scholarly journals UNSCHEDULED RETURN VISITS TO THE EMERGENCY DEPARTMENT: INCIDENCE, REASONS, POSSIBLE SOLUTIONS

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Aušra Bilotienė–Motiejūnienė ◽  
Andrius Klimašauskas ◽  
Eglė Kontrimavičiūtė ◽  
Rūta Janulevičienė ◽  
Dovilė Majauskytė ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Providers ◽  
Delayed Diagnosis ◽  
Time Frame ◽  
Underlying Disease ◽  
Advanced Search ◽  
Institutional Costs ◽  
Return Visits ◽  
Tract Infections ◽  
Time Frames

The rate of attendance at the Emergency Department (ED) is annually increasing worldwide. Return vi­sits constitute 5% of all visits to the ED. The aim of this review is to determine the incidence and reasons of the readmissions to the ED as well as to provide possible solutions in order to avoid unscheduled re­turn visits. Therefore, literature review was conduc­ted using the databases of Medline, PubMed, Cinahl and Cochrane (from inception to September, 2019). Various keywords were used in the advanced search: return visits, unscheduled returns, revisits, unplan­ned return visits, readmission. Approximately 40 ar­ticles that met the inclusion criteria were selected for this paper. Various time frames – 48 hours, 72 hours, 7 days, 30 days, 180 days ‒ were applied for the eva­luation of return visits. Unplanned return visits (URV) are more likely to happen in elderly patients, in those who have the underlying disease and in younger chil­dren aged less than six years. The main causes of the return visits are the factors related to the patients or to the physicians (disease progression, medical errors, delayed diagnosis, or misdiagnosis). The highest re­turn rates according to the medical conditions have been recorded for the abdominal pain, urinary tract infections, and migraine. Hospitalized patients cons­titute up to 40% of returning patient cases. There is no consensus on the term or time frame employed to classify the return visits to the ED. Most commonly used readmission time frames reveal the evidence regarding the factors related to patients, illnesses, and staff. The future researches should focus on pa­tient education, clinicians and healthcare providers in order to facilitate the creation of predictive models for reduction of unplanned readmissions. These pro­ceedings will significantly reduce the expenses, both personnel resources and institutional costs.

scholarly journals The Impact of the Lisbon Football Derby on the Profile of Emergency Department Admissions

2014 ◽  
Vol 27 (6) ◽  
pp. 700 ◽  
Author(s):  
André Almeida ◽  
Mónica Eusébio ◽  
Jaime Almeida ◽  
Matteo Boattini
Keyword(s):  
Emergency Department ◽  
Time Frame ◽  
Subsequent Increase ◽  
Manchester Triage System ◽  
Sports Events ◽  
Period Data ◽  
Global Increase ◽  
Time Frames ◽  
The Impact ◽  
Urgency Level

<p lang="en-US" style="margin-bottom: 0.35cm; line-height: 200%;" class="western"><span style="font-family: Arial,sans-serif;"><span style="font-size: small;"><strong>Background:</strong> Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city’s football derby.<br /><strong>Material and Methods:</strong> Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly.<br /><strong>Results: </strong>A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05).<br /><strong>Discussion:</strong> A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue.<br /><strong>Conclusion:</strong> During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.<br /><strong>Keywords:</strong> Emergency Service, Hospital; Triage; Sports; Soccer; Portugal.</span></span></p>

scholarly journals Risk Factors for Emergency Department Unscheduled Return Visits

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 457
Author(s):  
Soh ◽  
Lin ◽  
Pan ◽  
Ho ◽  
Mahadevan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Delayed Diagnosis ◽  
Diagnostic Errors ◽  
Neurological Deficits ◽  
Return Visits

Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.

Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department

2020 ◽  
pp. 1-10
Author(s):  
Dwee Wee Lim ◽  
Htet Lin Htun ◽  
Lay See Ong ◽  
Huiling Guo ◽  
Angela Chow
Keyword(s):  
United States ◽  
Emergency Department ◽  
Respiratory Tract Infections ◽  
Healthcare Providers ◽  
Antibiotic Use ◽  
The United States ◽  
Factors Associated ◽  
Antibiotics Use ◽  
Tract Infections ◽  
To Receive

