scholarly journals Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis (Preprint)

2018 ◽  
Author(s):  
Gang Luo ◽  
Michael D Johnson ◽  
Flory L Nkoy ◽  
Shan He ◽  
Bryan L Stone
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Predictive Model ◽  
Hospital Admissions ◽  
The United States ◽  
Operational Definition ◽  
Emergency Department Visits ◽  
Threshold Values ◽  
Emergency Department Patients ◽  
Definition Of

BACKGROUND Bronchiolitis is the leading cause of hospitalization in children under 2 years of age. Each year in the United States, bronchiolitis results in 287,000 emergency department visits, 32%-40% of which end in hospitalization. Frequently, emergency department disposition decisions (to discharge or hospitalize) are made subjectively because of the lack of evidence and objective criteria for bronchiolitis management, leading to significant practice variation, wasted health care use, and suboptimal outcomes. At present, no operational definition of appropriate hospital admission for emergency department patients with bronchiolitis exists. Yet, such a definition is essential for assessing care quality and building a predictive model to guide and standardize disposition decisions. Our prior work provided a framework of such a definition using 2 concepts, one on safe versus unsafe discharge and another on necessary versus unnecessary hospitalization. OBJECTIVE The goal of this study was to determine the 2 threshold values used in the 2 concepts, with 1 value per concept. METHODS Using Intermountain Healthcare data from 2005-2014, we examined distributions of several relevant attributes of emergency department visits by children under 2 years of age for bronchiolitis. Via a data-driven approach, we determined the 2 threshold values. RESULTS We completed the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis. Appropriate hospital admissions include actual admissions with exposure to major medical interventions for more than 6 hours, as well as actual emergency department discharges, followed by an emergency department return within 12 hours ending in admission for bronchiolitis. Based on the definition, 0.96% (221/23,125) of the emergency department discharges were deemed unsafe. Moreover, 14.36% (432/3008) of the hospital admissions from the emergency department were deemed unnecessary. CONCLUSIONS Our operational definition can define the prediction target for building a predictive model to guide and improve emergency department disposition decisions for bronchiolitis in the future.

scholarly journals Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis (Preprint)

2018 ◽  
Author(s):  
Gang Luo ◽  
Bryan L Stone ◽  
Flory L Nkoy ◽  
Shan He ◽  
Michael D Johnson
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Characteristic Curve ◽  
The United States ◽  
Emergency Department Visits ◽  
Classification Model ◽  
Future Research ◽  
Machine Learning Classification ◽  
Accurate Model ◽  
Emergency Department Patients

BACKGROUND In children below the age of 2 years, bronchiolitis is the most common reason for hospitalization. Each year in the United States, bronchiolitis causes 287,000 emergency department visits, 32%-40% of which result in hospitalization. Due to a lack of evidence and objective criteria for managing bronchiolitis, clinicians often make emergency department disposition decisions on hospitalization or discharge to home subjectively, leading to large practice variation. Our recent study provided the first operational definition of appropriate hospital admission for emergency department patients with bronchiolitis and showed that 6.08% of emergency department disposition decisions for bronchiolitis were inappropriate. An accurate model for predicting appropriate hospital admission can guide emergency department disposition decisions for bronchiolitis and improve outcomes, but has not been developed thus far. OBJECTIVE The objective of this study was to develop a reasonably accurate model for predicting appropriate hospital admission. METHODS Using Intermountain Healthcare data from 2011-2014, we developed the first machine learning classification model to predict appropriate hospital admission for emergency department patients with bronchiolitis. RESULTS Our model achieved an accuracy of 90.66% (3242/3576, 95% CI: 89.68-91.64), a sensitivity of 92.09% (1083/1176, 95% CI: 90.33-93.56), a specificity of 89.96% (2159/2400, 95% CI: 88.69-91.17), and an area under the receiver operating characteristic curve of 0.960 (95% CI: 0.954-0.966). We identified possible improvements to the model to guide future research on this topic. CONCLUSIONS Our model has good accuracy for predicting appropriate hospital admission for emergency department patients with bronchiolitis. With further improvement, our model could serve as a foundation for building decision-support tools to guide disposition decisions for children with bronchiolitis presenting to emergency departments. INTERNATIONAL REGISTERED REPOR RR2-10.2196/resprot.5155

Management of Poisoning and Drug Overdose

2021 ◽  
Author(s):  
Timothy J Wiegand ◽  
Manish M Patel ◽  
Kent R. Olson
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Activated Charcoal ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
The United States ◽  
Emergency Department Visits ◽  
The Body ◽  
Smoke Inhalation ◽  
Drug Induced

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

Abstract 3898: Predictors Of Admissions In Patients Presenting To Emergency Department With Transient Ischemic Attacks In United States- A National Survey

