scholarly journals Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019–December 2020

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 791
Author(s):  
Simone Gambazza ◽  
Alessandro Galazzi ◽  
Filippo Binda ◽  
Onorina Passeri ◽  
Paola Bosco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Emergency Departments ◽  
Lower Number ◽  
University Hospital ◽  
Tertiary Level ◽  
Significant Drop ◽  
General Decrease ◽  
Ed Visits

During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (−46.4%), and we recorded a −15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.

Abstract WP289: Increasing Emergency Department Use of Advanced Neuroimaging in the Mechanical Thrombectomy Era

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lauren E Mamer ◽  
Keith E Kocher ◽  
James Cranford ◽  
Phillip A Scott
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Mandatory Reporting ◽  
Data Set ◽  
Stroke Treatment ◽  
Mri Brain ◽  
Ed Visits ◽  
Prospective Longitudinal

Introduction: Data supporting mechanical thrombectomy substantially expanded both the time available for treatment and need for advanced neuroimaging in patients with suspected stroke. These factors potentially increase emergency department (ED) use of neuroimaging resources, though the existence and magnitude of effect is unknown, particularly in a broad hospital population including non-stroke center emergency departments. Hypothesis: ED use of CT-angiography (CTA) and CT-Perfusion (CTP) imaging is both increasing and accelerating from 2013 to 2018. Methods: Prospective, longitudinal, single-state cohort study of ED visits using existing California OSHPD dataset (a mandatory reporting database of all CA-licensed, non-federal, emergency department encounters either discharged or transferred) from 2013 to 2018. NCHCT (CPT 70450), CTA Head (CPT 70496), CTP (CPT 0042T) and MRI Brain (CPT 70553) use in the data set, as determined by Common Procedural Terminology (CPT) codes, was analyzed using descriptive statistics and tests of comparison. Results: All advanced neuroimaging increased during the period. Use of NCHCT increased 61% over the study period, from 2,432 to 3,922 per 100,000 ED visits (p trend < .001). Use of CTA increased 405%, from 39 to 197 per 100,000 encounters (p trend < .001). Use of CTP increased 230%, from 3 to 10 per 100,000 encounters (p trend < .001). Use of MRI Brain increased 19%, from 52 to 62 per 100,000 encounters (p trend < .001). On a year-over-year basis, both CTA and CTP use is accelerating, with substantial increases noted between 2017 and 2018. Conclusions: We identified recent, substantial, temporal changes in CTA and CTP neuroimaging acquisition among CA emergency departments in the nascent mechanical thrombectomy era. Dramatic changes in CTA and CTP use suggest that changes are occurring in ED evaluation of neurological emergencies. If true, this differs substantially from the speed of ED acceptance of rt-PA for stroke treatment. Further analysis from the CA OSHPD and other (NEDS) datasets is planned to better understand the patient, hospital, and clinical factors driving these neuroimaging trends in the ED.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

Patterns and Results of Triage Advice Before Emergency Department Visits Made by Patients With Cancer

2021 ◽  
pp. OP.20.00617
Author(s):  
Arthur S. Hong ◽  
Hannah Chang ◽  
D. Mark Courtney ◽  
Hannah Fullington ◽  
Simon J. Craddock Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Urgent Care ◽  
Telephone Triage ◽  
Patients With Cancer ◽  
Oncology Care ◽  
Ed Visits ◽  
The University

PURPOSE: Patients with cancer undergoing treatment frequently visit the emergency department (ED) for commonly anticipated complaints (eg, pain, nausea, and vomiting). Nearly all Medicare Oncology Care Model (OCM) participants prioritized ED use reduction, and the OCM requires that patients have 24-hour telephone access to a clinician, but actual reductions in ED visits have been mixed. Little is known about the use of telephone triage for acute care. METHODS: We identified adults aged 18+ years newly diagnosed with cancer, linked to ED visits from a single institution within 6 months after diagnosis, and then analyzed the telephone and secure electronic messages in the preceding 24 hours. We coded interactions to classify the reason for the call, the main ED referrer, and other attempted management. We compared the acuity of patient self-referred versus clinician-referred ED visits by modeling hospitalization and ED visit severity. RESULTS: From 2011 to 2018, 3,247 adults made 5,371 ED visits to the university hospital and self-referred to the ED 58.5% of the time. Clinicians referred to outpatient or oncology urgent care for 10.3% of calls but referred to the ED for 61.3%. Patient self-referred ED visits were likely to be hospitalized (adjusted Odds Ratio [aOR], 0.89, 95% CI, 0.64 to 1.22) and were not more severe (aOR, 0.75, 95% CI, 0.55 to 1.02) than clinician referred. CONCLUSION: Although patients self-referred for six of every 10 ED visits, self-referred visits were not more severe. When patients called for advice, clinicians regularly recommended the ED. More should be done to understand barriers that patients and clinicians experience when trying to access non-ED acute care.

