scholarly journals Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use: A Nationwide Observational Study in Taiwan

2020 ◽  
Author(s):  
Chih-Yuan Lin ◽  
Yue-Chune Lee
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Observational Study ◽  
Policy Implementation ◽  
Emergency Care ◽  
Research Database ◽  
New York University ◽  
Hospital Emergency ◽  
Visit Rate ◽  
Ed Visits

Abstract Background: Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use.Methods: Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from one million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation.Results: From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate.Conclusions: Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.

scholarly journals Effectiveness of hospital emergency department regionalization and categorization policy on appropriate patient emergency care use: a nationwide observational study in Taiwan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chih-Yuan Lin ◽  
Yue-Chune Lee
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Observational Study ◽  
Policy Implementation ◽  
Emergency Care ◽  
Research Database ◽  
New York University ◽  
Hospital Emergency ◽  
Visit Rate ◽  
Ed Visits

Abstract Background Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use. Methods Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from 1 million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation. Results From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate. Conclusions Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.

scholarly journals Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use: A Nationwide Observational Study in Taiwan

2020 ◽  
Author(s):  
Chih-Yuan Lin ◽  
Yue-Chune Lee
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Observational Study ◽  
Policy Implementation ◽  
Emergency Care ◽  
Research Database ◽  
New York University ◽  
Hospital Emergency ◽  
Visit Rate ◽  
Ed Visits

Abstract Background: Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use.Methods: Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from one million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation.Results: From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate.Conclusions: Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.

scholarly journals Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

2020 ◽  
Author(s):  
Chih-Yuan Lin ◽  
Yue-Chune Lee
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Emergency Care ◽  
Research Database ◽  
Policy Intervention ◽  
Hospital Emergency Department ◽  
Care Policy ◽  
Hospital Emergency ◽  
Visit Rate ◽  
Ed Visits

Abstract Background: The goal of this study was to examine the effect of hospital emergency department (ED) regionalization policy and the categorization of hospital emergency care policy (categorization policy) on patient appropriate ED use.Methods: We conducted an observational study of the effect of emergency care policy intervention on patients' visits. Seven years of data from the Taiwan National Health Insurance Research Database (NHIRD) were examined. Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization policies in 2007 and 2009, respectively. There were 1,835,860 ED visits found among one million random samples from the NHIRD between 2005 and 2011. ED visits were categorized by the modified New York University ED algorithm. A time series analysis was performed to examine the change in the rate of appropriate ED use after the policy took effect.Results: Total ED visits increased by 10.7% from 2005 to 2011. Average appropriate ED visit rate was 66.9% during the policy intervention. The trend in the appropriate ED visit rate showed no significant policy effect.Conclusions: Provider side of regionalization and categorization policies did increase emergency care accessibility. However, regionalization and categorization policies no significant effect on patient appropriate ED use.

scholarly journals How the COVID-19 pandemic has adversely affected the economics of U.S. emergency care

2020 ◽  
Author(s):  
Jesse M. Pines ◽  
Mark S. Zocchi ◽  
Bernard S. Black ◽  
Rebecca Kornas ◽  
Pablo Celedon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Observational Study ◽  
Emergency Care ◽  
Moving Averages ◽  
Ed Visits ◽  
National Emergency

ABSTRACTObjectiveWe describe how the coronavirus (COVID-19) pandemic impacted emergency department (ED) economics, acuity, and staffing.MethodsWe conducted an observational study of visits during January to September 2020 compared to 2019 in 136 EDs staffed by a national emergency medicine group. We created ratios of three-week moving averages for 2020 visits, acuity, costs divided by 2019 moving averages, by age and ED size. We tabulated reductions in clinician hours and FTEs compared to early 2020 staffing.Results2020-2019 ED visit ratios declined in March nadiring mid-April for both adults (to 0.60) and children (to 0.30) and rose thereafter but remained below 2019 levels through September 2020. The ratio of adult RVUs/visit rose to 1.1 for adults and 1.2 for children in the early pandemic, falling to 1.04 and 1.1 through September. The ratio of direct salary expenses in freestanding (FSED) and small EDs declined less dramatically than in medium and large EDs. Clinical revenues in medium and large EDs declined more sharply and recovered slowly but plateaued well below 2019 levels. By September 2020, expenses were still higher than revenues for small EDs, similar for FSEDs, and somewhat higher for medium and large EDs. During the pandemic, physician hours fell 15% and APP hours 27% during COVID-19 translating to 174 lost physician and 193 lost APP FTEs.ConclusionThe COVID-19 pandemic reduced ED visits and increased acuity in the first 7 months of the pandemic, leading to a contraction of the ED workforce, and threatening ED economics, more so in small and FSEDs.