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nauman Tariq ◽  
Saqib A Chaudhry ◽  
Ashter Rizvi ◽  
M Fareed K Suri ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Primary Diagnosis ◽  
Transient Ischemic Attacks ◽  
Hospital Type ◽  
Nationally Representative

Background: The estimates of patients who present with transient ischemic attacks (TIA) in the emergency departments (ED) of United states and their disposition including factors that determine hospital admission are not well understood. Objective: We used a nationally representative database to determine the rate and predictors of admission in TIA patients presenting to the ED. Methods: We analyzed the data from National Emergency Department Sample (NEDS 2006-2007) for all patients presenting with primary diagnosis of TIAs in the United States. Samples were weighted to provide national estimates of TIA hospitalizations and identify factors that increase the odds of hospital admission including age, sex, type of insurance, hospital type (urban teaching, urban nonteaching and non urban). Multivariate logistic regression analysis was used to identify predictors of hospital admission. Results: Of the total of 631750 patients presenting with TIA to the EDs in a period of two years in US, 41, 9447 (66.4%) were admitted to the hospital. In the multivariate analysis, independent factors associated with hospital admissions were women (odds ratio[OR] 1.042, 95% confidence interval [CI] 1.014-1.071, p =0.003) , Medicare insurance type (OR 0.82, 95% CI 0.88-0.93, p<0.0001), and urban non-teaching hospital ED (OR 0.825, 95% CI 0.778-0.875, p<0.0001). Conclusion: Approximately 70% of all patients presenting with TIAs to the EDs within United States are admitted. Factors unrelated to patients condition such as insurance status and ED affiliated hospital type play an important role in the decision to admit TIA patients to the hospitals.

scholarly journals Risk prediction and segmentation models used in the United States for assessing risk in whole populations: a critical literature review with implications for nurses’ role in population health management

JAMIA Open ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. 205-214 ◽  
Author(s):  
Alvin D Jeffery ◽  
Sharon Hewner ◽  
Lisiane Pruinelli ◽  
Deborah Lekan ◽  
Mikyoung Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Prediction ◽  
Critical Review ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Visits ◽  
Cochrane Library ◽  
Diagnostic Codes ◽  
Google Search ◽  
Segmentation Models

Abstract Objective We sought to assess the current state of risk prediction and segmentation models (RPSM) that focus on whole populations. Materials Academic literature databases (ie MEDLINE, Embase, Cochrane Library, PROSPERO, and CINAHL), environmental scan, and Google search engine. Methods We conducted a critical review of the literature focused on RPSMs predicting hospitalizations, emergency department visits, or health care costs. Results We identified 35 distinct RPSMs among 37 different journal articles (n = 31), websites (n = 4), and abstracts (n = 2). Most RPSMs (57%) defined their population as health plan enrollees while fewer RPSMs (26%) included an age-defined population (26%) and/or geographic boundary (26%). Most RPSMs (51%) focused on predicting hospital admissions, followed by costs (43%) and emergency department visits (31%), with some models predicting more than one outcome. The most common predictors were age, gender, and diagnostic codes included in 82%, 77%, and 69% of models, respectively. Discussion Our critical review of existing RPSMs has identified a lack of comprehensive models that integrate data from multiple sources for application to whole populations. Highly depending on diagnostic codes to define high-risk populations overlooks the functional, social, and behavioral factors that are of great significance to health. Conclusion More emphasis on including nonbilling data and providing holistic perspectives of individuals is needed in RPSMs. Nursing-generated data could be beneficial in addressing this gap, as they are structured, frequently generated, and tend to focus on key health status elements like functional status and social/behavioral determinants of health.

scholarly journals National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4695-4695
Author(s):  
Mohamed Mokhtar Bakr ◽  
Umar Zahid ◽  
Pavan Tenneti ◽  
Alsadiq Waleed Al-Hillan ◽  
Faiz Anwer
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
The United States ◽  
Emergency Department Visits ◽  
P Value ◽  
Health Care Burden ◽  
Ed Visits ◽  
National Trends