ENT cases seen at a local ‘walk-in centre’: a one year review

2008 ◽  
Vol 123 (3) ◽  
pp. 339-342 ◽  
Author(s):  
T Rourke ◽  
P Tassone ◽  
C Philpott ◽  
A Bath
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
General Practitioner ◽  
Emergency Departments ◽  
Foreign Bodies ◽  
Healthcare Providers ◽  
One Year

AbstractAim and method:This retrospective study reviewed the ENT-related cases seen, and the discharge or transfer outcomes, at both a local ‘walk-in centre’ and the respective emergency department, over one year in Norwich.Results:Of the 7657 ENT cases seen at the walk-in centre, the commonest conditions included tonsillitis or pharyngitis, otalgia, cough, and deafness. In comparison, 1586 patients were seen at the emergency department, and the commonest conditions were epistaxis and throat foreign bodies. Of the ENT cases seen at the walk-in centre, 85.4 per cent were treated and discharged. Of the 14.6 per cent referred to other healthcare providers, 11.1 per cent were to the general practitioner. In comparison, the emergency department discharged 41.2 per cent and referred 58.8 per cent to other healthcare providers.Conclusion:This study indicates that ENT cases may constitute a large proportion of patients seen in walk-in centres, and that the case types seen may differ from those presenting to emergency departments. It also indicates that walk-in centres may potentially be assessing, treating and discharging 85.4 per cent of ENT patients seen.

scholarly journals Diagnosis and Treatment of Acute Gout at a University Hospital Emergency Department

2015 ◽  
Vol 9 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Naomi Schlesinger ◽  
Diane C Radvanski ◽  
Tina C Young ◽  
Jonathan V McCoy ◽  
Robert Eisenstein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Diagnosis And Treatment ◽  
Acute Gout ◽  
Inflammatory Drug ◽  
Ed Visits ◽  
Inflammatory Drugs ◽  
The Mean ◽  
Anti Inflammatory

Background : Acute gout attacks account for a substantial number of visits to the emergency department (ED). Our aim was to evaluate acute gout diagnosis and treatment at a University Hospital ED. Methods : Our study was a retrospective chart review of consecutive patients with a diagnosis of acute gout seen in the ED 1/01/2004 - 12/31/2010. We documented: demographics, clinical characteristics, medications given, diagnostic tests, consultations and whether patients were hospitalized. Descriptive and summary statistics were performed on all variables. Results : We found 541 unique ED visit records of patients whose discharge diagnosis was acute gout over a 7 year period. 0.13% of ED visits were due to acute gout. The mean patient age was 54; 79% were men. For 118 (22%) this was their first attack. Attack duration was ≤ 3 days in 75%. Lower extremity joints were most commonly affected. Arthrocentesis was performed in 42 (8%) of acute gout ED visits. During 355 (66%) of ED visits, medications were given in the ED and/or prescribed. An anti-inflammatory drug was given during the ED visit during 239 (44%) visits. Medications given during the ED visit included: NSAIDs: 198 (56%): opiates 190 (54%); colchicine 32 (9%) and prednisone 32 (9%). During 154 (28%) visits an anti-inflammatory drug was prescribed. Thirty two (6%) were given no medications during the ED visit nor did they receive a prescription. Acute gout rarely (5%) led to hospitalizations. Conclusion : The diagnosis of acute gout in the ED is commonly clinical and not crystal proven. Anti-inflammatory drugs are the mainstay of treatment in acute gout; yet, during more than 50% of ED visits, anti-inflammatory drugs were not given during the visit. Thus, improvement in the diagnosis and treatment of acute gout in the ED may be required.

Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital

physioscience ◽  
2021 ◽  
Author(s):  
Balz Winteler ◽  
Franziska Geese ◽  
Beat Lehmann ◽  
Kai-Uwe Schmitt
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Added Value ◽  
University Hospital ◽  
Care Staff ◽  
Health Care Staff ◽  
Ed Visits ◽  
Department Evaluation ◽  
Electronic Patient File ◽  
Patient File

Abstract Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases. Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED. Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted. Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients. Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.

scholarly journals Profile of the Population Cared for in a Referral Emergency Unit

2011 ◽  
Vol 19 (3) ◽  
pp. 548-556 ◽  
Author(s):  
Gabriella Novelli Oliveira ◽  
Michele de Freitas Neves Silva ◽  
Izilda Esmenia Muglia Araujo ◽  
Marco Antonio Carvalho-Filho
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Back Pain ◽  
Retrospective Study ◽  
Chest Pain ◽  
Young Women ◽  
Adult Population ◽  
Low Complexity ◽  
University Hospital ◽  
Emergency Unit

Acquiring knowledge concerning the characteristics of the population that seeks an emergency department can support the planning of health actions. This study identifies the socio-demographic profile and the main complaints of the adult population cared for in a Referral Emergency Unit (RECU). This descriptive and retrospective study was conducted in the RECU of a university hospital in the State of Sao Paulo, Brazil. The sample was composed of the service’s care forms generated for the period between January and December 2008. The instrument was based on data contained in the care forms. Young women (14 to 54 years old), residents of neighborhoods near the RECU, spontaneously sought the service during the week from 7am to 7pm. The most frequent complaints were headache, back pain, abdominal and chest pain. The conclusion is that most of the sample was young adults, of productive age, female, who spontaneously sought the service on weekdays during the day. Most complaints were of low complexity.

scholarly journals The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years

2016 ◽  
Vol 62 (6) ◽  
pp. 506-512 ◽  
Author(s):  
Rodrigo Locatelli Pedro Paulo ◽  
André Broggin Dutra Rodrigues ◽  
Beatriz Marcondes Machado ◽  
Alfredo Elias Gilio
Keyword(s):  
Emergency Department ◽  
Acute Diarrhea ◽  
Hospital Admissions ◽  
Reduction Rate ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Main Diagnosis ◽  
Ed Visits ◽  
The Impact ◽  
Children Under 5

Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005) and the post-vaccine (2007–2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

CHANGES IN THE VISITS TO EMERGENCY DEPART MENT OF NON-INFECT IOUS HOSPITA L DURING THE EARLY COV ID-19 STATE OF EPIDEMIC

2020 ◽  
Vol 7 (2) ◽  
pp. 99-102
Author(s):  
Goutam Chourasia ◽  
Wiesław Krzysztof Sycz ◽  
Igor Wolniakowski ◽  
Krzysztof Dudek ◽  
Barbara Porębska ◽  
...  
Keyword(s):  
Emergency Department ◽  
Early Stage ◽  
University Hospital ◽  
Lower Percentage ◽  
Study Group ◽  
Important Data ◽  
Medical Resources ◽  
Ed Visits

Introduction: The epidemiology of Emergency Department (ED) visits provides important data regarding demand for the medical resources. The aim: To present changes in the visits to ED of University Hospital during the early stage of Covid-19 state of epidemic. Matrial and Methods: All ED visits during the 3 periods each lasting one weeks in 2018, 2019, and 2020 respectively were analysed. The data related to patients ’visits in the emergency department were gathered. Results: The percentage of patients admitted between 23-29.03 in 2020 year was 23.7% of the study group and constituted a significantly lower percentage than those admitted in 2028 who constituted 37.2% and 2019 who constituted 39.1% p<0.001. There was no significant differences between percentages of patients admitted to ED and brought by EMS among studied periods. The percentage of patients admitted to other ward of the hospital was higher in 2020 than in 2018 and 2019. Conclusions: 1. During early stage of COVID-19 epidemic state the number of ED significantly decreased both patients brought by EMS and non EMS pathway. 2. Patients admitted to ED are more often admitted to other ward of the hospital. 3. The mortality during ED stay is similar than in similar periods in previous years.

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