scholarly journals Effect of the SARS outbreak on visits to a community hospital emergency department

CJEM ◽  
2006 ◽  
Vol 8 (05) ◽  
pp. 323-328 ◽  
Author(s):  
Michael Heiber ◽  
W.Y. Wendy Lou
Keyword(s):  
Emergency Department ◽  
Community Hospital ◽  
Early Stage ◽  
Age Groups ◽  
Respiratory Illness ◽  
Hospital Emergency Department ◽  
Infants And Toddlers ◽  
Hospital Emergency ◽  
Ed Visits ◽  
Number Of Visits

ABSTRACTObjectives:To examine the effect of severe acute respiratory syndrome (SARS) on visits to a community hospital emergency department (ED) during the early stage of the Toronto outbreak in 2003 and for the same period in 2004. We focused on visits for respiratory illness (SARS-like symptoms) and different age groups.Methods:This study is a retrospective review of ED discharge diagnoses obtained from a computerized database, examining the 4-week period starting March 28 for the years 2001-2004. We obtained the discharge diagnosis, age and visit date for each ED patient during the relevant time intervals, then compared visit data from 2003 and 2004 with a baseline derived from the average number of visits during 2001 and 2002. We constructed groupings based on age and respiratory-illness symptoms.Results:During the SARS outbreak in 2003, ED visits declined by 21% (95% confidence interval [CI], 18%–24%) over the 4-week study period. The greatest reduction was for combined infant and toddler visits (69%; 95% CI, 58%–79%); these did not recover the following year. However, during the SARS outbreak there was a large increase in the number of visits for respiratory illnesses in adults (61%; 95% CI, 46%–75%) and in teenagers (132%; 95% CI, 82%–182%).Conclusions:During the SARS outbreak, total ED visits fell. The relative decline was most notable for infants and toddlers. By contrast, there was an increase in respiratory illness–related visits for adults and teenagers. In 2004, the year following the SARS outbreak, visit patterns shifted toward baseline levels, but ED visits by infants and toddlers remained depressed.

Why are people increasingly attending the emergency department? A study of the French healthcare system

2019 ◽  
Vol 36 (9) ◽  
pp. 548-553 ◽  
Author(s):  
Helene Colineaux ◽  
Fanny Pelissier ◽  
Laure Pourcel ◽  
Thierry Lang ◽  
Michelle Kelly-Irving ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Regression Models ◽  
Age Groups ◽  
Average Increase ◽  
Linear Regression Models ◽  
Clinical Classification ◽  
Therapeutic Procedures ◽  
Ed Visits

ObjectiveIt is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types.MethodsThis observational study covers all ED visits between 2002 and 2015 by adult inhabitants of the Midi-Pyrénées region in France. Their characteristics were collected from the emergency visit summaries. We modelled the visit rates per year using linear regression models, and an increase was considered significant when the 95% CIs did not include zero. The severity of the patients’ condition during ED visit was determined through the ‘Clinical Classification of Emergency’ score. Non-severe visits were those where the patient was stable, and the physician deemed no intervention necessary. Intermediate-severity visits concerned patients who were stable but requiring diagnostic or therapeutic procedures.ResultsThe 37 studied EDs managed >7 million visits between 2002 and 2015. There was an average increase of +4.83 (95% CI 4.33 to 5.32) visits per 1000 inhabitants each year. The increase in non-severe visit types was +0.88 (95% CI 0.42 to 1.34) per 1000 inhabitants, while the increase in intermediate-severity visit types was +3.26 (95% CI 2.62 to 3.91) per 1000 inhabitants. This increase affected all age groups and all sexes.DiscussionIt appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.

scholarly journals Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019357 ◽  
Author(s):  
Laura G Burke ◽  
Robert C Wild ◽  
E John Orav ◽  
Renee Y Hsia
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Emergency Care ◽  
High Intensity ◽  
Patient Characteristics ◽  
Medicare Beneficiaries ◽  
Absolute Increase ◽  
Hospital Admission Rate ◽  
Outpatient Visits ◽  
Change In Mean

