scholarly journals Inappropriateness of Repeated Laboratory and Radiological Tests for Transferred Emergency Department Patients

2019 ◽  
Vol 8 (9) ◽  
pp. 1342 ◽  
Author(s):  
Jérôme Bertrand ◽  
Christophe Fehlmann ◽  
Olivier Grosgurin ◽  
François Sarasin ◽  
Omar Kherad
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Laboratory Tests ◽  
Chart Review ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Emergency Department Patients ◽  
Radiological Procedures

Background: Laboratory and radiographic tests are often repeated during inter-hospital transfers from secondary to tertiary emergency departments (ED), despite available data from the sending structure. The aim of this study was to identify the proportion of repeated tests in patients transferred to a tertiary care ED, and to estimate their inappropriateness and their costs. Methods: A retrospective chart review of all adult patients transferred from one secondary care ED to a tertiary care ED during the year 2016 was carried out. The primary outcome was the redundancy (proportion of procedure repeated in the 8 h following the transfer, despite the availability of the previous results). Factors predicting the repetition of procedures were identified through a logistic regression analysis. Two authors independently assessed inappropriateness. Results: In 2016, 432 patients were transferred from the secondary to the tertiary ED, and 251 procedures were repeated: 179 patients (77.2%) had a repeated laboratory test, 34 (14.7%) a repeated radiological procedure and 19 (8.2%) both. Repeated procedures were judged as inappropriate for 197 (99.5%) laboratory tests and for 39 (73.6%) radiological procedures. Conclusion: Over half of the patients transferred from another emergency department had a repeated procedure. In most cases, these repeated procedures were considered inappropriate.

Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 71-74
Author(s):  
Krista Hawrylyshyn ◽  
Shelley L. McLeod ◽  
Jackie Thomas ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Chart Review ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Rule Out

AbstractObjectiveThe objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the emergency department (ED) where ectopic pregnancy had not yet been excluded.MethodsThis was a retrospective chart review of pregnant (<12-week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.ResultsOf the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes, and 71 (12.9%) had other outcomes that included therapeutic abortion, molar pregnancy, or resolution of βHCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal ultrasound during their index ED visit, and 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy.ConclusionThese results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

Retrospective Chart Review of Emergency Department Patients with Cancer and Non-Neutropenic Fever

2020 ◽  
Vol 59 (5) ◽  
pp. 774
Author(s):  
Jason J. Bischof ◽  
Patrick J. Sylvester ◽  
Jennifer A. Frey ◽  
Julie Stephens ◽  
Becca Hammond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Neutropenic Fever ◽  
Patients With Cancer ◽  
Emergency Department Patients

scholarly journals P063: Identification of emergency department patients for referral to rapid-access addiction services: A retrospective chart review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S86
Author(s):  
J. Hann ◽  
H. Wu ◽  
A. Gauri ◽  
K. Dong ◽  
N. Lam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Care Team ◽  
Addiction Medicine ◽  
Multivariable Logistic Regression Model ◽  
Factors Associated ◽  
Extract Information

Introduction: Emergency Department (ED) visits related to substance use are rapidly increasing. Despite this, few Canadian EDs have immediate access to addiction medicine specialists or on-site addiction medicine clinics. This study characterized substance-related ED presentations to an urban tertiary care ED and assessed need for an on-site rapid-access addiction clinic (RAAC). Methods: This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC.This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC. Results: Of the 557 enrolment forms received, 458 were included in the analysis. 64% of included patients were male and 36% were female, with a median age of 35.0 years. Polysubstance use was seen in 23% of patients, and alcohol was the most common substance indicated (60%), followed by stimulants (32%) and opioids (16%). The median ED length of stay for included patients was 483 minutes, compared to 354 minutes for all-comers discharged from the ED during the study period. 28% of patients had a previous ED visit within 7 days of the index visit, and an additional 17% had a visit in the preceding 30 days. The ED care team indicated ‘Yes’ for RAAC referral from the ED for 66% of patients, for a mean of 4.3 patients referred per day during the study period. Multivariable analysis showed that all substances (except cannabis) correlated to a statistically significant increase in likelihood for indicating ‘Yes’ for RAAC referral from the ED (alcohol, stimulants, opioids, polysubstance; p &lt; 0.05). Patients presenting to the ED with a chief complaint related to substance use were also more likely to be referred (p = 0.01). Conclusion: This retrospective chart review characterized substance-related presentations at a Canadian urban tertiary care ED. Approximately four patients per day would have been referred to an on-site RAAC had one been available. The RAAC model has been implemented in other Canadian hospitals, and collaborating with these sites to begin developing this service would be an important next step.

scholarly journals Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients

2019 ◽  
Vol 11 (03) ◽  
pp. 259-264 ◽  
Author(s):  
Hyun Sok Park ◽  
Sang Guk In ◽  
Hai-Jeon Yoon ◽  
Woon Jeong Lee ◽  
Seon Hee Woo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Severe Acute Pancreatitis ◽  
Predictive Values ◽  
Neutrophil Lymphocyte Ratio ◽  
Independent Variables ◽  
Severe Group ◽  
Emergency Department Patients

Abstract CONTEXT: Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity. AIMS: We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients. SETTINGS AND DESIGN: This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017. SUBJECTS AND METHODS: Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables. STATISTICAL ANALYSIS USED: Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables. RESULTS: Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821). CONCLUSIONS: The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.

scholarly journals Acute cannabis intoxication in the emergency department: the effect of legalization

