scholarly journals A Profile for Frequent Emergency Department Users: Determining a Baseline for Targeted Interventions

2015 ◽  
Keyword(s):  
Emergency Department ◽  
Targeted Interventions

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

scholarly journals A tool to identify potential primary care presentations in the hospital emergency department

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Schütze ◽  
R Rees ◽  
S Asha ◽  
K Eagar
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Public Health Issue ◽  
Accurate Data ◽  
Hospital Emergency ◽  
Targeted Interventions ◽  
International Trends ◽  
Significant Public Health ◽  
Access To Primary Care ◽  
The Impact

Abstract Background Access to primary care has an impact on health outcomes and is a significant public health issue. Limited access to primary care has seen non-urgent presentations to hospital emergency departments continue to rise globally. A lack of a universal workable definition of what a primary care presentation is has impeded national and international estimations of the true burden. Our aim was to develop a standardised code frame to identify potential primary care patients in the emergency department to allow accurate data estimations to be made, and help inform future interventions. Methods An audit of medical records was conducted in two major hospitals in Sydney, Australia. A code frame was developed, tested and applied retrospectively to five years of data. Results Of 601,168 presentations to the emergency department, 171,906 (29%) were deemed to be potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Conclusions This standardised code frame enables accurate retrospective local and national data estimations of the impact of primary care presentations in the emergency department, which was previously not available. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care. Key messages This robust tool will enable more accurate data estimations of primary care appropriate presentations in the emergency department, which can assist planning and policy efforts. It can be easily adapted to incorporate triage codes in international settings and provides a useful tool for comparing international trends.

scholarly journals Individual and Social Factors Related to Trajectories of Blackouts among Underage Drinkers in the Emergency Department

2019 ◽  
Vol 54 (4) ◽  
pp. 370-377 ◽  
Author(s):  
Erin E Bonar ◽  
Jason E Goldstick ◽  
Rebecca M Cunningham ◽  
Anne C Fernandez ◽  
Alan K Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Controlled Trial ◽  
Peer Influences ◽  
Drug Misuse ◽  
Greek Life ◽  
Prescription Drug Misuse ◽  
Targeted Interventions ◽  
Acute Injuries ◽  
Baseline Characteristics

Abstract Aims Alcohol-related blackouts can result in acute injuries and other negative outcomes. Among underage risky drinkers, we examined longitudinal trajectories of blackout frequency following an emergency department (ED) visit, and identified baseline characteristics associated with blackout trajectory membership. Methods Participants (ages 14–20; N = 836) attending an ED who screened positive for risky drinking and enrolled in a randomized-controlled trial of brief alcohol interventions were assessed at baseline, 3-, 6-, and 12-months. We used group-based trajectory modeling to determine characteristic trajectories of blackout frequency over 12-months in relation to baseline characteristics: demographics, substance use, delinquency, depression/anxiety symptoms, sexual assault, dating violence, and peer and sibling influences. Results We identified four groups: No/Low blackouts (n = 248; 29.7%), Declining blackouts (n = 92; 11.0%), Moderate blackouts (n = 337; 40.3%) and High blackouts (n = 159; 19.0%); group membership did not differ based on intervention receipt. In adjusted analyses, compared to the No/Low group all other groups had higher odds of having an alcohol-related baseline ED visit. Female sex, alcohol consumption, prescription drug misuse, sexual assault while incapacitated due to substances, and negative peer influences were positively associated with membership in the High group; College/Greek life involvement was also highest. Negative peer influences and being in high school (vs. College/Greek life) also distinguished the Moderate group. Conclusion Blackout frequency was largely stable over time and riskier trajectories were marked by risk factors such as negative peer influences and college/Greek life involvement. Findings may inform targeted interventions, particularly for women who were in higher risk trajectories.

Factors Associated With Pediatric Burn Clinic Follow-up After Emergency Department Discharge

2021 ◽  
Author(s):  
Paige L Seegan ◽  
Kavya Tangella ◽  
Nicholas P Seivert ◽  
Elizabeth Reynolds ◽  
Andrea S Young ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sociodemographic Factors ◽  
Burn Patients ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Patient Gender ◽  
Race Ethnicity ◽  
Emergency Department Discharge ◽  
Improve Health

Abstract Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children’s hospital over a 2-year period (January 2018–December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within 1 week. A total of 196 patients (Mage = 5.5 years; 54% male) were included in analyses. Average % TBSA was 1.9 (SD = 1.5%). One third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (odds ratio [OR] = 1.00; 95% confidence interval [CI]: [0.99–1.00], P = .045), patients with superficial burns (OR = 9.37; 95% CI: [2.50–35.16], P = .001), patients with smaller % TBSA (OR = 1.37; 95% CI: [1.07–1.76], P = .014), and patients with Medicaid insurance (OR = 0.22; 95% CI: [0.09–0.57], P = .002) or uninsured/unknown insurance (OR = 0.07; 95% CI: [0.02–0.26], P = .000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.

