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 Cartography of Emergency Department Visits for Asthma – Targeting High-Morbidity Populations

2004 ◽  
Vol 11 (6) ◽  
pp. 427-433 ◽  
Author(s):  
Pierre Lajoie ◽  
Andrée Laberge ◽  
Germain Lebel ◽  
Louis-Philippe Boulet ◽  
Marie Demers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Administrative Database ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Age Group ◽  
Obstructive Pulmonary Disease ◽  
Asthmatic Patients ◽  
South Central ◽  
Ed Visits

BACKGROUND:Asthma education should be offered with priority to populations with the highest asthma-related morbidity. In the present study, the aim was to identify populations with high-morbidity for asthma from the Quebec Health Insurance Board Registry, a large administrative database, to help the Quebec Asthma and Chronic Obstructive Pulmonary Disease Network target its interventions.METHODS:All emergency department (ED) visits for asthma were analyzed over a one-year period, considering individual and medical variables. Age- and sex-adjusted rates, as well as standardized rate ratios related to the overall Quebec rate, among persons zero to four years of age and five to 44 years of age were determined for 15 regions and 163 areas served by Centres Locaux de Services Communautaires (CLSC). The areas with rates 50% to 300% higher (P<0.01) than the provincial rate were defined as high-morbidity areas. Maps of all CLSC areas were generated for the above parameters.RESULTS:There were 102,551 ED visits recorded for asthma, of which more than 40% were revisits. Twenty-one CLSCs and 32 CLSCs were high-morbidity areas for the zero to four years age group and five to 44 years age group, respectively. For the most part, the high-morbidity areas were located in the south-central region of Quebec. Only 47% of asthmatic patients seen in ED had also seen a physician in ambulatory care.CONCLUSION:The data suggest that a significant portion of the population seeking care at the ED is undiagnosed and undertreated. A map of high-morbidity areas that could help target interventions to improve asthma care and outcomes is proposed.

scholarly journals Care bundles to reduce re-admissions for patients with chronic obstructive pulmonary disease: a mixed-methods study

2019 ◽  
Vol 7 (21) ◽  
pp. 1-128 ◽  
Author(s):  
Katherine Morton ◽  
Emily Sanderson ◽  
Padraig Dixon ◽  
Anna King ◽  
Sue Jenkins ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Health Services ◽  
Hospital Mortality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Care Bundles ◽  
Admission Rates ◽  
Before And After ◽  
Bed Days

