Validity of the Emergency Severity Index in a Finnish Emergency Department 

2021 ◽  
Author(s):  
Kirsi Maria Kemp ◽  
Janne Alakare ◽  
Minna Kätkä ◽  
Mitja Lääperi ◽  
Lasse Lehtonen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Oldest Old ◽  
Statistical Significance ◽  
Age Groups ◽  
Severity Index ◽  
Emergency Severity Index ◽  
High Dependency ◽  
Secondary Outcomes

Abstract Background: The purpose of acuity assessment, triage, in the emergency department is to recognize critically ill patients and to allocate resources. The Emergency Severity Index (ESI) is used widely around the world and has been shown to be at least as good as other 5-level assessment instruments. In this study, we assess validity of the ESI triage system in a Finnish Emergency department for predicting 30-day mortality as primary outcome and hospital admissions, high dependency unit or intensive care unit admissions as secondary outcomes, and efficiency for predicting emergency department length-of-stay and utilized resources as secondary outcomes. Methods: We collected data of all adult patient visits to the emergency department during a one-month period. The data was analyzed for the primary and secondary outcomes stratified by age: younger adults (18-64 years), older adults (65-79 years) and oldest old (>80 years). Results: Of the 5909 visits, 5511 were eligible for analysis, 2725 of them men. Median age was 59 years; 30-day mortality was 150 (2.7%). In all age groups, 30-day mortality was consecutively higher with statistical significance between each step from between categories 1 to 3. There were 2274 admissions, 190 of the to HDU or ICU.  Hospital admission rates were significantly higher between each step between categories 2 to 4 for all adults. HDU/ICU admissions were higher in category 2 than in category 3 in all age groups. Resource utilization was higher in category 3 than in category 4; categories 4 and 5 differed only in the younger adult group. Most patients in categories 4 and 5 required ≥2 and 0 resource, respectively. Median length of stay at the emergency department was 3h 47min. For all patients ED-LOS varied without linearity; LOS was longest in category 3 in all age groups. Conclusions: ESI seems to be a valid tool for acuity assessment in all age groups in our population: it recognized severely ill patients by predicting mortality and hospital admissions in the higher triage categories in all age groups. Having failed to predict both resource consumption and ED-LOS, ESI was not associated with efficiency in our population.

scholarly journals Decreasing Length of Stay in the Emergency Department With a Split Emergency Severity Index 3 Patient Flow Model

2013 ◽  
Vol 20 (11) ◽  
pp. 1171-1179 ◽  
Author(s):  
Rajiv Arya ◽  
Grant Wei ◽  
Jonathan V. McCoy ◽  
Jody Crane ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Flow Model ◽  
Patient Flow ◽  
Severity Index ◽  
Emergency Severity Index

scholarly journals Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial

2018 ◽  
Vol 51 (1) ◽  
pp. 1701567 ◽  
Author(s):  
Louise Rose ◽  
Laura Istanboulian ◽  
Lise Carriere ◽  
Anna Thomas ◽  
Han-Byul Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Case Manager ◽  
Emergency Department Visits ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Secondary Outcomes ◽  
Randomised Controlled ◽  
Component Case

We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.

scholarly journals Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program

2018 ◽  
Vol 42 (5) ◽  
pp. 542 ◽  
Author(s):  
Sharon Lawn ◽  
Sara Zabeen ◽  
David Smith ◽  
Ellen Wilson ◽  
Cathie Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
Length Of Stay ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Hospital Admissions ◽  
Self Management ◽  
Psychosocial Needs ◽  
Post Discharge ◽  
The Impact

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

scholarly journals Weight-for-Age Percentile as a Pediatric Predictor of Emergency Department Outcome

2019 ◽  
Vol 6 ◽  
pp. 2333794X1987703
Author(s):  
Vishal Naik ◽  
Cheryl Lefaiver ◽  
Avni Dervishi ◽  
Vinod Havalad
Keyword(s):  
Emergency Department ◽  
Severity Index ◽  
Normal Weight ◽  
Independent Effect ◽  
Key Factors ◽  
Emergency Severity Index ◽  
Logistic Regression Models ◽  
Younger Age ◽  
Ed Visits ◽  
Weight For Age

