Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients. Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression. Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07. Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.

Download Full-text

Causes of early postpartum complications that result in visits to the emergency department

PLoS ONE ◽

10.1371/journal.pone.0260101 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260101

Author(s):

Prabhpreet Hundal ◽

Rahim Valani ◽

Cassandra Quan ◽

Shayan Assaie-Ardakany ◽

Tanmay Sharma ◽

...

Keyword(s):

Emergency Department ◽

Health System ◽

Wound Care ◽

Group B Streptococcus ◽

Community Setting ◽

Retrospective Chart Review ◽

Postpartum Visit ◽

Early Postpartum ◽

Ed Visits ◽

Group B

Objective This study aimed to review the reasons why postpartum women present to the emergency department (ED) over a short term (≤10 days post-delivery) and to identify the risk factors associated with early visits to the ED. Methods This retrospective chart review included all women who delivered at a regional health system (William Osler Health System, WOHS) in 2018 and presented to the WOHS ED within 10 days after delivery. Baseline descriptive statistics were used to examine the patient demographics and identify the timing of the postpartum visit. Univariate tests were used to identify significant predictors for admission. A multivariate model was developed based on backward selection from these significant factors to identify admission predictors. Results There were 381 visits identified, and the average age of the patients was 31.22 years (SD: 4.83), with median gravidity of 2 (IQR: 1–3). Most patients delivered via spontaneous vaginal delivery (53.0%). The median time of presentation to the ED was 5.0 days, with the following most common reasons: abdominal pain (21.5%), wound-related issues (12.6%), and urinary issues (9.7%). Delivery during the weekend (OR 1.91, 95% CI 1.00–3.65, P = 0.05) was predictive of admission while Group B Streptococcus positive patients were less likely to be admitted (OR 0.22, CI 0.05–0.97, P<0.05) Conclusions This was the first study in a busy community setting that examined ED visits over a short postpartum period. Patient education on pain management and wound care can reduce the rate of early postpartum ED visits.

Download Full-text

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

BMC Emergency Medicine ◽

10.1186/s12873-021-00428-0 ◽

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.

Download Full-text

Documentation of Firearm Safety Screening During Emergency Department Visits for Assault-Related Injury

Health Promotion Practice ◽

10.1177/15248399211029340 ◽

2021 ◽

pp. 152483992110293

Author(s):

Lauren B. Mulcahy ◽

Monika K. Goyal ◽

Joanna Cohen

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Retrospective Chart Review ◽

High Risk Group ◽

Emergency Department Visits ◽

Washington Dc ◽

Increased Risk ◽

Icd 10 ◽

Ed Visits ◽

Firearm Safety

Assault-injured youth have an increased risk of future violence. Identifying firearm access among youth in the emergency department (ED) creates an opportunity for interventions aimed at reducing future violent events. We performed this study to determine the extent to which children with assault-related injuries are screened for access to firearms in the ED. We performed a retrospective chart review of all medical records from adolescent ED visits to an academic, tertiary care pediatric hospital in Washington DC with ICD-10 codes related to assault in a 3-month period. We found that among 252 assault-related encounters, none had any documentation of firearm access in the provider note, social work note, or psychiatry consultant note. Therefore, we concluded that firearm access screening is rarely documented in ED visits among patients who present for an assault, highlighting an important missed opportunity for firearm access screening among this high-risk group.

Download Full-text

Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

Download Full-text

Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020486 ◽

2021 ◽

Vol 18 (2) ◽

pp. 486

Author(s):

Pavani Rangachari ◽

Jie Chen ◽

Nishtha Ahuja ◽

Anjeli Patel ◽

Renuka Mehta

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Risk Factor ◽

Childhood Asthma ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Primary Research ◽

Ed Visits ◽

The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

Download Full-text

Opioid tapering in patients with prescription opioid use disorder: A retrospective study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.005 ◽

2017 ◽

Vol 17 (1) ◽

pp. 167-173 ◽

Cited By ~ 1

Author(s):

Kehua Zhou ◽

Peng Jia ◽

Swati Bhargava ◽

Yong Zhang ◽

Taslima Reza ◽

...

Keyword(s):

Trigger Point ◽

Retrospective Chart Review ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Office Visits ◽

Opioid Use ◽

Clinical Practices ◽

Medication Assisted Treatment ◽

Opioid Tapering ◽

Prescription Opioid Use

AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

Download Full-text

P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽

10.1017/cem.2016.259 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S106-S106

Author(s):

E. Losier ◽

A. McCollum ◽

P. Jarrett ◽

R. McCloskey ◽

P. Nicholson ◽

...

Keyword(s):

Emergency Department ◽

Assisted Living ◽

Demographic Data ◽

Care Home ◽

Functional Decline ◽

Retrospective Chart Review ◽

Community Services ◽

Level 3 ◽

Ed Visits ◽

One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

Download Full-text

Syndromic Surveillance of Emergency Department Visits for Acute Adverse Effects of Marijuana, Tri-County Health Department, Colorado, 2016-2017

Public Health Reports ◽

10.1177/0033354919826562 ◽

2019 ◽

Vol 134 (2) ◽

pp. 132-140 ◽

Cited By ~ 1

Author(s):

