scholarly journals One-Year Readmission and Emergency Department Presentation After an Epilepsy-Related Admission in People with Intellectual Disability: A Registry-Linkage Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Peiwen Liao
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Linkage Study ◽  
Adjusted Incidence Rate ◽  
One Year ◽  
Service Data ◽  
Patients With Epilepsy ◽  
The Impact

IntroductionIntellectual disability (ID) is a neurodevelopmental condition that affects approximately 1-2% of the population, and epilepsy is a common comorbidity in people with ID. Although hospital admission for epilepsy is also common, little is known about the impact of ID on healthcare use following an epilepsy admission. Objectives and ApproachUsing linked administrative health datasets that included hospital admissions and disability service data, we aimed to examine whether the presence of ID led to greater or lesser use of healthcare services following an epilepsy admission, as represented by all-cause unplanned readmissions and emergency department (ED) presentations. Comparing the rate of readmissions and ED presentations within 30, 90 and 365 days of the first epilepsy admission during the study period, the effect of ID was assessed using Poisson regression. ResultsA total of 18,987 patients had an epilepsy admission between 2005 and 2014, and of these, 3,256 (17.1%) had ID. Compared to patients without ID, patients with ID had a higher risk of unplanned readmissions within each follow-up period (adjusted incidence rate ratio (IRR) with 95% CI: 30 days: 1.48 (1.34, 1.65); 90 days: 1.42 (1.31, 1.54); 365 days: 1.49 (1.40, 1.59)). Differences were also found in the reasons for readmission, including more readmissions for neurological disorders. Similarly, the ED presentation risk was elevated in patients with ID (adjusted IRR: 30 days: 1.34 (1.23, 1.46); 90 days: 1.33 (1.24, 1.42); 365 days: 1.38 (1.30, 1.46)). Conclusion / ImplicationsIn patients with epilepsy, the presence of ID appears to increase the chance of a readmission or ED presentation following a hospital admission for epilepsy, with the reasons for readmission also potentially different. This suggests the potential for improvements in post-admission screening and management.

scholarly journals One-year readmission and Emergency department presentation after an epilepsy admission in people with intellectual disability: a registry-linkage study

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Peiwen Liao ◽  
Simone Reppermund ◽  
Claire Vajdic ◽  
Julian N Trollor ◽  
Preeyaporn Srasuebkul
Keyword(s):  
Emergency Department ◽  
Intellectual Disability ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Linkage Study ◽  
Index Admission ◽  
Important Indicator ◽  
The Status ◽  
The Impact

Background with rationaleAlthough hospital admissions for epilepsy are common in people with intellectual disability (ID), little is known about the quality of inpatient care and outcomes after admission. To fill this gap, this project examines readmission, an important indicator for the quality of hospital care, and emergency department (ED) presentation after epilepsy admissions in people with ID compared to those without ID. Main AimTo examine whether people with ID have a higher risk of all-cause readmissions and ED presentations after discharge from the index admission (i.e. first admission within the study period) for epilepsy than people without ID. MethodsIn this retrospective data-linkage study, several linked administrative health datasets including but not restricted to hospital admissions, emergency department presentations, disability services and mental health ambulatory care are used to define the cohort, exposure and outcome. The cohort includes patients with and without ID who were admitted to hospital for epilepsy between 2002 and 2014 in New South Wales, Australia. The readmission rates and ED presentations within 28 days, 2-3 months, 4-6 months, and 7-12 months respectively will be compared between patients with and without ID. The effect of a diagnosis of ID on the risk of readmission and ED presentation within a year following the separation from the index admission will be estimated by Poisson regression. Results and conclusionsThe demographics and comorbidity profile of participants at the index epilepsy admission will be presented. Readmission and ED presentation rates within each chunk of follow-up will be calculated by the status of ID and the incidence rate ratio will be provided to estimate the impact of ID on these outcomes. Findings will provide insight into how patients with ID and epilepsy fare in hospital care and help to guide future management of epilepsy in people with ID.