ObjectiveThere has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED).Design, setting and participantsObservational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012.Outcomes measuresBilling intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling.ResultsHigh-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (−0.68% per year; 95% CI −0.71% to −0.65%; P<0.001), while the ICU rate of admission rose from 11.7% to 12.3% (+0.11% per year; 95% CI 0.09% to 0.12%; P<0.001). When we stratified by diagnosis category, there was a moderate correlation between change in visits billed as high intensity and the change in mean number of services provided per visit (r=0.38; 95% CI 0.07 to 0.63). Trends in patient characteristics and services provided accounted moderately for the trend in practice intensity for outpatient visits (pseudo R2of 0.47) but very little for inpatient visits (0.051) and visits overall (0.148).ConclusionsIncreases in services provided in the ED moderately account for the trends in billing for high-intensity emergency care for outpatient visits.

scholarly journals Understanding the characteristics of recurrent visits to the emergency department by paediatric patients: a retrospective observational study conducted at three tertiary hospitals in Korea

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018208 ◽  
Author(s):  
Byung-Soo Kim ◽  
Jung-Youn Kim ◽  
Sung-Hyuk Choi ◽  
Young-Hoon Yoon
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Medical Condition ◽  
Paediatric Population ◽  
Retrospective Observational Study ◽  
Main Diagnosis ◽  
Paediatric Patients ◽  
Common Diagnosis ◽  
The Usa ◽  
Ed Visits

ObjectivesThe number of paediatric patients visiting the emergency department (ED) continues to rise. In South Korea, approximately 25% of the patients who visit the ED are paediatric patients. In the USA, about 20% of the paediatric population were found to have visited the ED in the past year. A recent study demonstrated that 4.5%–8% of patients account for 25% of all ED visits. Therefore, the aim of this study was to identify the characteristics of recurrent visits.MethodsDesign: retrospective observational study. Setting: this study examined and analysed medical record data involving three tertiary EDs. Participants: a total of 46 237 ED visits by patients <16 years during 1-year period. Main outcome measures: data collected included the number of recurrent ED patients, frequency of recurrent visits, age, sex, insurance status, period until recurrent visit (days), main diagnosis and ED discharge results.ResultsExcluding patients with multiple visits, the total number of paediatric patients who fit the study criteria was 33 765. Among these patients, 23 384 (69.2%) had no recurrent ED visits in the subsequent year after their first visit. A total of 15 849 (46.8%) patients were toddlers (between age 1 and 4 years). In the patient group without a recurrent visit, fever was the most common diagnosis.ConclusionsOur study reviewed medical records to inspect the characteristics of patients who return to care. Higher recurrent visit frequency was associated with using the 119 rescue centre service, having a medical condition, with younger age and a higher rate of hospitalisation. Analysis of the factors associated with frequent ED visits will help to improve care for paediatric patients who visit the ED.

scholarly journals A Prospective Evaluation of Asthma Management: Emergency and Continuing Care for Asthma

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 282-286
Author(s):  
Sai Sravanthi T ◽  
Donthu Raj Kiran ◽  
Sundaravadivel V P ◽  
Kayalvizhi E
Keyword(s):  
Emergency Department ◽  
Asthma Management ◽  
Continuing Care ◽  
Hospital Emergency Department ◽  
Prospective Evaluation ◽  
Hospital Emergency ◽  
Major Aspect ◽  
Asthma Patients ◽  
Ed Visits

Previous assessments of asthma management have demonstrated huge consideration holes in the administration of intense asthma. As a major aspect of potential “Global Survey of Asthma Practice (GASP)” we tentatively assessed an associate of asthma patients who went to a University subsidiary hospital “emergency department (ED)”. Patients going to ED with intense asthma were tentatively assessed with normalized evaluation apparatus. Pattern attributes, pre affirmation asthma the executives, examinations done in the ED just as release drugs were completely recorded. In this investigation, we have indicated that patients going to the ED have an unnecessary utilization of salvage medicine with a background marked by continuous earlier ED visits and hospitalizations with intense asthma. This information recommends there keeps on being a huge consideration hole both in-network and Emergency Department regarding ideal administration of intense asthma. Asthma is a long term inflammatory sickness of lungs airways. It is portrayed by feature and repeating suggestions, reversible wind stream impediment, and simply triggered bronchospasms. The appearances include scenes of hacking, wheezing, windedness, & chest snugness. These might occur rare times every day or every week. Rely on an individual, asthma indications might turn out to be more terrible around evening time or with practice.

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