Abstract Objective: Overuse of antibiotics in the emergency department (ED) for uncomplicated acute respiratory tract infections (uARTIs) is a public health issue that needs to be addressed. We aimed to identify factors associated with antibiotic use for uARTIs in adults presenting at the ED. Design: We searched Medline, Embase, PsycINFO and the Cochrane Library for articles published from 1 January 2005 to 30 June 2017 using a predetermined search strategy. Titles and abstracts of English articles on antibiotic prescription and inappropriate antibiotic use for adult ARTI at EDs were assessed, followed by full article review, by 2 authors. Setting: Emergency departments. Participants: Adults aged 18 years and older. Results: Of the 2,591 articles retrieved, 12 articles met the inclusion criteria and 11 studies were conducted in the United States. Patients with normal C-reactive protein levels and positive influenza tests were less likely to receive antibiotic treatment. Nonclinical factors associated with antibiotic use were longer waiting time and perceived patient desire for antibiotics. Patients attended by internal medicine physicians comanaged by house staff or who visited an ED which provided education to healthcare providers on antibiotics use were less likely to receive antibiotics. Conclusions: English-language articles that fulfilled the selection criteria outside the United States were limited. Factors associated with antibiotics use are multifaceted. Education of healthcare providers presents an opportunity to improve antibiotic use.

Effects of Momentary Affect on Satisfaction Judgments

2020 ◽  
Vol 41 (2) ◽  
pp. 61-67
Author(s):  
Marko Tončić ◽  
Petra Anić
Keyword(s):  
Linear Models ◽  
Time Frame ◽  
Hierarchical Linear Models ◽  
Curvilinear Relationship ◽  
Positive And Negative Affect ◽  
Transient Events ◽  
Time Frames ◽  
Events Data ◽  
Level Satisfaction ◽  
Source Of Information

Abstract. This study aims to examine the effect of affect on satisfaction, both at the between- and the within-person level for momentary assessments. Affect is regarded as an important source of information for life satisfaction judgments. This affective effect on satisfaction is well established at the dispositional level, while at the within-person level it is heavily under-researched. This is true especially for momentary assessments. In this experience sampling study both mood and satisfaction scales were administered five times a day for 7 days via hand-held devices ( N = 74 with 2,122 assessments). Several hierarchical linear models were fitted to the data. Even though the amount of between-person variance was relatively low, both positive and negative affect had substantial effects on momentary satisfaction on the between- and the within-person level as well. The within-person effects of affect on satisfaction appear to be more pronounced than the between-person ones. At the momentary level, the amount of between-person variance is lower than in studies with longer time-frames. The affect-related effects on satisfaction possibly have a curvilinear relationship with the time-frame used, increasing in intensity up to a point and then decreasing again. Such a relationship suggests that, at the momentary level, satisfaction might behave in a more stochastic manner, allowing for transient events/data which are not necessarily affect-related to affect it.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

scholarly journals Injuries and frequent use of emergency department services: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040272
Author(s):  
Catherine Laferté ◽  
Andréa Dépelteau ◽  
Catherine Hudon
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Cohort Studies ◽  
Eligibility Criteria ◽  
Geriatric Population ◽  
Physical Injuries ◽  
Frequent Use ◽  
Different Types ◽  
Ed Visits ◽  
Return Visits

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.

scholarly journals A Volatility Estimator of Stock Market Indices Based on the Intrinsic Entropy Model

Entropy ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 484
Author(s):  
Claudiu Vințe ◽  
Marcel Ausloos ◽  
Titus Felix Furtună
Keyword(s):  
Stock Market ◽  
Time Frame ◽  
Data Sets ◽  
Entropy Model ◽  
Daily Data ◽  
Volatility Models ◽  
Derivative Instruments ◽  
Securities Industry ◽  
Time Frames ◽  
Financial Securities

Grasping the historical volatility of stock market indices and accurately estimating are two of the major focuses of those involved in the financial securities industry and derivative instruments pricing. This paper presents the results of employing the intrinsic entropy model as a substitute for estimating the volatility of stock market indices. Diverging from the widely used volatility models that take into account only the elements related to the traded prices, namely the open, high, low, and close prices of a trading day (OHLC), the intrinsic entropy model takes into account the traded volumes during the considered time frame as well. We adjust the intraday intrinsic entropy model that we introduced earlier for exchange-traded securities in order to connect daily OHLC prices with the ratio of the corresponding daily volume to the overall volume traded in the considered period. The intrinsic entropy model conceptualizes this ratio as entropic probability or market credence assigned to the corresponding price level. The intrinsic entropy is computed using historical daily data for traded market indices (S&P 500, Dow 30, NYSE Composite, NASDAQ Composite, Nikkei 225, and Hang Seng Index). We compare the results produced by the intrinsic entropy model with the volatility estimates obtained for the same data sets using widely employed industry volatility estimators. The intrinsic entropy model proves to consistently deliver reliable estimates for various time frames while showing peculiarly high values for the coefficient of variation, with the estimates falling in a significantly lower interval range compared with those provided by the other advanced volatility estimators.

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