Diabetes Detection and Communication among Patients Admitted through the Emergency Department of a Public Hospital

Early identification/diagnosis of diabetes and frequent monitoring of hyperglycemia reduces hospitalizations and diabetes-related complications. The present study investigated the proportion of older adults coded with diabetes or newly diagnosed during their admissions and assessed discharge summary content for diabetes-related information. The study used electronic data on 4796 individuals aged ≥60 years admitted through the emergency department (ED) of a public hospital from 2017 to 2018 extracted using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM code). The proportion of admitted patients who were diagnosed with diabetes over a one-year period, proportion with glycated hemoglobin A1c (HbA1c) and random blood glucose (RBG) test performed during their stay, length of stay, discharge summary information and the factors associated with elevated HbA1c (>7%/53 mmol/mol) were investigated. In total, 8.6% of ED presentations to the hospital were coded with diabetes, excluding gestational consisting of 879 patients (449 males, 430 females) aged ≥ 60 years (74.6 ± 8.9 years). In total, 98% had type 2 diabetes (n = 863), 53% were Australian-born (n = 467), and the mean body mass index (BMI, 31 ± 7 kg/m2; n = 499, 56.8%), RBG (9.8 ± 5.2 mmol/L; n = 824, 93.7%) and HbA1c (8.0 ± 2.0%; n = 137, 15.6%) and length of stay (6.7 ± 25.4 days) were similar between gender, age, and nationality (p > 0.05). Three coded patients (0.3%) were newly diagnosed during the admission. In total, 86% had elevated HbA1c, but this was recorded in 20% of discharge summaries. Patients who are on a combination therapy (adjusted odds ratio 23%, 95% confidence intervals: 7%/38%), those on SGLT2 Inhibitors (aOR, 14%: 2%/26%) or had a change in medication (aOR, 40%: 22%/59%) had lower odds of having elevated HbA1c during admission. The low diagnosis rate of diabetes and the lack of clinical assessment of HbA1c in older adults admitted through the ED of a South Western Sydney public hospital suggest that many patients with diabetes either remain undiagnosed even during admission and/or are going to the ED with unknown diabetes that is unidentified with current practices. The clinically important HbA1c results were only infrequently communicated with general practitioners (GPs).

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Validation of ICD-10-CM codes for injuries complicating pregnancy, childbirth and the puerperium: a medical record review

Injury Prevention ◽

10.1136/injuryprev-2019-043512 ◽

2021 ◽

Vol 27 (Suppl 1) ◽

pp. i9-i12

Author(s):

Anna Hansen ◽

Dana Quesinberry ◽

Peter Akpunonu ◽

Julia Martin ◽

Svetla Slavova

Keyword(s):

Emergency Department ◽

Medical Record ◽

International Classification Of Diseases ◽

Medical Record Review ◽

Full Sample ◽

Emergency Department Data ◽

Classification Of Diseases ◽

Icd 10 ◽

Record Review

IntroductionThe purpose of this study was to estimate the positive predictive value (PPV) of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for injury, poisoning, physical or sexual assault complicating pregnancy, childbirth and the puerperium (PCP) to capture injury encounters within both hospital and emergency department claims data.MethodsA medical record review was conducted on a sample (n=157) of inpatient and emergency department claims from one Kentucky healthcare system from 2015 to 2017, with any diagnosis in the ICD-10-CM range O9A.2-O9A.4. Study clinicians reviewed medical records for the sampled cases and used an abstraction form to collect information on documented presence of injury and PCP complications. The study estimated the PPVs and the 95% CIs of O9A.2-O9A.4 codes for (1) capturing injuries and (2) capturing injuries complicating PCP.ResultsThe estimated PPV for the codes O9A.2-O9A.4 to identify injury in the full sample was 79.6% (95% CI 73.3% to 85.9%) and the PPV for capturing injuries complicating PCP was 72.0% (95% CI 65.0% to 79.0%). The estimated PPV for an inpatient principal diagnosis O9A.2-O9A.4 to capture injuries was 90.7% (95% CI 82.0% to 99.4%) and the PPV for capturing injuries complicating PCP was 88.4% (95% CI 78.4% to 98.4%). The estimated PPV for any mention of O9A.2-O9A.4 in emergency department data to capture injuries was 95.2% (95% CI 90.6% to 99.9%) and the PPV for capturing injuries complicating PCP was 81.0% (95% CI 72.4% to 89.5%).DiscussionThe O9A.2-O9A.4 codes captured high percentage true injury cases among pregnant and puerperal women.