Abstract National Trends in Leukemia Related Emergency Department Visits, Health Care Burden and Disposition Rate in the United States, 2010-2014. Background: Recently emergency department (ED) utilization has been increasing for the management of acute conditions. Utilization of ED healthcare services by hematology and oncology patients have been documented previously. Cancer patients frequently visit the EDs with acute symptoms, that may require further assessment, management, and even hospitalization. Whether the incidence of leukemia related ED visits has altered is unknown. The aim of this study was to analyze the trend of leukemia related ED visits, healthcare cost associated with the visit and the discharge disposition from ED. Methods: We utilized Nationwide Emergency Department Sample (NEDS) dataset for this study. NEDS is a part of the Healthcare Cost and Utilization Project (HCUP) database and contains the information of more than 950 United States (US) hospitals that is weighted to the national estimates. We used five years of data from 2010 to 2014 to examine the trends in prevalence and rates of ED visits, cost, and disposition (such as admission, discharge and death in ED). We defined patients with leukemia (acute myeloid, chronic myeloid, acute lymphocytic, and chronic lymphocytic leukemias) by using the international classification of disease, 9th revision, clinical modification (ICD-9-CM) codes. Cochrane-Armitage test was used to assess the trend of leukemia ER visits over five years. We used estimated US census population to calculate the rate of leukemia related ED visits. Furthermore, we assessed the predictors of hospital admission by using multivariable logistic regression model. Results: Between 2010 to 2014, a nationally weighted estimate of 771,510 patients visited ED with leukemia. The frequency of leukemia related ED visits increased 21.7% from 138,038 to 167,935 during this period that accounted for 0.12% of all ED visits. The rate of leukemia related ED visits increased 20.5% from 44 to 53 per 100,000 census population, which was statistically significant (p=0.04) on a trend test. The total national cost of leukemia related visit increased by 81% from $544 million in 2010 to $984 million in 2014 (p-value<0.001). While the mean cost of each leukemia related ED visit increased 50.7% from $2367 in 2010 to $3566 in 2014 (p-value <0.001). Rate of discharge to home from ED for leukemia related visits increased 31.6% (from 22.88% in 2010 to 30.12% in 2014) (p<0.05). Similarly, the rate of in hospital admission decreased 9% from 2010 to 2014. The rate of death in a leukemia related visit remained same (0.17%) from 2010 to 2013 but in 2014 death rate increased from 0.17% to 0.23% (p-value >0.05). In an adjusted multivariable logistic regression analysis, increasing age (OR 1.02 95% CI 1.024, 1.027), male gender (OR 1.15, 95% CI 1.114, 1.188), patient location in metropolitan area (OR 2.08, 95% CI 1.88, 2.22) and northeast location (OR 1.16, 95% CI 1.03, 1.32) were found to be significantly associated with the higher odds of in hospital admission following leukemia related ED visits. While few other variables like residents of higher income quartile and those holding Medicaid, insurance were also found to be positively associated with the hospitalization but were not statistically significant (OR>1.00, p>0.05). Conclusions: There is an increasing trend of leukemia related ED utilization and associated total and mean/median costs over time, while the rate of hospitalization for leukemia associated visit from ED have decreased. Oncology providers need to plan care accordingly to reduce ER visits and hospital admission for patients with leukemia. Disclosures No relevant conflicts of interest to declare.

scholarly journals Emergency Department Visits by Patients with Substance Use Disorder in the United States

2021 ◽  
Vol 22 (5) ◽  
pp. 1076-1085
Author(s):  
Xingyu Zhang ◽  
Ningyuan Wang ◽  
Fengsu Hou ◽  
Yaseen Ali ◽  
Aaron Dora-Laskey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Clinical Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
Emergency Department Patients ◽  
A Site ◽  
Injured Patients

Introduction: We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons. Methods: Using 2016–2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD. Results: Of all adult ED visits (N = 27,609) in the US in 2016–2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66-1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09-1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14-1.43) and intensive care unit (aOR 1.40, CI, 1.05-1.85). Conclusion: Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD.

scholarly journals MO031EFFECTS OF PREDICTIVE MODELLING RISK DIRECTED INTERVENTIONS ON HOSPITALIZATION RATES IN HAEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sheetal Chaudhuri ◽  
Sophia Rosen ◽  
John Larkin ◽  
Len A Usvyat ◽  
David Sweet ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Admission ◽  
Predictive Model ◽  
Hospital Admissions ◽  
Interdisciplinary Team ◽  
The United States ◽  
South Florida ◽  
Low Risk ◽  
Hospitalization Rates ◽  
The Impact