Screening instruments for identification of vulnerable older adults at the emergency department: a critical appraisal

2018 ◽  
Vol 17 (3) ◽  
pp. 124-129
Author(s):  
Carmen S van Dam ◽  
◽  
Nadia Moss ◽  
Sophie A Schaper ◽  
Marijke C Trappenburg ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Cohort Study ◽  
Patient Outcomes ◽  
Critical Appraisal ◽  
Functional Decline ◽  
Screening Instruments ◽  
Targeted Interventions ◽  
Observational Prospective Cohort Study ◽  
Level Of Agreement

Background: Early detection of vulnerable older adults at the emergency department (ED) and implementation of targeted interventions to prevent functional decline may lead to better patient outcomes. Objective: To assess the level of agreement between four frequently used screening instruments: ISAR-HP, VMS, InterRAI ED Screener and APOP. Methods: Observational prospective cohort study in patients ≥ 70 years attending Dutch ED. Results: The prevalence of vulnerability ranged from 19% (APOP) to 45% (ISAR-HP). Overall there was a moderate agreement between the screening instruments (Fleiss Kappa of 0.42 (p<0.001)). Conclusion: Depending on the screening instrument used, either only a small percentage or almost as many as half of the presenting patients will be eligible for targeted interventions, leading to large dissimilarities in working processes, resources and costs.

scholarly journals Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department

CJEM ◽  
2013 ◽  
Vol 15 (04) ◽  
pp. 214-226 ◽  
Author(s):  
Jessica Moe ◽  
Allan L. Bailey ◽  
Ryan Oland ◽  
Linda Levesque ◽  
Heather Murray
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Administrative Database ◽  
Fiscal Year ◽  
Future Research ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Frequent Users ◽  
Targeted Interventions ◽  
Admission Rates

ABSTRACTIntroduction:Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED.Methods:We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories.Results:The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users.Conclusions:We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.

scholarly journals Exploring trajectories of emergency department visits using a laboratory-based indicator of serious illness

2019 ◽  
Vol 26 (1) ◽  
pp. 205-217
Author(s):  
Ofir Ben-Assuli ◽  
Rema Padman ◽  
Itamar Shabtai
Keyword(s):  
Emergency Department ◽  
Medical Condition ◽  
Developmental Trajectories ◽  
Emergency Department Visits ◽  
Future Research ◽  
Electronic Health Record Data ◽  
Serious Illness ◽  
Targeted Interventions ◽  
The Stability ◽  
Over Time

Repeated emergency department visits have become a serious challenge worldwide. Despite prior research indicating that laboratory results may provide early alerts about such patients on their upcoming adverse events, few studies have examined their role as a critical indicator of the stability of a patient’s medical condition over time. We model and analyze the developmental trajectories of patients’ creatinine levels, a key laboratory marker of serious illness, as a potential risk stratification mechanism across many emergency department visits. We apply group-based statistical methodology to electronic health record data of 70,385 patients, with 3–15 emergency department visits, to identify and profile these trajectories for the entire population, for males and for females. Results reveal three distinct creatinine-based trajectory groups over time with significantly differing characteristics that may enable targeted interventions for each group. Future research will incorporate additional disease markers to identify longitudinal factors leading to repeated emergency department visits.

scholarly journals Dog bite Emergency department presentations in Brisbane metro south: Epidemiology and exploratory medical geography for targeted interventions

One Health ◽  
2021 ◽  
Vol 12 ◽  
pp. 100204
Author(s):  
Alexander Pekin ◽  
Hester Rynhoud ◽  
Bradley Brennan ◽  
Ricardo J. Soares Magalhães
Keyword(s):  
Emergency Department ◽  
Medical Geography ◽  
Dog Bite ◽  
Targeted Interventions

Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study

2020 ◽  
pp. emermed-2020-209891
Author(s):  
Leopold Simma ◽  
Florian Bauder ◽  
Thomas Schmitt-Mechelke
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Point Of Care ◽  
Convulsive Status Epilepticus ◽  
Monitoring Point ◽  
Cns Disorders ◽  
Targeted Interventions ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Acute Seizures

IntroductionThe aim of this study was to determine the feasibility and clinical utility of point-of-care electroencephalogram (pocEEG) in the paediatric emergency department (ED) for children presenting with acute non-traumatic central nervous system (CNS) disorders.MethodsRetrospective observational study of prospectively collected data in paediatric patients (0–16 years) with acute non-traumatic CNS-disorders presenting between April 2014 and February 2017 to a single paediatric ED in Switzerland.The 2-channel EEG was applied to all patients presenting with acute seizures or impaired consciousness to the ED. For a pocEEG, scalp surface electrodes are applied in five locations, thus allowing registration of fronto-temporal bilateral cortical activity. Neurology consultants assisted with interpretation of readings. EEG findings and clinical characteristics were collected. Feasibility and usefulness were rated via Likert scale.Results36 patients with acute seizures or altered mental status were analysed. Age range was 9 months to 15 years, median age of 34 months. 21 of 36 (58%) patients arrived out of hours. Application of electrodes was rated as ‘easy’ in 28 (77.8%) patients and rated as ‘difficult’ in 8 (22.2%). The utility of the EEG was rated by physicians as ‘very useful/diagnostic’ in 13 cases (36%), ‘useful’ in 21 cases (58%), ‘not useful’ in two cases (8%). None were rated ‘negative.’ConclusionUptake of pocEEG introduction has been very encouraging. Provider ratings were overwhelmingly positive. Recognition of non-convulsive status epilepticus was improved and pocEEG facilitated more targeted interventions.

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