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Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study (Preprint)

10.2196/preprints.22491 ◽

2020 ◽

Author(s):

Rai-Fu Chen ◽

Kuei-Chen Cheng ◽

Yu-Yin Lin ◽

I-Chiu Chang ◽

Cheng-Han Tsai

Keyword(s):

Older Adults ◽

Emergency Department ◽

Health Insurance ◽

Chronic Illness ◽

Length Of Stay ◽

Prediction Model ◽

Older Adult ◽

National Health Insurance ◽

Research Database ◽

Return Visits

BACKGROUND Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. OBJECTIVE This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. METHODS We used stratified and randomized data from Taiwan’s National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. RESULTS The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. CONCLUSIONS Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.

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Ocular emergencies presenting to an emergency department in Central Spain from 2013 to 2018

European Journal of Ophthalmology ◽

10.1177/1120672119896420 ◽

2019 ◽

pp. 112067211989642

Author(s):

Alicia Galindo-Ferreiro ◽

Hortensia Sanchez-Tocino ◽

Yago Varela-Conde ◽

Cecilia Diez-Montero ◽

Minal Belani-Raju ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Primary Care Physicians ◽

International Classification Of Diseases ◽

Tertiary Hospital ◽

University Hospital ◽

Care Providers ◽

Primary Health Care Providers ◽

Ocular Surface Diseases ◽

Classification Of Diseases

Purpose: To determine the frequency of ocular conditions among patients presenting to an emergency department at a tertiary hospital in Spain. Methods: A retrospective, longitudinal analysis of all patients who presented to the ocular emergency department of Rio Hortega University Hospital, Valladolid, Spain, from 2013 to 2018 was performed. Data on demographics, ophthalmic examination, and diagnosis were collected. Diseases were classified according the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results: We had 20,822 patients, of which 10,878 (52.2%) were women. The main age categories were 45–65 years (7391 patients; 35.5%) and 15–45 years (5979 patients; 28.2%). Most of the patients (17,793; 85.5%) were discharged on the same day. Conjunctival pathology was the most common cause of presentation (4110; 19.7%), followed by corneal disorders (4025; 19.3%). Acute conjunctivitis was diagnosed in 2920 (14%) and ocular trauma in 2125 (10.2%) patients. Non-emergency ophthalmic conditions were diagnosed in 1581 (7.6%) patients. Retinal detachments and peripheral holes occurred more commonly in patients aged 45–65 years ( p <0.001). Corneal or conjunctival disorders and lid inflammation ( p <0.001) were more frequent in women, whereas men had higher incidences of trauma ( p <0.001). Conclusion: Most of our patients presented ocular surface diseases. Men were more vulnerable to trauma, mainly superficial foreign body. The majority of the patients presented with uncomplicated ocular conditions that would be managed more cost-effectively by primary health care providers. We advocate greater education of primary care physicians and patients in managing simple ocular emergencies to reduce the cases presenting to an emergency department of a tertiary hospital.

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Using the Self-Controlled Tree-Temporal Scan Statistic to Assess the Safety of Live Attenuated Herpes Zoster Vaccine

American Journal of Epidemiology ◽

10.1093/aje/kwz104 ◽

2019 ◽

Vol 188 (7) ◽

pp. 1383-1388 ◽

Cited By ~ 3

Author(s):

W Katherine Yih ◽

Martin Kulldorff ◽

Inna Dashevsky ◽

Judith C Maro

Keyword(s):

Older Adults ◽

Herpes Zoster ◽

Adverse Events ◽

International Classification Of Diseases ◽

The Self ◽

Scan Statistic ◽

Diagnosis Codes ◽

Classification Of Diseases ◽

Safety Studies ◽

Temporal Scan Statistic

Abstract The self-controlled tree-temporal scan statistic allows detection of potential vaccine- or drug-associated adverse events without prespecifying the specific events or postexposure risk intervals of concern. It thus opens a promising new avenue for safety studies. The method has been successfully used to evaluate the safety of 2 vaccines for adolescents and young adults, but its suitability to study vaccines for older adults had not been established. The present study applied the method to assess the safety of live attenuated herpes zoster vaccination during 2011–2017 in US adults aged ≥60 years, using claims data from Truven Health MarketScan Research Databases. Counts of International Classification of Diseases diagnosis codes recorded in emergency department or hospital settings were scanned for any statistically unusual clustering within a hierarchical tree structure of diagnoses and within 42 days after vaccination. Among 1.24 million vaccinations, 4 clusters were found: cellulitis on days 1–3, nonspecific erythematous condition on days 2–4, “other complications . . .” on days 1–3, and nonspecific allergy on days 1–6. These results are consistent with local injection-site reactions and other known, generally mild, vaccine-associated adverse events and a favorable safety profile. This method might be useful for assessing the safety of other vaccines for older adults.