BackgroundChronic obstructive pulmonary disease (COPD) is the commonest respiratory disease in the UK, accounting for 10% of emergency hospital admissions annually. Nearly one-third of patients are re-admitted within 28 days of discharge.ObjectivesThe study aimed to evaluate the effectiveness of introducing standardised packages of care (i.e. care bundles) as a means of improving hospital care and reducing re-admissions for COPD.DesignA mixed-methods evaluation with a controlled before-and-after design.ParticipantsAdults admitted to hospital with an acute exacerbation of COPD in England and Wales.InterventionCOPD care bundles.Main outcome measuresThe primary outcome was re-admission to hospital within 28 days of discharge. The study investigated secondary outcomes including length of stay, total number of bed-days, in-hospital mortality, 90-day mortality, context, process and costs of care, and staff, patient and carer experience.Data sourcesRoutine NHS data, including numbers of COPD admissions and re-admissions, in-hospital mortality and length of stay data, were provided by 31 sites for 12 months before and after the intervention roll-out. Detailed pseudo-anonymised data on care during admission were collected from a subset of 14 sites, in addition to information about delivery of individual components of care collected from random samples of medical records at each location. Six case study sites provided data from interviews, observation and documentary review to explore implementation, engagement and perceived impact on delivery of care.ResultsThere is no evidence that care bundles reduced 28-day re-admission rates for COPD. All-cause re-admission rates, in-hospital mortality, length of stay, total number of bed-days, and re-admission and mortality rates in the 90 days following discharge were similar at implementation and comparator sites, as were resource utilisation, NHS secondary care costs and cost-effectiveness of care. However, the rate of emergency department (ED) attendances decreased more in implementation sites than in comparator sites {implementation: incidence rate ratio (IRR) 0.63 [95% confidence interval (CI) 0.56 to 0.70]; comparator: IRR 1.14 (95% CI 1.04 to 1.26) interactionp < 0.001}. Admission bundles appear to be more complex to implement than discharge bundles, with 3.7% of comparator patients receiving all five admission bundle elements, compared with 7.6% of patients in implementation sites, and 28.3% of patients in implementation sites receiving all five discharge bundle elements, compared with 0.8% of patients in the comparator sites. Although patients and carers were unaware that care was bundled, staff view bundles positively, as they help to standardise working practices, support a clear care pathway for patients, facilitate communication between clinicians and identify post-discharge support.LimitationsThe observational nature of the study design means that secular trends and residual confounding cannot be discounted as potential sources of any observed between-site differences. The availability of data from some sites was suboptimal.ConclusionsCare bundles are valued by health-care professionals, but were challenging to implement and there was a blurring of the distinction between the implementation and comparator groups, which may have contributed to the lack of effect on re-admissions and mortality. Care bundles do appear to be associated with a reduced number of subsequent ED attendances, but care bundles are unlikely to be cost-effective for COPD.Future workA longitudinal study using implementation science methodology could provide more in-depth insights into the implementation of care bundles.Trial registrationCurrent Controlled Trials ISRCTN13022442.FundingThis project was funded by the National Institute for Health Research Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 21. See the NIHR Journals Library website for further project information.

scholarly journals Specialist emergency care and COPD outcomes

2018 ◽  
Vol 5 (1) ◽  
pp. e000334 ◽  
Author(s):  
Nicholas David Lane ◽  
Karen Brewin ◽  
Tom Murray Hartley ◽  
William Keith Gray ◽  
Mark Burgess ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Care ◽  
Single Point ◽  
Chronic Obstructive ◽  
Competency Assessment ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease ◽  
Support Unit ◽  
Ventilated Patients

IntroductionIn exacerbation of chronic obstructive pulmonary disease (ECOPD) requiring hospitalisation greater access to respiratory specialists improves outcome, but is not consistently delivered. The UK National Confidential Enquiry into Patient Outcome and Death 2015 enquiry showed over 25% of patients receiving acute non-invasive ventilation (NIV) for ECOPD died in hospital. On 16 June 2015 the Northumbria Specialist Emergency Care Hospital (NSECH) opened, introducing 24/7 specialty consultant on-call, direct admission from the emergency department to specialty wards and 7-day consultant review. A Respiratory Support Unit opened for patients requiring NIV. Before NSECH the NIV service included mandated training and competency assessment, 24/7 single point of access, initiation of ventilation in the emergency department, a door-to-mask time target, early titration of ventilation pressures and structured weaning. Pneumonia or hypercapnic coma complicating ECOPD have never been considered contraindications to NIV. After NSECH staff-patient ratios increased, the NIV pathway was streamlined and structured daily multidisciplinary review introduced. We compared our outcomes with historical and national data.MethodsPatients hospitalised with ECOPD between 1 January 2013 and 31 December 2016 were identified from coding, with ventilation status and radiological consolidation confirmed from records. Age, gender, admission from nursing home, consolidation, revised Charlson Index, key comorbidities, length of stay, and inpatient and 30-day mortality were captured. Outcomes pre-NSECH and post-NSECH opening were compared and independent predictors of survival identified via logistic regression.ResultsThere were 6291 cases. 24/7 specialist emergency care was a strong independent predictor of lower mortality. Length of stay reduced by 1  day, but 90-day readmission rose in both ventilated and non-ventilated patients.ConclusionProvision of 24/7 respiratory specialist emergency care improved ECOPD survival and shortened length of stay for both non-ventilated and ventilated patients. The potential implications in respect to service design and provision nationally are substantial and challenging.

