scholarly journals Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Hospital Discharge ◽  
Care Home ◽  
University Hospital ◽  
General Malaise ◽  
Thoracic Pain ◽  
Factors Associated ◽  
Polymerase Chain ◽  
Main Factors

Introduction: The aim of this study was to describe the symptomatology and main factors associated with readmission to the Emergency Department (ED) in COVID-19 patients discharged from hospital during the first wave of the pandemic at the San Cecilio University Hospital, Granada, Spain. Methods: An observational longitudinal study was conducted in a cohort of 441 patients admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR) from 1 March to 15 April 2020. Patients were followed up through medical records 6 months after discharge. Sociodemographic, clinical and symptomatologic variables were collected. Descriptive, bivariate and multivariate logistic regression analyses were performed. Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1%men. In-hospital mortality was 18.1%. The presence of persistent symptomatology was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological (31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months following hospital discharge. The main factors associated with readmission to the ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P = 0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012), hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P = 0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88–10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89) remained as risk factors. Conclusions: The presence of persistent symptomatology after hospital discharge in our cohort was common and varied. Polymedication and living in a care home made up the most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain, general malaise and hematological symptoms were identified as potential markers of severity, along with others predictors. These findings might be useful for optimizing follow-up strategies. Future studies conducted in other geographical areas are necessary to corroborate our results.

scholarly journals Factors associated with typical enteropathogenic Escherichia coli infection among children <5 years old with moderate-to-severe diarrhoea in rural western Kenya, 2008–2012

2020 ◽  
Vol 148 ◽  
Author(s):  
K. Fagerli ◽  
R. Omore ◽  
S. Kim ◽  
J. B. Ochieng ◽  
T. L. Ayers ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Severe Diarrhoea ◽  
Western Kenya ◽  
Factors Associated ◽  
Case Comparison ◽  
Escherichia Coli Infection ◽  
Logistic Regressions ◽  
Stool Specimens ◽  
Polymerase Chain

Abstract Typical enteropathogenic Escherichia coli (tEPEC) infection is a major cause of diarrhoea and contributor to mortality in children <5 years old in developing countries. Data were analysed from the Global Enteric Multicenter Study examining children <5 years old seeking care for moderate-to-severe diarrhoea (MSD) in Kenya. Stool specimens were tested for enteric pathogens, including by multiplex polymerase chain reaction for gene targets of tEPEC. Demographic, clinical and anthropometric data were collected at enrolment and ~60-days later; multivariable logistic regressions were constructed. Of 1778 MSD cases enrolled from 2008 to 2012, 135 (7.6%) children tested positive for tEPEC. In a case-to-case comparison among MSD cases, tEPEC was independently associated with presentation at enrolment with a loss of skin turgor (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) 1.37–3.17), and convulsions (aOR 2.83, 95% CI 1.12–7.14). At follow-up, infants with tEPEC compared to those without were associated with being underweight (OR 2.2, 95% CI 1.3–3.6) and wasted (OR 2.5, 95% CI 1.3–4.6). Among MSD cases, tEPEC was associated with mortality (aOR 2.85, 95% CI 1.47–5.55). This study suggests that tEPEC contributes to morbidity and mortality in children. Interventions aimed at defining and reducing the burden of tEPEC and its sequelae should be urgently investigated, prioritised and implemented.

scholarly journals Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department

Cureus ◽  
2020 ◽  
Author(s):  
Kelly Lien ◽  
Barrett A Grattan ◽  
Alexandra L Reynard ◽  
Jocelynn Peters ◽  
Jennifer L Parr
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Post Discharge ◽  
Factors Associated

scholarly journals Aleitamento materno exclusivo em prematuros de hospitais Amigo da Criança: estudo comparativo

2018 ◽  
Vol 16 (3) ◽  
pp. 319
Author(s):  
Ariane Thaise Alves Monteiro ◽  
Edilaine Giovanini Rossetto ◽  
Kauana Olanda Pereira ◽  
Mariana Charif Lakoski ◽  
Marcela Maria Birolim ◽  
...  
Keyword(s):  
Comparative Study ◽  
Hospital Discharge ◽  
Preterm Infants ◽  
Premature Infants ◽  
Exclusive Breastfeeding ◽  
Clinical Characteristics ◽  
Demographic Characteristics ◽  
University Hospital ◽  
Factors Associated ◽  
The University