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Understanding the use of emergency department and urgent care services by diabetic patients of a Family Medicine Health Team: a retrospective observational study

Primary Health Care Research & Development ◽

10.1017/s1463423616000396 ◽

2016 ◽

Vol 18 (02) ◽

pp. 200-207 ◽

Cited By ~ 1

Author(s):

Matthew Ward

Keyword(s):

Emergency Department ◽

Family Medicine ◽

Observational Study ◽

International Classification Of Diseases ◽

Urgent Care ◽

Retrospective Observational Study ◽

Diabetic Patients ◽

Health Team ◽

Scale Scores ◽

Classification Of Diseases

Aim To understand the frequency, urgency, and rationale of emergency department and urgent care (ED/UC) use by diabetic patients of a Family Medicine Health Team (FHT). Methods A retrospective, observational study with comparison control groups was conducted from 1 January 2013 to 31 December 2014. A total of 693 diabetic patients were compared with two, age-standardized non-diabetic groups: one with a higher disease burden based on International Classification of Diseases 9 diagnoses and the other from a randomized patient pool. Findings The diabetic group utilized ED/UC services 1.25 and 1.92 times more often than the two control populations, consistent with that observed in other studies. Canadian Triage and Acuity Scale scores were essentially the same for the diabetic population. Only 3.1% of visits were for diabetic related emergencies, in contrast to the expected 23% by surveyed physicians of the FHT. Diabetic patient’s sought treatment for cellulitis, wounds, abscesses, and infections more often than the control populations.

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Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018190 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018190 ◽

Cited By ~ 18

Author(s):

Marcel Émond ◽

Valérie Boucher ◽

Pierre-Hugues Carmichael ◽

Philippe Voyer ◽

Mathieu Pelletier ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Hospital Length ◽

Cognitive Status ◽

Hospital Ward ◽

Hospital Length Of Stay ◽

Multicentre Cohort Study ◽

Multicentre Cohort

ObjectiveWe aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment.DesignThis is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward.SettingThe study took place in four Canadian EDs.Participants338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent.Main outcome(s) and measure(s)The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes.ResultsMean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient.ConclusionsAn incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.

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Impact of a telemedicine eICU cart on sepsis management in a community hospital emergency department

Journal of Telemedicine and Telecare ◽

10.1177/1357633x17691862 ◽

2017 ◽

Vol 24 (3) ◽

pp. 202-208 ◽

Cited By ~ 14

Author(s):

Shana M Machado ◽

Erika H Wilson ◽

John O Elliott ◽

Kim Jordan

Keyword(s):

Emergency Department ◽

Hospital Costs ◽

International Classification Of Diseases ◽

Surviving Sepsis Campaign ◽

Sepsis Management ◽

Institutional Review ◽

Classification Of Diseases ◽

Ninth Edition ◽

Complications And Mortality

Introduction Intensivist involvement for patients with sepsis is associated with decreased complications and mortality, and lower hospital resource utilization, but few studies have evaluated outcomes for patients exposed to electronic intensive care unit (eICU) telemedicine sepsis management in the emergency department (ED). In this study, we assess whether eICU cart exposure in the ED improved compliance with components of the 2010 Surviving Sepsis Campaign bundles, length of stay (LOS), disposition and hospital costs. Methods An institutional review board-approved, retrospective cohort study was completed on patients with confirmed sepsis who presented to our ED from July 2010 through February 2013. Results Of 711 patient ED encounters, 314 cases met criteria for analysis (95 exposed and 219 non-exposed). Patient cohorts had similar demographics and comorbid International Classification of Diseases, Ninth Edition (ICD-9) diagnoses. The exposed cohort received antibiotics more quickly (122.3 minutes ±83.3 versus 163.4 minutes ±204.4, p = 0.043) and were more likely to have lactic acid levels drawn within six hours (98.9% vs. 90%, p = 0.019). The exposed cohort had a shortened ED LOS (in days) 0.08 ± 0.28 versus 0.16 ± 0.37, p = 0.036. Hospital LOS, disposition and death were similar in both cohorts. Total hospital costs for the exposed cohort were lower and less variable (US$19,713 ± 16,550 vs. US$24,364 ± 25068), but this was not significant ( p = 0.274). Discussion Our findings suggest that in individuals with confirmed sepsis, ED exposure to a telemedicine-based eICU cart impacted adherence to aspects of the Surviving Sepsis Campaign recommended bundle, but did not impact overall survival and medical costs.

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