Consent for Medical Services for Children and Adolescents

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 290-291
Author(s):  
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Routine Care ◽  
Emergency Department Visits ◽  
Medical Attention ◽  
Unaccompanied Minors ◽  
Sexually Transmitted ◽  
Practical Guidelines ◽  
Societal Changes ◽  
Definition Of

Major societal changes affecting the provision of child health care have occurred over the last few decades. In the area of emergency services, consent for medical treatment is an important issue. The purpose of this statement is to outline major considerations involving consent and provide the physician with practical guidelines concerning this issue. Today fewer than one third of children live in two-parent families in which only the father works outside the home.1,2 Because of foster care placement, or temporary or permanent arrangements with relatives or friends, parents may not be available to give consent for treatment of their children.3-6 Unaccompanied minors may seek medical attention in any one of a number of locations. Some go to the emergency department, 14% of which have no policy regarding consent for the care of these patients.7 Unaccompanied minors younger than 18 years of age account for 3.4% of all emergency department visits.7 Twenty-two states and the District of Columbia now have laws concerning the "mture minor." Most other states have provisions in which competent minors may arrange for care involving contraceptives, pregnancy, abortion, sexually transmitted diseases, drug and alcohol abuse, and psychiatric disorders.8 The dilemma for emergency physicians and practicing pediatricians alike is whether to follow a strict interpretation of the law or to adopt a more practical approach. Clearly, consent is not required in life- or limb-threatening emergencies,8,9 although the definition of emergency varies from state to state. However, in most instances, only routine care, not emergency care, is needed. As a result, many physicians fear charges of battery or litigation should their judgement regarding treatment be questioned.8

scholarly journals Interrupted time Series Design to Evaluate ICD-9-CM to ICD-10-CM Coding Changes on Trends in Colorado Emergency Department visits Related to Traumatic Brain Injury

2020 ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
P Value ◽  
Icd 10 ◽  
The Usa ◽  
Definition Of

Abstract Background. The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the USA led public health professionals to propose a surveillance definition of traumatic brain injury (TBI) that uses ICD-10-CM codes. The proposed definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI definition. The purpose of this study was to evaluate this change in surveillance methods on monthly rates of TBI-related emergency department visits in Colorado from 2012 to 2017.Results. The monthly rate of TBI-related emergency department visits in the transition month to ICD-10-CM (October 2015) decreased 41 visits per 100,000 population (p-value <0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. Conclusion. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates over time. The findings inform estimation of TBI magnitude based on ICD coded data and decisions about allocating TBI resources based on an estimated TBI magnitude.

scholarly journals FALL INJURY CHARACTERISTICS ASSOCIATED WITH EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS AMONG OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S495-S495
Author(s):  
Namkee G Choi ◽  
Diana M DiNitto ◽  
Mark E Kunik
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Fall Prevention ◽  
Emergency Department Visits ◽  
The Body ◽  
Medical Attention ◽  
Healthcare Use ◽  
Fall Injuries ◽  
Injury Characteristics ◽  
Fall Injury

Abstract Fall injuries and related healthcare use among older adults are increasing in the US. Based on the 2013-2017 US National Health Interview Survey public use data, this study examined fall injury characteristics that are associated with emergency department (ED) visits and hospitalizations among those aged ≥60 years who received medical attention for their fall injuries within a 91-day reference period (N=1,840). Our findings show that nearly a third of these older adults received care from emergency medical services (EMS), presumably for a “lift assist” to get off the floor and/or for ED or hospital transport; a little more than one-third had an ED visit only; and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that hip and head injuries, face injuries, and broken bones/fractures (from any type of injury) were likelier causes of hospitalization than injuries to other parts of the body. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization, while fall injuries that occurred away from home and those with lung disease and memory problems were associated with higher risk of ED use only. These healthcare use data indicate the significant toll that fall injuries exact upon older adults and healthcare system. Fall prevention programs should target risk factors that are specific to serious injuries and be made more accessible. Strategies for implementing scalable, adaptable, and measurable fall prevention models by EMS providers and ED staff are also needed.

scholarly journals Status and Patients Satisfaction Attended at Emergency Department of a Tertiary Level Hospital in Dhaka City

2019 ◽  
Vol 6 (1) ◽  
pp. 53-58
Author(s):  
Khursheda Akhtar ◽  
Md Mamun Or Rashid ◽  
Khodeza Akhtar ◽  
Ayesha Siddika ◽  
Syeda Subrina Siddika
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Providers ◽  
Emergency Services ◽  
Medical Attention ◽  
Care Providers ◽  
Emergency Unit ◽  
Cross Sectional ◽  
Patients Satisfaction ◽  
Mean Waiting Time