scholarly journals Admissions to Norwegian Hospitals during the COVID-19 Pandemic

2021 ◽  
pp. 140349482110008 ◽  
Author(s):  
Jon Helgeland ◽  
Kjetil E. Telle ◽  
Mari Grøsland ◽  
Beate M. Huseby ◽  
Siri Håberg ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Age Groups ◽  
Admission Rate ◽  
Well Being ◽  
Future Research ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Individual Level ◽  
Admission Rates ◽  
Level Information

Background: In mid-March 2020, the Norwegian government implemented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, and hospitals prepared to handle an unpredictable inflow of patients with COVID-19. Aim: The study was performed to describe the changes in hospital admissions during the first phase of the pandemic. Methods: The Norwegian Institute of Public Health established a national preparedness register with daily updates on COVID-19 cases and the use of health services. We used individual-level information on inpatients from the electronic journal systems for all hospitals in Norway to estimate daily hospital admissions. Results: Before the onset of the pandemic in March, there was an average of 2400 inpatient admissions per day in Norway, which decreased to approximately 1500 in the first few days after lockdown measures were implemented. The relative magnitudes of the decreases were similar in men and women and across all age groups. The decreases were substantial for both elective (54%) and emergency (29%) inpatient care. The admission rate gradually increased and reached pre-pandemic levels in June. However, the reductions in admissions for pneumonia and chronic obstructive pulmonary disease seemed to persist. Conclusions: The elective and emergency inpatient admission rates were substantially reduced a few days after the pandemic response measures were implemented. The ways in which the lack or postponement of care may have affected the health and well-being of patients is an important issue to be addressed in future research.

Invasive-noninvasive Sequential Ventilation for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 22 (3) ◽  
pp. 160-168
Author(s):  
Jian-Da Huang ◽  
Tong-Jie Gu ◽  
Zhi-Lin Hu ◽  
Dan-Fei Zhou ◽  
Jun Ying
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Relevant Literature ◽  
Total Duration ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Relative Risks

Background: The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Method: PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Result: Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76). Conclusion: The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.

scholarly journals Trends in Hospital Admissions for Chronic Obstructive Pulmonary Disease in Men and Women in SPAIN, 1998 to 2018

2021 ◽  
Vol 10 (7) ◽  
pp. 1529
Author(s):  
Domingo Orozco-Beltrán ◽  
Juan Manuel Arriero-Marin ◽  
Concepción Carratalá-Munuera ◽  
Juan J. Soler-Cataluña ◽  
Adriana Lopez-Pineda ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Annual Percent Change ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Men And Women ◽  
Admission Rates ◽  
Percent Change

The prevalence of chronic obstructive pulmonary disease (COPD) is rising faster in women in some countries. An observational time trends study was performed to assess the evolution of hospital admissions for COPD in men and women in Spain from 1998 to 2018. ICD-9 diagnostic codes (490–492, 496) from the minimum basic data set of hospital discharges were used. Age-standardised admission rates were calculated using the European Standard Population. Joinpoint regression models were fitted to estimate the annual percent change (APC). In 2018, the age-standardised admission rate per 100,000 population/year for COPD was five times higher in men (384.8, 95% CI: 381.7, 387.9) than in women (78.6, 95% CI: 77.4, 79.9). The average annual percent change (AAPC) was negative over the whole study period in men (−1.7%/year, 95% CI: −3.1, −0.2) but positive from 2010 to 2018 (1.1%/year, 95% CI: −0.8, 2.9). In women, the APC was −6.0% (95%CI: −7.1, −4.9) from 1998 to 2010, but the trend reversed direction in the 2010–2018 period (7.8%/year, 95% CI: 5.5, 10.2). Thus, admission rates for COPD decreased from 1998 to 2010 in both men and women but started rising again until 2018, modestly in men and sharply in women.

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