Grace E. Marx ◽

Yushiuan Chen ◽

Michele Askenazi ◽

Bernadette A. Albanese

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Medical Records ◽

Surveillance System ◽

Syndromic Surveillance ◽

Marijuana Use ◽

Emergency Department Visits ◽

Diagnostic Codes ◽

Icd 10 ◽

Ed Visits

Objectives: In Colorado, legalization of recreational marijuana in 2014 increased public access to marijuana and might also have led to an increase in emergency department (ED) visits. We examined the validity of using syndromic surveillance data to detect marijuana-associated ED visits by comparing the performance of surveillance queries with physician-reviewed medical records. Methods: We developed queries of combinations of marijuana-specific International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes or keywords. We applied these queries to ED visit data submitted through the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) syndromic surveillance system at 3 hospitals during 2016-2017. One physician reviewed the medical records of ED visits identified by ≥1 query and calculated the positive predictive value (PPV) of each query. We defined cases of acute adverse effects of marijuana (AAEM) as determined by the ED provider’s clinical impression during the visit. Results: Of 44 942 total ED visits, ESSENCE queries detected 453 (1%) as potential AAEM cases; a review of 422 (93%) medical records identified 188 (45%) true AAEM cases. Queries using ICD-10 diagnostic codes or keywords in the triage note identified all true AAEM cases; PPV varied by hospital from 36% to 64%. Of the 188 true AAEM cases, 109 (58%) were among men and 178 (95%) reported intentional use of marijuana. Compared with noncases of AAEM, cases were significantly more likely to be among non-Colorado residents than among Colorado residents and were significantly more likely to report edible marijuana use rather than smoked marijuana use ( P < .001). Conclusions: ICD-10 diagnostic codes and triage note keyword queries in ESSENCE, validated by medical record review, can be used to track ED visits for AAEM.

Download Full-text

Patterns of Support Service, Emergency Department, and Hospital Utilization in Patients with Advanced Cancer: A Descriptive Study

Journal of Palliative Care ◽

10.1177/0825859719851492 ◽

2019 ◽

Vol 35 (1) ◽

pp. 34-39

Author(s):

Caitlyn H. McNaughton ◽

Michael Horst ◽

Emily Gehron ◽

Shanthi Sivendran ◽

Julie Nguyen ◽

...

Keyword(s):

Advanced Cancer ◽

Support Services ◽

Severe Disease ◽

Community Setting ◽

Retrospective Chart Review ◽

Support Service ◽

Advanced Cancer Patients ◽

Individual Support ◽

Nurse Navigator ◽

Ed Visits

Context: Palliative care in oncology provides multiple benefits, however access to specialty palliative clinicians is limited in community cancer centers. Individual support services are more often available, but little is known on the utilization and impact of these services. Objectives: To describe the utilization of outpatient support services in the advanced cancer population and the association with ED and hospital use in a community setting. Methods: A retrospective chart review of 314 patients with advanced cancer of lung, gastrointestinal, genitourinary, and gynecologic origin was conducted. Data collected included demographics, descriptive data, type and number of support services (symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor) within 90 days of diagnosis and descriptions of ED visits/hospitalizations within 12 months of diagnosis. Support services were available to patients by referral. Results: 29.6% of patients were deceased within 6 months and were considered to have severe disease. Patients with severe disease had a significantly greater mean number of support services than patients with non-severe disease (8.9 vs 6.0, p=0.001) and had a greater mean number of visits per year to the ED (6.4 vs 1.8, p<0.001). A greater proportion of patients with severe disease had palliative consultations (48.9% vs 21.7%, p<0.001), but 65.5% of palliative consultations occurred after an ED or hospital visit. Conclusion: Our data demonstrated that advanced cancer patients with severe disease had increased healthcare utilization in all areas measured. Despite high utilization, outpatient support services used in a reactive manner were not effective in reducing ED or hospital visits.

Download Full-text

Chronic Pain in the Emergency Department: A Pilot Interdisciplinary Program Demonstrates Improvements in Disability, Psychosocial Function, and Healthcare Utilization

Pain Research and Management ◽

10.1155/2018/1875967 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Joshua A. Rash ◽

Patricia A. Poulin ◽

Yaadwinder Shergill ◽

Heather Romanow ◽

Jeffrey Freeman ◽

...

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Pain Catastrophizing ◽

Tertiary Care ◽

Care Plan ◽

Care Hospital ◽

Opioid Use ◽

Care Plans ◽

Individualized Care ◽

Ed Visits

Objective. To evaluate the feasibility of an individualized interdisciplinary chronic pain care plan as an intervention to reduce emergency department (ED) visits and improve clinical outcomes among patients who frequented the ED with concerns related to chronic pain. Methods. A prospective cohort design was used in an urban tertiary care hospital. As a pilot program, fourteen patients with chronic pain who frequented the ED (i.e., >12 ED visits within the last year, of which ≥50% were for chronic pain) received a rapid interdisciplinary assessment and individualized care plan that was uploaded to an electronic medical record system (EMR) accessible to the ED and patient’s primary care provider. Patients were assessed at baseline and every three months over a 12-month period. Primary outcomes were self-reported pain and function assessed using psychometrically valid scales. Results. Nine patients completed 12-month follow-up. Missing data and attrition were handled using multiple imputation. Patients who received the intervention reported clinically significant improvements in pain, function, ED visits, symptoms of depression, pain catastrophizing, sleep, health-related quality of life, and risk of future aberrant opioid use. Discussion. Individualized care plans uploaded to an EMR may be worth implementing in hospital EDs for high frequency visitors with chronic pain.

Download Full-text