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Robert Baraniecki ◽  
Puru Panchal ◽  
Danya Deepsee Malhotra ◽  
Alexandra Aliferis ◽  
Zaka Zia
Keyword(s):  
Emergency Department ◽  
Chart Review ◽  
Primary Outcome ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Before And After ◽  
Icd 10 ◽  
Ed Visits ◽  
October 17 ◽  
Recreational Use

Abstract Background On October 17, 2018, the Cannabis Act decriminalized the recreational use of cannabis in Canada. This study seeks to determine how legalization of cannabis has impacted emergency department (ED) visits for acute cannabis intoxication. Methods We conducted a retrospective chart review at an academic ED in Hamilton, Ontario. We assessed all visits with a cannabis-related ICD-10 discharge code 6 months before and after legalization (October 17, 2018) to determine cases of acute cannabis intoxication. The primary outcome was the rate of ED visits. Secondary outcomes included number of visits distributed by age, length of stay, co-ingestions, and clinical course in the emergency department (investigations and treatment). Results There was no difference in the overall rate of ED visits following legalization (2.44 vs. 2.94 visits/1000, p = 0.27). However, we noted a 56% increase in visits among adults aged 18–29 (p = 0.03). Following legalization, a larger portion of patients required observation without interventions (25% vs 48%, p < 0.05). Bloodwork and imaging studies decreased (53% vs. 12%, p < 0.05; 29% vs. 2%, p < 0.05); however, treatment with benzodiazepines increased (24% vs. 51%, p < 0.05). Conclusions Legalization was not associated with a change in the rate of cannabis-related ED visits in our study. More research is needed regarding changing methods of cannabis ingestion and trends among specific age groups.

scholarly journals Risk Factors for Revisiting After Emergency Department Discharge: a Longitudinal Retrospective Chart Review

2020 ◽  
Author(s):  
Chie Teramoto ◽  
Satoko Nagata ◽  
Takashi Naruse ◽  
Susumu Nakajima ◽  
Shinichiroh Yokota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Logistic Regression ◽  
Chart Review ◽  
Multiple Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Multiple Logistic Regression ◽  
Enabling Factors ◽  
History Of ◽  
Hospital Use

Abstract Background: Emergency department (ED) patients are often discharged after treatment for minor illnesses. However, many of these patients revisit the ED. This study aimed to describe ED revisit rate and investigate the risk factors for 3-day/30-day ED revisit. Methods: A longitudinal retrospective chart review was used to extract data regarding predisposing factors (e.g. gender, age), enabling factors (e.g. economic status, ambulance use) and need factors (e.g. diagnosis at ED discharge, history of diseases), from the medical charts of patients discharged from an ED in Tokyo, Japan, from February to December 2013. Multiple logistic regression analyses were used to predict 3-day/30-day ED revisit based on initial visit information. Results: During the studied period, 8,754 patients were discharged from the ED, of whom 48.8% were men, and the mean age was 39.7 years. Of these, 338 (3.9%) revisited the ED within three days and 682 (7.8%) revisited the ED within 30 days of discharge. In the multiple logistic regression analysis, risk factors for 3-day ED revisits were: having a history of same hospital use, arriving by ambulance, having a common problem (e.g. fever), and history of asthma. Risk factors for 30-day ED revisits were using health care services and having a history of same hospital use. Conclusions: In this study, the rate of ED revisit was less than that reported by other studies, which might be because most patients included in this study usually visited the hospital. Our results show that the predictive factors for 3-day/30-day ED revisit in Japan were similar to those in other countries. Patients with the abovementioned factors should be carefully screened on their initial ED visit, and some follow-up care in clinical and community settings should be arranged.

Decision aid for early identification of acute underlying illness in emergency department patients with atrial fibrillation or flutter

CJEM ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 301-308
Author(s):  
Frank X. Scheuermeyer ◽  
Monica Norena ◽  
Grant Innes ◽  
Brian Grunau ◽  
Jim Christenson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Decision Aid ◽  
Chart Review ◽  
Primary Outcome ◽  
Specific Therapy ◽  
Factors Associated ◽  
Underlying Illness ◽  
Patients At Risk ◽  
Emergency Department Patients

ABSTRACTBackgroundEmergency department (ED) patients with atrial fibrillation or flutter (AFF) with underlying occult condition such as sepsis or heart failure, and who are managed with rate or rhythm control, have poor prognoses. Such conditions may not be easy to identify early in the ED evaluation when critical treatment decisions are made. We sought to develop a simple decision aid to quickly identify undifferentiated ED AFF patients who are at high risk of acute underlying illness.MethodsWe collected consecutive ED patients with electrocardiogram-proven AFF over a 1-year period and performed a chart review to ascertain demographics, comorbidities, and investigations. The primary outcome was having an acute underlying illness according to prespecified criteria. We used logistic regression to identify factors associated with the primary outcome, and developed criteria to identify those with an underlying illness at presentation.ResultsOf 1,083 consecutive undifferentiated ED AFF patients, 400 (36.9%) had an acute underlying illness; they were older with more comorbidities. Modeling demonstrated that three predictors (ambulance arrival; chief complaint of chest pain, dyspnea, or weakness; CHA2DS2-VASc score greater than 2) identified 93% of patients with acute underlying illness (95% confidence interval [CI], 91–96%) with 54% (95% CI, 50–58%) specificity. The decision aid missed 28 patients; (7.0%) simple blood tests and chest radiography identified all within an hour of presentation.ConclusionsIn ED patients with undifferentiated AFF, this simple predictive model rapidly differentiates patients at risk of acute underlying illness, who will likely merit investigations before AFF-specific therapy.

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