scholarly journals Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

2020 ◽  
Author(s):  
Averi L. Gibson MD ◽  
Byron Y. Chen ◽  
Max P. Rosen MD ◽  
S. Nicolas Paez ◽  
Hao S. Lo MD
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Ct Scanning ◽  
Complicated Diverticulitis ◽  
Volume Data ◽  
Uncomplicated Diverticulitis ◽  
Abdominopelvic Ct ◽  
Significant Difference ◽  
Emergency Imaging ◽  
The Impact

Abstract Purpose: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute non-traumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.Methods: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute non-traumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.Results: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

scholarly journals Socioeconomic status and the use of computed tomography in the emergency department

CJEM ◽  
2014 ◽  
Vol 16 (04) ◽  
pp. 288-295 ◽  
Author(s):  
Rajesh Bhayana ◽  
Marian J. Vermeulen ◽  
Qi Li ◽  
Chelsea R. Hellings ◽  
Carl Berdahl ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Socioeconomic Status ◽  
Abdominal Pain ◽  
Low Socioeconomic Status ◽  
Access To Health Care ◽  
Ct Scanning ◽  
Administrative Databases ◽  
Significant Difference ◽  
Pain Patients

ABSTRACT Background: Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED). Methods: A retrospective cohort study of all Ontario ED patients (April 1, 2009, to March 31, 2010) using administrative databases was conducted, and patients were stratified into SES quintiles based on median neighbourhood income. Using multivariate logistical regression, CT scan use within SES quintiles was compared for all patients and subgroups based on chief complaints: headache, abdominal pain, and complex abdominal pain (age ≥ 65 years, high acuity, and admittance to hospital). Results: We analyzed 4,551,101 patient visits, of which 52% were female. Overall, 8.2% underwent CT scanning. In adjusted analyses, the lowest SES patients were less likely to undergo CT scanning overall and in all clinical subgroups, except for complex abdominal pain. Compared to the lowest SES quintile, the adjusted odds ratios of CT scanning in the highest SES quintile were 1.08 (95% CI 1.07–1.09), 1.28 (95%CI 1.22–1.34), and 1.24 (95% CI 1.21–1.27) for all patients, headache pain patients, and abdominal pain patients, respectively. For patients presenting with complex abdominal pain, no significant difference in CT use was observed. Conclusion: Lowest SES ED patients were less likely to receive CT scans overall and in headache and abdominal pain subgroups. No difference was seen among complex abdominal pain patients, suggesting that as clinical indications for the test become more clearcut, use across SES quintiles differs less.

The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times, emergency department length of stay, and patient safety

2014 ◽  
Vol 21 (6) ◽  
pp. 605-613 ◽  
Author(s):  
Seyed Amirhossein Razavi ◽  
Jamlik-Omari Johnson ◽  
Michael T. Kassin ◽  
Kimberly E. Applegate
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Length Of Stay ◽  
Oral Contrast ◽  
Ct Examination ◽  
Abdominopelvic Ct ◽  
The Impact

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

scholarly journals COVID-19 Pandemic Once Again Exposes the Weakest Link in Laboratory Services: Specimen Delivery

2020 ◽  
Vol 51 (6) ◽  
pp. e83-e86 ◽  
Author(s):  
Ivana Lapić ◽  
Sven Komljenović ◽  
Josip Knežević ◽  
Dunja Rogić
Keyword(s):  
Emergency Department ◽  
Turnaround Time ◽  
Blood Sampling ◽  
Central Laboratory ◽  
Weakest Link ◽  
Laboratory Services ◽  
Significant Difference ◽  
The Impact ◽  
Usual Laboratory

Abstract Objective Reorganization of the emergency department (ED) during the COVID-19 pandemic implied closure of the ED-dedicated laboratory and manual transport of all specimens to the dislocated central laboratory. The impact of such reorganization on laboratory turnaround time (TAT) was examined. Methods The TAT from blood sampling to specimen reception (TAT1), from specimen reception to test reporting (TAT2), and from sampling to test reporting (TAT3) were compared between the pandemic peak month in 2020 and the same month in 2019. We evaluated whether TAT2 fulfills the recommended 60-minute criteria. Results A statistically significant difference was observed for all comparisons (P &lt;.001), with TAT1 prominently contributing to TAT3 prolongation (from 48 minutes to 108 minutes) and exceeding the recommended 60-minute criteria. The TAT2 was extended from 33 minutes to 49 minutes. Conclusion An ED reorganization compromised the usual laboratory services for patients in the ED, with manual specimen delivery being the main cause for TAT prolongation.

Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits

2017 ◽  
Vol 31 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Tina Joseph ◽  
Rebecca A. Barros ◽  
Elise Kim ◽  
Bupendra Shah
Keyword(s):  
Emergency Department ◽  
Clinical Pharmacist ◽  
Medication Reconciliation ◽  
Emergency Department Visits ◽  
Optimal Timing ◽  
Significant Difference ◽  
The Impact ◽  
Late Group ◽  
Hospital Use

Background: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. Objective: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. Methods: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. Results: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). Conclusion: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

scholarly journals The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain

Anaesthesia ◽  
2018 ◽  
Vol 74 (1) ◽  
pp. 69-73 ◽  
Author(s):  
M. Rockett ◽  
S. Creanor ◽  
R. Squire ◽  
A. Barton ◽  
J. Benger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Abdominal Pain ◽  
Emergency Department Patient ◽  
Patient Controlled Analgesia ◽  
The Impact

scholarly journals Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Michael Agustin ◽  
Lori Lyn Price ◽  
Augustine Andoh-Duku ◽  
Peter LaCamera
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Included Study ◽  
Chi Square ◽  
Significant Difference ◽  
Protocol Compliance ◽  
Sepsis And Septic Shock ◽  
The Impact

Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p=0.68). Both groups have similar compliance with the 3-hour protocol (p=0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p=0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

scholarly journals Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Kelly Kamimura-Nishimura ◽  
Vikram Chaudhary ◽  
Folake Olaosebikan ◽  
Maryam Azizi ◽  
Sneha Galiveeti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Controlled Trial ◽  
Intervention Group ◽  
Newborn Care ◽  
Secondary Outcome ◽  
Control Group ◽  
Anticipatory Guidance ◽  
Guidance Program ◽  
Significant Difference ◽  
The Impact

Objective.We aimed to evaluate the impact of an intensified anticipatory guidance program in the nursery on Emergency Department (ED) use for nonurgent conditions (NUCs) in the neonatal period.Methods. Parturient mothers of healthy newborns were randomized to an intervention group or control group. Baseline and 1-month follow-up knowledge surveys regarding newborn care were conducted. The primary outcome was the proportion of neonates who used the ED for a NUC. Secondary outcome was change in caregivers’ knowledge on NUC.Results. Of a total of 594 mothers, 323 (54%) agreed to participate and were randomized to intervention (n=170) or control (n=153) group. Most were Hispanic (68%), single (61%), primiparous (39%), and without high school diploma (44%). 35 (21%) neonates in the intervention group and 41 (27%) in the control group were brought at least once for a NUC to the ED (p=0.12). There was no statistically significant difference in within subject change on knowledge scores between the two study arms.Conclusions. Neonatal ED visits for NUCs occur frequently. This nursery-based intensified anticipatory guidance program had no statistically significant impact on neonatal ED use for NUC, nor on neonatal care-relevant knowledge among parturient mothers. Alternative modalities and timing of parental educational intervention may need to be considered. This trial is registered with Clinical Trials NumberNCT01859065(Clinicaltrials.gov).

scholarly journals 112 Impact of the COVID-19 pandemic on emergency department visits at a university medical centre

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e81-e82
Author(s):  
Viviane Mallette ◽  
Claude Cyr
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Department Visits ◽  
Medical Centre ◽  
Pediatric Care ◽  
Emergency Room Visits ◽  
Traumatic Injuries ◽  
Health Measures ◽  
Significant Difference ◽  
The Impact

Abstract Primary Subject area Emergency Medicine - Paediatric Background The new coronavirus, SARS-Cov-2, responsible for a global pandemic, led to the declaration of a health emergency and the implementation of large-scale public health measures by governments in 2020. Those measures, combined with the overlapping symptoms of COVID-19 disease and common viral infections in children, have led hospitals to prepare for possible changes in volume of emergency room visits by children. Objectives This study aims to determine the effect of the pandemic and governmental restrictions on the use of the emergency department by pediatric patients at a university medical centre, as well as to assess the impact on the severity of initial presentations. Design/Methods A single-centre study was conducted at a university hospital among children aged 0 to 17 who visited the emergency room. We used interrupted time series analysis to compare the average of pre-COVID-19 data (from January 1 2017, to December 31 2019) with data from the first wave of the COVID-19 pandemic (from January 1 to September 2020). Emergency room visits, initial triage codes, and admission and pediatric consultation rates were analyzed to assess whether there was a significant difference between periods. Results An important increase in total daily visits (+11.18, 95% CI [6.23-16.14]) was first observed with the emergence of COVID-19 cases in Canada. Then, during the strict confinement, which corresponds to an active period of COVID-19, we detected a significant drop in daily visits (-25.64, 95% CI [-30.4 to -20.66]), which continued while progressively loosening restrictions. The proportion of admissions and pediatric consultations rose slightly only throughout the time of intensive health measures (respectively +4.07% and +3.32%), but no changes in the severity of the triage codes at the emergency department were observed for all periods. Traumatic injuries also saw a significant decrease (p=0.018) when comparing data by groups of diagnosis. Conclusion These results show a significantly lower number of children’s visits to the emergency room of a university medical centre, and a transient increase in pediatric care with little impact on the immediate severity of the initial presentations during strict government health measures in the first wave of COVID-19. These measures also had a beneficial effect in reducing the number of traumatic injuries.

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