Aim: to compare the prevalence of exclusive breastfeeding (EBF) and to verify the factors associated with its interruption in premature infants hospitalized at Baby-Friendly hospitals. Method: this is a comparative study performed with 107 premature infants admitted to the neonatal unit of two hospitals in Paraná. Data were obtained through interviews with mothers and analysis of infant records at hospital discharge and 15 days after delivery. Results: the prevalence of EBF was 29.2% in the University Hospital and 15.3% in the Philanthropic Hospital. At hospital discharge, associations with clinical characteristics of infants predominated, and 15 days after discharge there was a greater association with the socio-demographic characteristics of the parents. Conclusion: the prevalence of EBF, which was shown to be low at the time of hospital discharge in both hospitals, decreased after discharge, reinforcing the need for other strategies, in addition to those provided at Baby-Friendly hospitals, for the promotion and support of EBF in preterm infants.

scholarly journals Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children’s Hospital in Nice

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056476
Author(s):  
Antoine Tran ◽  
Anne-Laure Hérissé ◽  
Marion Isoardo ◽  
Petri Valo ◽  
Anne-Marie Maillotte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Care Pathway ◽  
Emergency Department Visits ◽  
Secondary Outcome ◽  
Medical Visit ◽  
Paediatric Emergency Department ◽  
Factors Associated ◽  
Paediatric Emergency

ObjectiveTo evaluate compliance with the French National Authority for Health’s (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.DesignProspective, single centre.SettingFourth biggest PED in France in terms of attendance (CHU-Lenval).Patients280 patients of whom 249 were included in the statistical analysis.Main outcome measuresThe primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviewsResults77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS’s postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS’s postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).ConclusionPostbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.Trial registration numberThe study bears the clinical trial number NCT02863627.

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.

scholarly journals Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study

2020 ◽  
Vol 4 (21) ◽  
pp. 5373-5377
Author(s):  
Jason B. Hill ◽  
David Garcia ◽  
Mark Crowther ◽  
Bryan Savage ◽  
Shira Peress ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Venous Thromboembolism ◽  
Traditional Approach ◽  
Increased Risk ◽  
Polymerase Chain ◽  
Anticoagulant Prophylaxis ◽  
Very High ◽  
Overall Mortality

Abstract Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be at increased risk for venous thromboembolism (VTE), especially if they become critically ill with COVID-19. Some centers have reported very high rates of thrombosis despite anticoagulant prophylaxis. The electronic health record (EHR) of a New Orleans–based health system was searched for all patients with polymerase chain reaction–confirmed SARS-CoV-2 infection who were either admitted to hospital or treated and discharged from an emergency department between 1 March 2020 and 1 May 2020. From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). In the 637 patients who required mechanical ventilation at some point during their hospital stay, 45 developed VTE (7.2%). After a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075 admitted who were discharged alive (0.14%). Among 6153 patients with COVID-19 who were hospitalized or treated in emergency departments, we did not find evidence of unusually high VTE risk. Pending further evidence from prospective, controlled trials, our findings support a traditional approach to primary VTE prevention in patients with COVID-19.

scholarly journals Factors associated with physician follow-up among patients with chest pain discharged from the emergency department

2015 ◽  
Vol 187 (5) ◽  
pp. E160-E168 ◽  
Author(s):  
Michael K.Y. Wong ◽  
Julie T. Wang ◽  
Andrew Czarnecki ◽  
Maria Koh ◽  
Jack V. Tu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Factors Associated

scholarly journals The Implementation of European Association of Urology Guidelines in the Management of Acute Epididymo-Orchitis

2007 ◽  
Vol 89 (8) ◽  
pp. 799-803 ◽  
Author(s):  
Mary AE Garthwaite ◽  
G Johnson ◽  
S Lloyd ◽  
I Eardley
Keyword(s):  
Emergency Department ◽  
European Association ◽  
Implementation Strategies ◽  
Sexual History ◽  
Study Cohort ◽  
Junior Staff ◽  
Polymerase Chain ◽  
European Association Of Urology ◽  
Made In

INTRODUCTION Acute epididymo-orchitis is a common and increasing problem. This retrospective study reviewed whether the European Association of Urology guidelines for the management of acute epididymo-orchitis, which form the basis of this Trust's present inter-departmental guidelines, are being effectively implemented. PATIENTS AND METHODS Case notes of 53 patients attending the emergency department with acute epididymo-orchitis over a 6-month period were reviewed retrospectively. The hospital results' database was used to confirm the diagnostic tests requested on patients at the time of their initial presentation. RESULTS Of the study cohort, 26 patients were aged ≤ 35 years and 27 patients were aged > 35 years. The results demonstrated that a sexual history was documented in only 43.4% of cases. A mid-stream urine sample was sent for routine culture in 54.7% of cases whilst urine for the Chlamydia polymerase chain reaction (PCR) test was obtained in 17% and a urethral swab performed in 5.6%. Antibiotics were prescribed in 81% of cases. Of these patients, 46.5% received ciprofloxacin alone (mean age, 52 years; range, 18–87 years), 25.5% received doxycycline alone (mean age, 30 years; range, 18–45 years) and 21% received both ciprofloxacin and doxycycline (mean age, 33 years; range 18–49 years). In 26.4% of cases, verbal advice to attend a genito-urinary medicine clinic was given, whilst a formal telephone referral was made in only one case. Formal urological follow-up was arranged for only three out of 11 patients aged > 50 years. CONCLUSIONS Although a joint emergency department/urology clinical protocol for the investigation and treatment of acute epididymo-orchitis already exists within the Trust, our current management conforms to this in only a minority of cases. Many different strategies can be employed in the implementation of clinical practice guidelines and all are associated with variable degrees of success. The regular movement of junior staff through each department necessitates that the distribution of management protocols and guidelines occurs at frequent intervals throughout the year and that their implementation is continuously monitored so that, if necessary, further implementation strategies can be employed.