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

scholarly journals Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad H. Al-Qahtani ◽  
Abdullah A. Yousef ◽  
Bassam H. Awary ◽  
Waleed H. Albuali ◽  
Mohammed A. Al Ghamdi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Binary Logistic Regression ◽  
Total Sample ◽  
Age Group ◽  
Chi Squared ◽  
Improper Use ◽  
Level Shifts ◽  
The Impact

Abstract Background The Emergency Repartment (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Management of non-traumatic epistaxis in adults in the emergency department

2021 ◽  
pp. 1-6
Author(s):  
Ashley Reed ◽  
Martyn Barnes ◽  
Caroline Howard
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
University Teaching ◽  
Attendance Rate ◽  
Interrupted Time Series Analysis ◽  
Current Management ◽  
Emergency Ambulance ◽  
Bed Days ◽  
The Impact

Background/aims Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. Methods The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019–20. Results The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing. Conclusions The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.

Impact of Frailty and Sociodemographic Factors on Hospital Admission From an Emergency Department Observation Unit

2016 ◽  
Vol 32 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Michael J. Zdradzinski ◽  
Michael P. Phelan ◽  
Sharon E. Mace
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Multivariable Analysis ◽  
Disability Insurance ◽  
Sociodemographic Factors ◽  
College Graduation ◽  
Screening Criteria ◽  
Katz Index ◽  
Increased Risk ◽  
The Impact

Understanding factors associated with an increased risk of hospital admission from emergency department (ED) observation units (OUs) could be valuable in disposition decisions. To evaluate the impact of frailty and sociodemographic factors (SDFs) on admission risk, patients in an ED OU were surveyed. Survey measures included SDFs, social habits, and frailty measured by the Katz Index of Independence in Activities of Daily Living. Of 306 surveyed, 18% were admitted and 82% were discharged. Demographics were similar between groups. More admitted patients responded positively to the Katz Index (28% vs 13%, P = .007; odds ratio = 2.73; 95% CI = 1.35-5.51). College graduation and current employment favored the discharge group, while admitted patients were more likely to receive Social Security disability insurance. Frailty remained associated with admission on multivariable analysis. Frailty, disability insurance, and lower education are predictors of admission from an OU and could serve as screening criteria in disposition decisions.

scholarly journals Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program

2018 ◽  
Vol 42 (5) ◽  
pp. 542 ◽  
Author(s):  
Sharon Lawn ◽  
Sara Zabeen ◽  
David Smith ◽  
Ellen Wilson ◽  
Cathie Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
Length Of Stay ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Hospital Admissions ◽  
Self Management ◽  
Psychosocial Needs ◽  
Post Discharge ◽  
The Impact

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

scholarly journals Burden of Alcohol Disorders on Emergency Department Attendances and Hospital Admissions in England

2019 ◽  
Vol 54 (5) ◽  
pp. 516-524 ◽  
Author(s):  
Thomas Phillips ◽  
Simon Coulton ◽  
Colin Drummond
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Chronic Alcohol ◽  
Alcohol Disorders ◽  
Excess Burden ◽  
Bed Days ◽  
Disproportionate Burden

We provide analysis from a national routine dataset that quantifies the disproportionate burden of alcohol disorders on ED workload. Our analysis identifies 13 specific presentations predictive of alcohol disorders in ED with excess burden on hospital admission, total bed days and overall costs related to chronic alcohol disorders.

scholarly journals Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

2020 ◽  
Vol 70 (695) ◽  
pp. e399-e405
Author(s):  
Rachel Denholm ◽  
Richard Morris ◽  
Sarah Purdy ◽  
Rupert Payne
Keyword(s):  
Hospital Admission ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Post Discharge ◽  
Emergency Hospital ◽  
Obstetrics And Gynaecology ◽  
Emergency Hospital Admission ◽  
Retrospective Cohort Analysis ◽  
The Impact

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

Sign in / Sign up

Export Citation Format

Share Document