Use of the emergency department by refugees under the Interim Federal Health Program

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S81-S82
Author(s):  
F. Bakewell ◽  
S. Addleman ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Family Physician ◽  
Financial Burden ◽  
Tertiary Care ◽  
Family Doctor ◽  
Number Of Patients ◽  
Refugee Claimants ◽  
Before And After

Introduction: In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits. Methods: We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits wherein an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011-2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Results: There were a total of 612 IFH claims made in the ED from 2011-2013. The demographic characteristics, acuity of presentation and discharge diagnosis were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, p<0.05) yet a higher proportion of these patients were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, p<0.05). Conclusion: A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012 represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate care for this population. Yet, the lack of primary care was not reflected in the follow-up advice offered by ED physicians to patients.

Emergent Intubation and CT Scan Pathology of Blunt Trauma Patients with Glasgow Coma Scale Scores of 3–13

1993 ◽  
Vol 8 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Albert K. Hsiao ◽  
Stuart P. Michelson ◽  
Jerris R. Hedges
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Head Ct ◽  
Coma Scale ◽  
Number Of Patients ◽  
Gcs Score ◽  
Pharmacologic Agents

AbstractIntroduction:Widely accepted guidelines for use of pharmacologic agents for prehospital intubation have not been fully developed. Toward the goal of formulating specific guidelines, this study sought to determine how well the Glasgow Coma Scale (GCS) score stratifies the need for emergent intubation (within 30 minutes of emergency department arrival or in the prehospital setting).Methods:A one-year, retrospective review of the charts of blunt trauma patients with presumed head injury who presented to the emergency department of a Level 1 trauma center with a GCS score of ≤13 was performed. A total of 120 patients met the inclusion and exclusion criteria.Results:A significant number of patients presenting with a GCS score of ≤9 required emergent intubation. A significant minority of patients presenting with a GCS score of 10–13 required emergent intubation (20%) or had intracranial pathology on head CT scan (23%), and the majority of patients from this subgroup did not require subsequent intubation. Alcohol or substance intoxication and communication barriers such as deafness and language difficulties limited the clinical examination.Conclusion:Patients with a presenting GCS score of ≤9 represent candidates for the use of pharmacologic agents to facilitate aggressive airway control by well-trained and supervised emergency medical technicians (EMTs). Emergent intubation of patients with a GCS score of 10–13 is problematic. Patients with a presenting GCS score of 10–13 must be evaluated individually and closely monitored. In the emergency department, head CT scans coupled with serial evaluations generally are warranted to assess underlying pathology in patients with a presenting GCS score of 10–13.

scholarly journals Impact of higher detection rate of residual pulmonary thromboemboli one-year after acute pulmonary embolism: modified CT scan imaging method with modified CT obstruction index

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Nakano ◽  
N Okumura ◽  
R Imai ◽  
M Yoshida ◽  
S Shimokata ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ct Scan ◽  
Pulmonary Arteries ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Imaging Method ◽  
Thromboembolic Pulmonary Hypertension ◽  
Exercise Induced ◽  
One Year ◽  
Chronic Thromboembolic Disease ◽  
Acute Pe

Abstract Background Recently, post pulmonary embolism (PE) syndrome or chronic thromboembolic disease after acute PE, has been recognized as important long-term complications. Furthermore, patients may develop with chronic thromboembolic pulmonary hypertension. Purpose We aimed to evaluate the frequency of residual pulmonary thromboemboli after acute PE by using our “higher”-resolution CT scan imaging method to detect residual thromboemboli down to sub-segmental pulmonary arteries. Methods This study was a prospective multi-center observational study. We enrolled consecutive 34 patients with acute symptomatic PE whose informed consent was obtained, and followed up for one year. One year after the onset of acute PE, patients were referred to our hospital and multiple examination including CT scan, 6-minute walk test (6MWT), questionnaire of SF-36, echocardiography and laboratory testing were performed. Additionally, we have modified the CT obstruction index (CTOI) to quantitatively evaluate the thromboemboli down to sub-segmental pulmonary arteries. Results Mean age was 60.5±15.8 years, and 56% were male. No patient was categorized as low recurrent VTE risk which was caused by transient factors, one patient was associated with active cancer, and 12% had known thrombophilia. In 85% of the patients, this onset was the first obvious episode of PE. At diagnosis, elevated B-type natriuretic peptide (BNP) (≥100 pg/ml) or N-terminal (NT)-proBNP (≥500 pg/ml) was observed in 45% of the patients. Median tricuspid regurgitation peak gradient (TRPG) by echocardiography was 30.9 (19.3–50.1) mmHg. Among all, 35% of the patients received single-drug approach with DOACs. At discharge, all of the patients except two were treated with DOACs. One year after the onset, 21% of the patient were in NYHA II and others were in NYHA I. It was notable that pulmonary thromboemboli was detected by our CT scan in 76% of the patients. Modified CTOI was median 11.9 (1.8–24.4) % as shown in the figure. In multiple regression analysis, TRPG at diagnosis and BNP at one month were significantly associated with mCTOI (β=0.536, p=0.002 and β=−0.482, p=0.003, respectively). Additionally, lowest SpO2 during 6MWT after one year from the onset, tended to inversely associate with mCTOI (β=−0.341, p=0.052). Conclusions Using our modified CT scan imaging method and modified CTOI, residual pulmonary thromboemboli was able to be detected more frequently than the previous studies. Residual pulmonary thromboemboli could be one of the cause of the post PE syndrome and lead to exercise-induced desaturation. Figures Funding Acknowledgement Type of funding source: None

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