scholarly journals COVID-19 Follow-App. Mobile App-Based Monitoring of COVID-19 Patients after Hospital Discharge: A Single-Center, Open-Label, Randomized Clinical Trial

2022 ◽  
Vol 12 (1) ◽  
pp. 24
Author(s):  
Ester Marquez-Algaba ◽  
Marc Sanchez ◽  
Maria Baladas ◽  
Claudia España ◽  
Hermes Salvatore Dallo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Hospital Discharge ◽  
Mobile App ◽  
Control Group ◽  
Primary Care Center ◽  
Open Label ◽  
Return Visits ◽  
Experimental Group

Introduction: In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people (both patients and health professionals), and reduce the risk of infection. Objective: To adapt and validate the use of a smartphone application for outpatient follow-up of COVID-19 patients after hospital discharge. Methods: We conducted an open-label clinical trial at Hospital Universitari Vall d’Hebron in Barcelona, Spain. Patients were randomly assigned in a 1:1 ratio to be followed by the Farmalarm app or by their primary care center. The primary endpoint was the reduction in the need for in-person return visits. Results: From 31 March to 4 May 2020, 150 patients were enrolled in the study at hospital discharge: 74 patients were randomized to the experimental group, and 76 to the control group. All patients in the control group and all except for six in the experimental group completed the study. During hospitalization, before study inclusion, all but 4 (97.3%) had viral pneumonia, 91 (60.7%) required supplemental oxygen, and 16 (10.7%) required intensive care unit (ICU) admission. COVID-19–related return visits to the emergency department were significantly higher in the control group (7.9% vs. 0%; p = 0.028) in the per-protocol analysis. Telephone consultations with the emergency department were performed by 12 (15.8%) patients in the control group and 0 (0%) in the experimental group (p < 0.001). Satisfaction with outpatient monitoring was rated higher by the experimental group (5 vs. 4 points; p < 0.001). Conclusions: Following COVID-19 hospital discharge, home follow-up via a mobile app was effective in reducing in-person return visits without undermining patient satisfaction or perception of health, compared with standard follow-up.

scholarly journals General practice attendances among patients attending a post-COVID-19 clinic: A pilot study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0016
Author(s):  
John Michael Broughan ◽  
Geoff McCombe ◽  
Gordana Avramovic ◽  
Des Crowley ◽  
Cheyenne Downey ◽  
...  
Keyword(s):  
Older Adults ◽  
General Practice ◽  
Pilot Study ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Clinic Visit ◽  
University Hospital ◽  
Care Needs ◽  
Medical Histories

BackgroundAbout 10-35% of people with COVID-19 merit medical care within three weeks of infection. However, the prevalence of ongoing care needs among those experiencing severe COVID-19 illness is unclear.AimThis pilot study aimed to address this knowledge gap by examining GP attendance trends among patients attending a post-COVID-19 hospital follow-up clinic, 3-6 months after an initial clinic visit.Design, and SettingData was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland.MethodParticipants completed questionnaires outlining their demographics, medical histories, emergency hospital admissions/re-admissions where applicable, and where relevant, GP attendances following hospital discharge. Analyses were conducted using descriptive/inferential statistics.ResultsParticipants’ (n=153) median age =43.5 (IQR =30.9–52.1 years). There were 105 females (68.6%, 95% CI=61.3%–75.9%). Various medical histories were reported among participants. 67 (43.2%, 95% CI=35.9%–51.6%) received emergency COVID-19 hospital care. Older adults, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI=13.7%–34.2%) and 26 (39%, 95% CI=27.3%–50.7%) attended GPs within seven and 30 days of hospital discharge. Older adults, people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees.ConclusionPersistent health issues appear to be common among severe COVID-19 patients, particularly those who are older adults, have pre-existing health problems, and had been in ICU and/or re-admission care. Larger scale studies of ongoing COVID-19 care needs in general practice/primary care are required.

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