Abstract Background and Aims End Stage Kidney Disease (ESKD) patients have high hospitalization rates. We have developed and deployed a predictive model to identify in-centre haemodialysis (HD) patients at an increased risk for all-cause hospitalization within the next 12 months. The model was used in a pilot called Dialysis Hospitalization Reduction Program (DHRP) to identify patients predicted to be at risk of &gt;=6 hospital admissions and provide additional interdisciplinary team intervention. We investigated the impact of the DHRP on hospitalization rates in HD patients. Method We used data from 45 clinics in South Alabama/Florida Panhandle regions of the United States who participated in DHRP pilot starting January 2016. The predictive model used more than 200 variables to stratify patients as high risk (&gt;=6 admissions), medium high risk (&gt;=3 admissions) and medium low risk (&gt;=1 admission) and low risk (&lt;1 admission). For patients identified at high risk of hospitalization, social workers assessed psychosocial barriers and offered additional psychosocial intervention to target those barriers. Dietitians utilized a high risk assessment looking at weight, nutrition, and access to food and supplements. Resident nurses assessed high risk patients focusing on anaemia, adequacy, access, blood pressure, fluid management, prior hospitalizations, glycaemic control and risk of skin ulcers and blood stream infection Data from patients at the participating clinics was collected and yearly hospital admission and day rates per patient year were calculated 2 years prior to (2014, 2015) and 3 years after (2016-2018) pilot start. Comparison clinics were chosen from neighbouring regions in South and North Florida (43 and 45 clinics respectively). Results Over the study period the number of patients ranged from 4661 to 5672 in the DHRP pilot clinics, 5416 to 5947 in South Florida control clinics, and 6087 to 7596 in North Florida control clinics. Hospitalization rates in pilot clinics during the first year of the DHRP remined similar to the rates during the two years preceding the pilot start. In the second and third years of the DHRP, pilot clinics showed reductions in hospital admission and day rates. At control clinics in both regions the hospital admissions and day rates showed increasing trends while DHRP clinics showed decreasing trends over the study period (Figures 1a and 1b). Conclusion These findings suggest predictive model risk directed interdisciplinary team interventions associate with lower hospitalization rates in HD patients, compared to controls. Further studies are needed to confirm these results.

scholarly journals Bridging the Intergenerational Gap: The Outcomes of a Student-Initiated, Longitudinal, Inter-professional, Inter-generational Home Visit Program

2020 ◽  
Author(s):  
Kennedy Ng ◽  
Gloria Yao Chi Leung ◽  
Angeline Jie-Yin Tey ◽  
Jia Quan Chaung ◽  
Si Min Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Service Learning ◽  
Hospital Admission ◽  
Older Patients ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Learning Program ◽  
Post Intervention ◽  
Admission Rates ◽  
Before And After

Abstract Background The older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aimed to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. Methods Teams consisting of healthcare undergraduates and lay volunteers – secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes. Patients’ satisfaction and clinical outcomes were also assessed. Results 226 healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1% and 62.4% respectively. 106 patients participated in TriGen. There was a statistically significant increase in Kogan’s Attitudes towards Old Persons scores pre- and post-intervention for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5 – 16.2, p < 0.001) and 8.3 (95%CI: 6.2 – 10.3, p < 0.001) respectively. There was a statistically significant increase in Palmore FAQ score pre- and post-intervention for SS students. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was a statistically significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. 51 patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. Conclusion TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of lay students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst lay volunteers (SS students) and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.

scholarly journals Take -home naloxone rescue kits following heroin overdose in the emergency department to prevent opioid overdose related repeat emergency department visits, hospitalization and death- a pilot study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joan Papp ◽  
Mayur Vallabhaneni ◽  
Ariel Morales ◽  
Jon W. Schrock
Keyword(s):  
Emergency Department ◽  
Composite Endpoint ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Overdose ◽  
Composite Outcome ◽  
Hospital System ◽  
Heroin Overdose ◽  
Emergency Department Patients ◽  
Overdose Deaths

Abstract Background Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Project DAWN (Deaths Avoided with Naloxone) is an opioid overdose education and naloxone distribution program in Ohio that distributes naloxone rescue kits at clinics and in the emergency departments of a single hospital system. Methods We performed a retrospective analytic cohort study comparing heroin overdose survivors who presented to the emergency department and were subsequently discharged. We compared those who received a naloxone rescue kit at discharge with those who did not. Our composite outcome was repeat opioid overdose related emergency department visit(s), hospitalization and death at 0–3 months and at 3–6 months following emergency department overdose. Heroin overdose encounters were identified by ICD- 9 or 10 codes and data was abstracted from the electronic medical record for emergency department patients who presented for heroin overdose and were discharged over a 31- month period between 2013 and 2016. Patients were excluded for previous naloxone access, incarceration, suicidal ideation, admission to the hospital or death from acute overdose on initial emergency department presentation. Data was analyzed with the Chi- square statistical test. Results We identified 291emergency department heroin overdose encounters by ICD-9 or 10 codes and were analyzed. A total of 71% of heroin overdose survivors received a naloxone rescue kit at emergency department discharge. Between the patients who did not receive a naloxone rescue kit at discharge, no overdose deaths occurred and 10.8% reached the composite outcome. Of the patients who received a naloxone rescue kit, 14.4% reached the composite endpoint and 7 opioid overdose deaths occurred in this cohort. No difference in mortality at 3 or 6 months was detected, p = 0.15 and 0.36 respectively. No difference in the composite outcome was detected at 3 or 6 months either, p = 0.9 and 0.99 respectively. Conclusions Of our emergency department patients receiving a naloxone rescue kit we did not find a benefit in the reduction of repeat emergency department visits hospitalizations, or deaths following a non-fatal heroin overdose.

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