Use of Health Care Services by Inner-city Infants in an Early Discharge Program

Objective. To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in a tertiary care children's hospital primary care clinic. Design. Retrospective cohort study. Setting. Large, metropolitan university hospital and a children's hospital. Patients. Term infants cared for in a single full-term nursery, before and after implementation of a coordinated early discharge program, who received primary care at the children's hospital. Intervention. The coordinated Early Discharge Program was characterized by in-hospital visits by hospitalbased coordinating nurses, home visits by nurses from a home nursing agency, and communication with physicians for necessary adjustments in postdischarge care. Methods. After linking birth hospital records and the children's hospital medical records, a retrospective chart review was performed to obtain maternal demographic information and birth hospital length of stay, as well as the infants' attendance at primary care clinic, immunizations, emergency department visits, and rehospitalization. Main Outcome Measures. Number of primary care visits in the first 3 months of life, completion of one series of immunizations by 3 months of life, and number of emergency department visits and rehospitalization during the first 3 months of life. Results. The early discharge group (n = 253) had a significantly shorter birth hospital length of stay (35 ± 24 hours, mean ± SD) when compared with the control group (n = 212) (52 ± 14 hours). The early discharge group was also younger than the control group at the first primary care visit, with significantly more infants visiting the primary care clinic in the first month of life. There was also a significant difference between the groups in the mean number of emergency department visits (early discharge = .61 visits/patient, control = .79 visits/patient) and the proportion of patients with no emergency department visits during the first 3 months of life (early discharge = 57%, control = 43%). There was no difference between the two groups in the proportion of infants completing one series of immunizations or in the number of infants rehospitalized during the study period. Conclusions. Coordinated early discharge with home nursing visits for inner-city infants may result in earlier use of primary care services. Furthermore, there is a significant decrease in use of the emergency department during the first 3 months of life, and no increase in rehospitalization.

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Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

PLoS ONE ◽

10.1371/journal.pone.0244097 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244097

Author(s):

John Pastor Ansah ◽

Salman Ahmad ◽

Lin Hui Lee ◽

Yuzeng Shen ◽

Marcus Eng Hock Ong ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Medicine ◽

Primary Care Clinic ◽

Public Hospitals ◽

Care Clinic ◽

Care Services ◽

Primary Care Services ◽

Number Of Patients ◽

Ed Crowding

Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.

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Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.3134 ◽

2021 ◽

Vol 4 (3) ◽

pp. e213134

Author(s):

Jenell Stewart ◽

Kathryn M. Stadeli ◽

Kristjana H. Ásbjörnsdóttir ◽

Margaret L. Green ◽

Giana H. Davidson ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Primary Care Clinic ◽

Emergency Department Visits ◽

Community Center ◽

Care Clinic

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The Academic Children's Hospital Primary Care Clinic: Responding to tie Challenges of a Changing Health Care Environment

Clinical Pediatrics ◽

10.1177/000992280003900805 ◽

2000 ◽

Vol 39 (8) ◽

pp. 473-478 ◽

Cited By ~ 5

Author(s):

Brian Berman

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Clinic ◽

Health Care Environment ◽

Care Environment ◽

Care Clinic ◽

Children's Hospital ◽

Children’S Hospital

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Increased Continuity of Care Associated with Decreased Hospital Admission and Emergency Department Visits for Pediatric Patients with Asthma in Children’s Hospital, KSMC Riyadh

The International Annals of Medicine ◽

10.24087/iam.2017.1.10.337 ◽

2017 ◽

Vol 1 (10) ◽

Author(s):

Emadia Alaki ◽

Aziza Donques ◽

Abdullah Alkhamri

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Continuity Of Care ◽

Pediatric Patients ◽

Emergency Department Visits ◽

Children's Hospital ◽

Children’S Hospital

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140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.450 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S200-S200

Author(s):

Michael Hansen ◽

Barbara Trautner ◽

Roger Zoorob ◽

George Germanos ◽

Osvaldo Alquicira ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Departments ◽

Primary Care Clinic ◽

Antibiotic Use ◽

Safety Net ◽

Care Clinic ◽

Primary Care Clinics ◽

Primary Care Patients ◽

Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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Connecting Medical Personnel to Dentists via Teledentistry in a Children's Hospital System: A Pilot Study

Frontiers in Oral Health ◽

10.3389/froh.2021.769988 ◽

2021 ◽

Vol 2 ◽

Author(s):

Kimberly J. Hammersmith ◽

Macaire C. Thiel ◽

Matthew J. Messina ◽

Paul S. Casamassimo ◽

Janice A. Townsend

Keyword(s):

New Technology ◽

Primary Care Clinic ◽

Dental Trauma ◽

Medical Personnel ◽

Urgent Care ◽

Hospital System ◽

Care Clinic ◽

Children's Hospital ◽

System A ◽

Children’S Hospital

Investigators evaluated feasibility, acceptability, and sustainability of a teledentistry pilot program within a children's hospital network between March, 2018, and April, 2019. The program connected dentists to medical personnel and patients being treated in urgent care clinics, a primary care clinic, and a freestanding emergency department via synchronous video consultation. Three separate but parallel questionnaires evaluated caregiver, medical personnel, and dentist perspectives on the experience. Utilization of teledentistry was very low (2%, 14/826 opportunities), but attitudes regarding this service were largely positive among all groups involved and across all survey domains. Uptake of new technology has barriers but teledentistry may be an acceptable service, especially in the case of dental trauma.

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