scholarly journals Factors Affecting 72-Hour Unplanned Return Visits after Emergency Department Index Discharge of a Tertiary Private Hospital in the Philippines

2020 ◽  
Vol 54 (5) ◽  
Author(s):  
Ma. Lourdes Concepcion D. Jimenez ◽  
Rafael L. Manzanera ◽  
Ronne D. Abeleda ◽  
Diego A. Moya ◽  
Jose V. Segura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Strong Association ◽  
Tertiary Hospital ◽  
The Philippines ◽  
Third Party ◽  
Factors Affecting ◽  
Premature Discharge ◽  
Return Visits ◽  
Emergency Department Patients

Objectives. This study aimed to analyze if the indicator 72-hours Unplanned Return Visits after EmergencyDepartment (ED) index discharge was influenced by the patient’s age, triage severity, month, payment methods,and length of stay. Likewise, it aimed to determine if the 72-hour Unplanned Return Visits was a robust indicator inassessing the quality of Emergency Department services. Methods. This was a retrospective single-center study from January to December 2017. Data were retrievedfrom a tertiary hospital in the Philippines. All Emergency Department patients discharged on their index visitwere monitored for Unplanned Return Visits within 72 hours in the hospital. A univariate and multivariate logisticregression model was used to assess the variables associated with the 72-hour Unplanned Return Visits. Results. The 72-hour Unplanned Return Visits rate was measured at 2.67%, with the highest occurrence on thefirst 24 hours, and with predominance on third-party payer (p.<.0001), pediatrics (p.<0001), January (p<.0001),February (p<.0001), November (p<.0001), December (p<0001), and shorter length of stay (p<.0001) dischargedafter ED index visit. Conclusions. Strong association of Unplanned Return Visits during the first 72 hours after Emergency Departmentindex discharge was found for patients financed through third party-payers, with seasonal variations andinclination to the younger population with shorter length of stay. These findings warrant exploratory studies todetermine the reasons for the 72-hour Unplanned Return Visits after Emergency Department index discharge andinvestigation on the association of premature discharge, socio-economic, health structure, and illness progression.

scholarly journals A Descriptive Study on the Factors Affecting the Length of Stay in the Emergency Department of a Tertiary Private Hospital in the Philippines

2018 ◽  
Vol 52 (6) ◽  
Author(s):  
Ma. Lourdes D. Jimenez ◽  
Rafael L. Manzanera ◽  
Jose J. Mira ◽  
Isabel M. Navarro ◽  
John Q. Wong
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Private Hospital ◽  
Descriptive Study ◽  
The Philippines ◽  
Older Age ◽  
Third Party ◽  
Factors Affecting ◽  
Party Payer ◽  
Age Range

Objective. The study aims to describe factors that contribute to the Length of Stay (LOS) in the Emergency Department (ED) patients of a Tertiary Private Hospital in Philippines. Methods. This is a retrospective descriptive study from September 1, 2015 to March 31, 2016 on the factors of ED consultations specifically on demographics (age and sex), payment schemes (Out of Pocket (OOP) and third party payer), shift times (morning, afternoon and night) and triage-levels were associated with LOS. Results. Our ED consultations with age (mean 40.75 years, SD 16.8, N 20,687, range 95) were dominated by females (56%), two age-range, 21-30 (28.4%) & 31-40 and third party payer (57%). LOS (mean of 4,40 hours, SD 3,89, N 18540, range 68) was significantly higher (p<0.001) on OOP patients, older age-range; 71-80, (3.5%) and 81-90, (2.3%). Emergent cases had higher incidence (X2= 30.2, p<0.001) on morning shift, urgent cases on afternoon shift and trauma cases on evening shift. Non-urgent cases were consistent on all time frames. LOS was significantly higher (X2=p<0.001) on urgent and emergent cases and on morning and afternoon shifts and significantly lowest, (p<0.001) on night shifts. Conclusion. Higher LOS was associated on the following: urgent and emergent triage- levels, older age range, OOP, and morning and afternoon shifts.

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

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.

scholarly journals Risk Stratification with Extreme Learning Machine: A Retrospective Study on Emergency Department Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Nan Liu ◽  
Jiuwen Cao ◽  
Zhi Xiong Koh ◽  
Pin Pin Pek ◽  
Marcus Eng Hock Ong
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Extreme Learning Machine ◽  
Tertiary Hospital ◽  
Support Vector ◽  
Characteristic Analysis ◽  
Scoring Method ◽  
Stratification Method ◽  
Emergency Department Patients ◽  
Learning Machine

This paper presents a novel risk stratification method using extreme learning machine (ELM). ELM was integrated into a scoring system to identify the risk of cardiac arrest in emergency department (ED) patients. The experiments were conducted on a cohort of 1025 critically ill patients presented to the ED of a tertiary hospital. ELM and voting based ELM (V-ELM) were evaluated. To enhance the prediction performance, we proposed a selective V-ELM (SV-ELM) algorithm. The results showed that ELM based scoring methods outperformed support vector machine (SVM) based scoring method in the receiver operation characteristic analysis.

scholarly journals LO065: Reduced length of stay and adverse events using Bier block for forearm fracture reduction in the pediatric emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S52-S53
Author(s):  
E. Fauteux-Lamarre ◽  
B. Burstein ◽  
A. Cheng ◽  
A. Bretholz
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Adverse Events ◽  
Forearm Fracture ◽  
Pediatric Emergency ◽  
Fracture Reduction ◽  
Pediatric Emergency Department ◽  
Forearm Fractures ◽  
Return Visits ◽  
Bier Block

Introduction: Distal forearm fractures are one of the most common injuries presenting to the pediatric emergency department. Procedural sedation (PS) is commonly used to provide analgesia during fracture reduction, but requires a prolonged recovery period and can be associated with adverse respiratory events. Bier block (BB) regional anesthesia is a safe alternative to PS for fracture reduction analgesia. We sought to assess the impact of BB on length of stay (LOS) and adverse events following forearm fracture reduction compared to PS. Methods: We performed a retrospective study of patients aged 6 to 18 years, presenting with forearm fractures requiring closed reduction from June 2012 to March 2014. The primary outcome measure was emergency department LOS; secondary outcomes included reduction success rates, adverse events and unscheduled return visits. Results: Two-hundred and seventy-four patients were included for analysis; 109 treated with BB, 165 underwent PS. Overall, mean LOS was 82 min shorter for patients treated in the BB group (279 min vs. 361 min, p<0.05). Sub-analysis revealed a reduced LOS among patients treated with BB for fractures involving a single bone (286 min vs. 388 min, p<0.001) and both-bones of the forearm (259 min vs. 321 min, p<0.05). Both BB and PS resulted in comparable rates of successful reduction (98.2% vs. 97.6%, p=0.74). There were no major adverse events in either group. Patients who received BB experienced significantly fewer minor adverse events (2.7% vs. 14.5%, p<0.05). Return visit rates were similar in the BB and PS groups (17.6% vs. 17.1%, p<0.05). Conclusion: Compared to PS, forearm fracture reduction performed with BB was associated with a reduced emergency department LOS and fewer adverse events, with no difference in reduction success or return visits.

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