Background: Emergency department is one of the most important parts of a hospital which is the point of major public health interest. Objective: The purpose of the present study was to find out the existing facilities of emergency department, to assess the satisfaction of patients and health care providers on emergency services. Method: This cross-sectional study was carried out at emergency department of Mugda Medical College, Dhaka, Bangladesh from January 2017 to June 2017 for a period of six (06) months. Research instruments were semi structured questionnaire. Existing facilities at emergency department were assessed by check list which was adopted from Table of Equipment (TOE) by Directorate General of Health Service (DGHS) and satisfaction level was categorized as good and bad. Face to face interview was taken from emergency patients and health care providers attending in emergency unit. Result: A total of 75 samples of respondents were selected purposively. Most of the respondents (30.0%) were in 26 to 35 years age group. According to their education level, 24(48.0%) were illiterate. Most of the respondents (76.0%) were attended to emergency unit by walking; however 48(96.0%) respondents attended by health care providers immediately. Half of the patients (50.0%) buy drugs from local dispensary and investigation in hospital was also done by half of the patients. After reaching at emergency, maximum patients 25(50.0%) waited for 1 to 5 minutes for receiving medical attention and mean waiting time was 10.14 minutes. Overall satisfactory level at emergency unit was good 23(46.0%) and bad 27(54.0%) (p<0.0001). Conclusion: Numbers of potential barriers influence the patients’ satisfaction. Periodic patient satisfaction survey should be institutionalized to provide feedback for continuous quality improvement. Journal of Current and Advance Medical Research 2019;6(1):53-58

Palliative homecare is associated with reduced high- and low-acuity emergency department visits at the end of life: A population-based cohort study of cancer decedents

2016 ◽  
Vol 31 (5) ◽  
pp. 448-455 ◽  
Author(s):  
Rinku Sutradhar ◽  
Lisa Barbera ◽  
Hsien-Yeang Seow
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Confidence Interval ◽  
End Of Life ◽  
Emergency Services ◽  
Relative Rate ◽  
Population Based ◽  
Emergency Department Visits ◽  
Policy Implications ◽  
High Acuity

Background: Prior work shows that palliative homecare services reduce the subsequent need for hospitalizations and emergency services; however, no study has investigated whether this association is present for emergency department visits of high acuity or whether it only applies to low-acuity emergency department visits. Aim: To examine the association between palliative versus standard homecare nursing and the rate of high-acuity and low-acuity emergency department visits among cancer decedents during their last 6 months of life. Design: This is a retrospective cohort study of end-of-life homecare patients in Ontario, Canada, who had confirmed cancer cause of death from 2004 to 2009. A multivariable Poisson regression analysis was implemented to examine the association between the receipt of palliative homecare nursing (vs standard homecare nursing) and the rate of high- and low-acuity emergency department visits, separately. Results: There were 54,743 decedents who received homecare nursing in the last 6 months of life. The receipt of palliative homecare nursing decreased the rate of low-acuity emergency department visits (relative rate = 0.53, 95% confidence interval = 0.50–0.56) and was significantly associated with a larger decrease in the rate of high-acuity emergency department visits (relative rate = 0.37, 95% confidence interval = 0.35–0.38). Conclusion: Receiving homecare nursing with palliative intent may decrease the need for dying cancer patients to visit the emergency department, for both high and low-acuity visits, compared to receiving general homecare nursing. Policy implications include building support for additional training in palliative care to generalist homecare nurses and increasing access to palliative homecare nursing.

scholarly journals Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis (Preprint)

2018 ◽  
Author(s):  
Gang Luo ◽  
Michael D Johnson ◽  
Flory L Nkoy ◽  
Shan He ◽  
Bryan L Stone
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Predictive Model ◽  
Hospital Admissions ◽  
The United States ◽  
Operational Definition ◽  
Emergency Department Visits ◽  
Threshold Values ◽  
Emergency Department Patients ◽  
Definition Of

BACKGROUND Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. OBJECTIVE The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. METHODS Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. RESULTS We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. CONCLUSIONS Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future.

scholarly journals COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Christian Dopfer ◽  
Martin Wetzke ◽  
Anna Zychlinsky Scharff ◽  
Frank Mueller ◽  
Frank Dressler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Adolescent Medicine ◽  
Medical Attention ◽  
Pediatric Emergency Department ◽  
Patient Morbidity ◽  
One Year ◽  
The Impact

Abstract Background The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. Methods We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. Conclusions Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.

scholarly journals Application of Machine Learning Techniques to Analyze Patient Returns to the Emergency Department

2020 ◽  
Vol 10 (3) ◽  
pp. 81
Author(s):  
Antonio Sarasa Cabezuelo
Keyword(s):  
Emergency Department ◽  
Emergency Service ◽  
Emergency Services ◽  
Prediction Models ◽  
Mean Squared Error ◽  
Area Under The Curve ◽  
Machine Learning Techniques ◽  
Rate Of Return ◽  
Medical Attention ◽  
Gradient Boosting

The study of the quality of hospital emergency services is based on analyzing a set of indicators such as the average time of first medical attention, the average time spent in the emergency department, degree of completion of the medical report and others. In this paper, an analysis is presented of one of the quality indicators: the rate of return of patients to the emergency service less than 72 h from their discharge. The objective of the analysis was to know the variables that influence the rate of return and which prediction model is the best. In order to do this, the data of the activity of the emergency service of a hospital of a reference population of 290,000 inhabitants were analyzed, and prediction models were created for the binary objective variable (rate of return to emergencies) using the logistic regression techniques, neural networks, random forest, gradient boosting and assembly models. Each of the models was analyzed and the result shows that the best model is achieved through a neural network with activation function tanh, algorithm levmar and three nodes in the hidden layer. This model obtains the lowest mean squared error (MSE) and the best area under the curve (AUC) with respect to the rest of the models used.

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