scholarly journals Impact of the COVID-19 pandemic on osteoporotic vertebral fracture incidence and follow-up at the emergency department. A retrospective study of a tertiary hospital in southern Spain

2022 ◽  
Keyword(s):  
Emergency Department ◽  
Vertebral Fracture ◽  
Tertiary Hospital ◽  
Time Of Day ◽  
Osteoporotic Vertebral Fracture ◽  
Patient Demographics ◽  
Follow Up Care ◽  
Patient Groups ◽  
The Impact

The COVID-19 pandemic has affected trauma practices all over the world. Despite the increasing number of studies focused on the epidemiology of vertebral fractures (VFs) in COVID-19 patients, the impact of the pandemic on the incidence of trauma pathologies at the emergency department (ED) remains unclear. In Spain, very few studies have explored how the pandemic has affected the care of patients with osteoporotic vertebral fracture (OVF) in the ED and on their follow-up. The aim of this work is to evaluate the impact on the demand for care and diagnosis of VF during the COVID-19 pandemic, as well as the repercussions on patient follow-up. A longitudinal retrospective observational study was designed comparing two cohorts (pre-COVID and COVID) of patients for whom an emergency computed tomography scan was requested due to suspected vertebral fracture. Information was gathered on patient demographics, number and type of OVFs, time of day at which the diagnosis was made, follow-up, and treatment received. Comparative analyses were performed between both patient groups, with stratification by time intervals according to the pandemic waves in the COVID cohort. A total of 581 eligible patients were included in the study. The analyzed cohorts included 288 patients (145 and 143 in the pre-COVID and COVID cohorts, respectively), with a mean age of 73.4 ± 13.8 years and 205 (71.4%) women. No significant differences were observed on most measured variables. In the COVID cohort, the group of patients who received follow up care had a significantly lower mean age than the group that did not receive follow up care (70.2 ± 12.7 vs 76.2 ± 14.1 years, respectively, p = 0.008). In conclusion, the COVID-19 pandemic has had little impact on the diagnosis and management of patients with OVF in our hospital. This could be explained by the specific characteristics of OVFs and the type of patients it affects. Our study has some limitations, mainly derived from its retrospective and single-center nature with a short follow-up interval.

scholarly journals The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Mandhkani Mahajan ◽  
Janine Alida Hogewoning ◽  
Jeroen Joseph Antonius Zewald ◽  
Margreet Kerkmeer ◽  
Mathilde Feitsma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intervention Group ◽  
Medical Problem ◽  
Control Group ◽  
Short Term ◽  
Patient Recall ◽  
Follow Up Care ◽  
The Impact ◽  
Comprehension Deficit

Abstract Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.

High incidence of patients lost to follow-up after venous thromboembolism diagnosis – Identifying an unmet need for targeted transition of care

Vascular ◽  
2021 ◽  
pp. 170853812110209
Author(s):  
Rae S Rokosh ◽  
Jack H Grazi ◽  
David Ruohoniemi ◽  
Eugene Yuriditsky ◽  
James Horowitz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Time Of Day ◽  
Transition Of Care ◽  
Initial Discharge ◽  
Significant Difference

Objectives Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. Methods This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. Results During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home ( p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1–3.6, p = 0.03) as opposed to home. Conclusions Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.

Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Time Of Day ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
The Impact ◽  
Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

scholarly journals A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

2021 ◽  
Author(s):  
Mei Qiu Lim ◽  
Fahad Javaid Siddiqui ◽  
Seyed Ehsan Saffari ◽  
Andrew Fu Wah Ho ◽  
Johannes Nathaniel Min Hui Liew ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Disease ◽  
Descriptive Analysis ◽  
Circuit Breaker ◽  
Historical Period ◽  
Management Planning ◽  
Crowd Management ◽  
Patient Demographics ◽  
Icd 10 ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

scholarly journals TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care

2019 ◽  
Author(s):  
Grace M Turner ◽  
Christel McMullan ◽  
Lou Atkins ◽  
Robbie Foy ◽  
Jonathan Mant ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Stroke Prevention ◽  
Community Care ◽  
Minor Stroke ◽  
Framework Analysis ◽  
Diverse Range ◽  
Follow Up Care ◽  
The Impact

Abstract Background Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided. We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support. Methods This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis. Results A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems. Conclusion HCPs could better communicate lay information about TIA/minor stroke diagnosis and secondary stroke prevention, and improve their identification of and response to important residual impairments affecting patients.

Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jimenez ◽  
Jorg Del Toro ◽  
Gregory Piazza ◽  
Augussina Rivas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Pulmonary Embolism ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Patient Groups ◽  
The Impact ◽  
Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

scholarly journals Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vida V. Bliokas ◽  
Alex R. Hains ◽  
Jonathan A. Allan ◽  
Luise Lago ◽  
Rebecca Sng
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Suicide Attempt ◽  
Repeated Measures ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Community Based ◽  
Treatment As Usual ◽  
The Impact

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

scholarly journals Effects of Mobilization Time on Occurrence of New Fractures after Vertebroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Ahmet Onur Akpolat ◽  
Sinan Karaca
Keyword(s):  
Risk Factor ◽  
Vertebral Fracture ◽  
Local Anesthesia ◽  
Postoperative Period ◽  
Statistical Difference ◽  
Treatment Options ◽  
Fracture Treatment ◽  
Osteoporotic Vertebral Fracture ◽  
The Mean

Introduction. Osteoporotic vertebral fracture treatment options include vertebroplasty, in which development of new fractures is among the possible complications which may develop during the postoperative period. We aim to evaluate whether or not postoperative mobilization time has effect on occurrence of new fractures. Materials and Methods. A total of 126 patients, consisting of 30 (39.7%) males and 96 (60.3%) females, who underwent sedation-assisted vertebroplasty under local anesthesia between January 2014 and June 2017 were retrospectively evaluated. Preoperative and postoperative visual analogue scores (VASs) and mobilization time (hours) were assessed. Day of new fracture occurrence during follow-up was assessed. Results. The mean follow-up period was 9 months (7–13 months). The most common fracture segment was the L1 vertebra (15.9%). The preoperative VAS was 8.29 ± 0.95, and the postoperative VAS was 2.33 ± 0.91. The change in VAS was statistically significant (p=0.01, p<0.05). Of all the patients, 21 (16.66%) had developed new fractures. No statistical difference was observed between mobilization time (hours) and formation of new fractures (p=0.48, p>0.05). Conclusion. We came to the conclusion that mobilization time (hours) was not a risk factor in the development of new fractures. In addition, there is no relationship between mobilization time and localization of new fractures.

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