This study is a retrospective cohort study that examines the association between weight-for-age percentile and pediatric admission incidence from the emergency department (ED) for all diagnoses. The charts of 1432 pediatric patients under 18 years with ED visits from 2013 to 2015 at a tertiary children’s hospital were reviewed. Analyses of subject age/weight stratifications were performed, along with ED disposition, reason for visit, and Emergency Severity Index (ESI). Multivariable logistic regression models were used to evaluate the independent effect of weight-for-age percentile on ED disposition while controlling for age, ESI, and reason for visit. Underweight subjects were more likely to be admitted than their normal weight counterparts when analyzed overall (odds ratio [OR] = 2.58, P < .01) and by age: less than 2.0 years of age (OR = 2.04, P = .033), between 2.01 and 6.0 years of age (OR = 8.60, P = .004), and between 6.01 and 13.0 years of age (OR = 3.83, P = .053). Younger age (OR = 0.935, P < .001) and higher acuity (OR = 3.49, P < .001) were also significant predictors of admission. No significant associations were found between weight and likelihood of admission for patients older than 13.01 years or between overweight/obese weight categories and admission for any age subgroups. This study suggests that underweight children younger than 13 years are at higher risk to be admitted from the ED than their normal weight, overweight, and obese counterparts. Even when controlling for other key factors, such as the ESI, a lower weight-for-age percentile was a reliable predictor of hospitalization.

scholarly journals P077: The health inequalities among foreign patients visiting the emergency room with injury: a nationwide population-based study in South Korea, 2013-2015

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S84-S84
Author(s):  
S. Jung ◽  
H. Lim ◽  
J. Kwon ◽  
N. Kim ◽  
D. Seo
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Room ◽  
Health Inequalities ◽  
Personal Information ◽  
Age Groups ◽  
Population Based ◽  
Emergency Rooms ◽  
Wide Range ◽  
Region Length

Introduction: Foreign patients often do not receive appropriate treatment in the emergency room as compared to locals. This is due to various causes such as language, insurance, and cultural differences. The purpose of this study was to investigate whether there is a wide range of health inequalities among foreigners who visited the emergency room with injury and to find out what causes it. Methods: We analyzed clinical data from the National Emergency Department Information System(NEDIS) database, which visited the emergency room from January 1, 2013 to December 31, 2015, in all age groups. Foreigners are classified based on the personal information described in the NEDIS. We analyzed the number of injuries, serious cases(death, operation, ICU admission), length of stay in ER, and transfer ratio. Results: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign patients. The incidence rate per 100,000 people per year was 2960.5 from locals and 1659.8 from foreigners. Serious outcomes were higher for foreigners than for locals(31.0% versus 23.2%, p<0.001). There was a further difference in the rural region. Length of stay was longer for foreigners(72 versus 69 minutes, median, p<0.001). The transfer rate was also higher for foreigners(1.9% versus 1.6%, p<0.001). Daegu had the highest ratio of foreigners’ injury compared to locals(ratio=0.998). Jeonnam(0.073) was the highest serious outcome rate in Korea, and Jeonbuk(0.070) was the second. The area with the longest length of stay in the Emergency department was the median 139 minutes for locals and 153 minutes for foreigners in Daegu. The more patients per day, the shorter the time spent in the emergency rooms(Spearman correlation coefficient=-0.388). This phenomenon was more prominent in locals(-0.624 versus -0.175). Multivariable logistic regression was used as a dependent variable for the serious outcomes of foreign patients. The foreign patients(OR=1.413, p<0.001), intention, no insurance, age, sex, urban area, low blood pressure, decreased consciousness, transfer, acuity, and length of stay were statistically significant. Conclusion: This study showed that there is a health inequality for foreigners who came to the emergency room due to injury in Korea. Also, serious outcomes from injury in foreigners have been shown to be related to various causes including factors of the foreigner.

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