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Hsuan C, Segel JE, Hsia RY, Wang Y, Rogowski J. Association of emergency department crowding with inpatient outcomes. Health Serv Res 2023; 58:828-843. [PMID: 36156243 PMCID: PMC10315392 DOI: 10.1111/1475-6773.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine the association of higher emergency department (ED) census with inpatient outcomes on the day of discharge (inpatient length of stay, in-hospital mortality, ED revisits, and readmissions). DATA SOURCES AND STUDY SETTING All-payer ED and inpatient discharge data and hospital characteristics data from all non-federal, general, and acute care hospitals in the state of California from October 1, 2015 to December 31, 2017. STUDY DESIGN In retrospective data analysis, we examined whether ED census was associated with inpatient outcomes for all inpatients, including those not admitted through the ED. The main predictor variable was ED census on day of discharge, categorized based on hospital year and day of week. Separate linear regression models with robust SEs and hospital fixed effects examined the association of ED census on inpatient outcomes (length of stay, 3-day ED revisit, 30-day all-cause readmission, in-hospital mortality), controlling for patient and visit-level factors. We stratified analyses by whether admission was elective or unscheduled. EXTRACTION METHODS Inpatient discharges in non-federal, general medical hospitals with EDs. PRINCIPAL FINDINGS We examined 5,784,253 discharges. The adjusted model showed that, compared to when the ED was below the median, higher ED census on the day of discharge was associated with longer inpatient length of stay, lower readmissions, and higher in-hospital mortality (90th percentile for length of stay: +0.8% [95% confidence interval, CI: +0.6% to +1.1%]; readmissions: -0.59 percentage points [or -5.6%] [95% CI: -0.0071 to -0.0048]; mortality: +0.14 percentage points [or +5.4%] [95% CI: +0.0009 to +0.0018]). [Correction added on 18 November 2022, after first online publication: '[odds rato, OR -5.6%]' and '[OR +5.4%]' of the preceding sentence have been corrected to '[or -5.6%]' and '[or +5.4%]', respectively, in this version.] Results for length of stay were primarily driven by patients with elective admissions, while results for readmissions and in-hospital mortality were primarily driven by patients with unscheduled admissions. CONCLUSIONS This study suggests that ED crowding may affect inpatients throughout the hospital, even patients who are already admitted to the hospital.
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Affiliation(s)
- Charleen Hsuan
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Joel E. Segel
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
- Penn State Cancer InstituteHersheyPennsylvaniaUSA
- Department of Public Health SciencesPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Renee Y. Hsia
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yinan Wang
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Jeannette Rogowski
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
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Comparison of outcomes in emergency department revisiting patients before and after coronavirus disease 2019 epidemic. Eur J Emerg Med 2022; 29:373-379. [PMID: 35620815 DOI: 10.1097/mej.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND IMPORTANCE The outbreak of COVID-19 challenged the global health system and specifically impacted the emergency departments (EDs). Studying the quality indicators of ED care under COVID-19 has been a necessary task, and ED revisits have been used as an indicator to monitor ED performance. OBJECTIVES The study investigated whether discrepancies existed among ED revisiting cases before and after COVID-19 and whether the COVID-19 epidemic was a predictor of poor outcomes of ED revisits. DESIGN Retrospective study. SETTINGS AND PARTICIPANTS We used electronic health records data from a tertiary medical center. Data of patients with 72-h ED revisit after the COVID-19 epidemic were collected from February 2020 to June 2020 and compared with those of patients before COVID-19, from February 2019 to June 2019. OUTCOME MEASURES AND ANALYSIS The investigated outcomes included hospital admission, ICU admission, out-of-hospital cardiac arrest, and subsequent inhospital mortality. Univariate and multivariate logistic regression models were used to identify independent predictors of 72-h ED revisit outcomes. MAIN RESULTS In total, 1786 patients were enrolled in our study - 765 in the COVID group and 1021 in the non-COVID group. Compared with the non-COVID group, patients in the COVID group were younger (53.9 vs. 56.1 years old; P = 0.002) and more often female (66.1% vs. 47.3%; P < 0.001) and had less escalation of triage level (11.6% vs. 15.0%; P = 0.041). The hospital admission and inhospital mortality rates in the COVID and non-COVID groups were 33.9% vs. 32.0% and 2.7% vs. 1.5%, respectively. In the logistic regression model, the COVID-19 period was significantly associated with inhospital mortality (adjusted odds ratio, 2.289; 95% confidence interval, 1.059-4.948; P = 0.035). CONCLUSION Patients with 72-h ED revisits showed distinct demographic and clinical patterns before and after the COVID-19 epidemic; the COVID-19 period was an independent predictor of increased inhospital mortality.
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Alaama AO, Alsulaimani HM, Alghamdi H, Alrehaili MM, Alsaud RN, Almuqati AM, Bukhari NR, Alhassan A, Bakhsh NM, Alwadei MH. Shock Index and Characteristics of "Bounce-Back" Patients in the Emergency Department of King Abdullah Medical City (KAMC): A Retrospective Analysis. Cureus 2022; 14:e29692. [PMID: 36321042 PMCID: PMC9616011 DOI: 10.7759/cureus.29692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background "Bounce back" patients is a term used to refer to patients returning to the emergency department within 72 hours after the first visit. This can be attributed to various factors related to diagnosis, management, or the health care system. Objective This study sought to evaluate the extent of bounce-back patients in the emergency department of King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, and then explore the possible relationship between shock index (SI) and bounce-back patients. Methods This is a retrospective chart review of the electronic system among patients who have returned to the emergency department within 72 hours from the index visit. All records were reviewed from May 2019 to May 2021. Vital signs were collected to calculate the shock index (heart rate/systolic blood pressure). The data were analyzed by SPSS Statistics v.27.0 (IBM Corp., Armonk, NY). Results A total of (506) responses were analyzed. The median age was 56 years with an IQR of 40-67, and males represented 55.3%. Around three-quarters of the second complaints (76.9%) were related to the index visit. The durations between the visits were as follows: 51.8% within 24 hours, 30.2% within 25-48 hours, and 18% within 49-72 hours. The median and IQR for shock index were 0.67 and 0.59-0.80 respectively, while the median and IQR for reverse shock index were 1.49 and 1.25-1.71 respectively. Diabetes and the duration between the two visits were associated with the complaints (p-value=0.005, p-value=0.011) respectively. Conclusion The majority of bounce-back cases occurred within the first 24 hours in our sample. Hypertension, diabetes, and ischemic heart diseases were the most prevalent comorbidities among the bounce-back patients. The majority of bounce-back patients (76.9%) presented with complaints related to the index visit.
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Affiliation(s)
| | | | | | | | - Reham N Alsaud
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | | | - Nuha R Bukhari
- Emergency Medicine, Security Forces Hospital, Makkah, SAU
| | - Anas Alhassan
- Emergency Medicine, King Abdullah Medical City, Makkah, SAU
| | - Noura M Bakhsh
- Emergency Medicine, King Fahad General Hospital, Makkah, SAU
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Daymont C, Balamuth F, Scott HF, Bonafide CP, Brady PW, Depinet H, Alpern ER. Elevated Heart Rate and Risk of Revisit With Admission in Pediatric Emergency Patients. Pediatr Emerg Care 2021; 37:e185-e191. [PMID: 30020247 PMCID: PMC6335199 DOI: 10.1097/pec.0000000000001552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to identify emergency department (ED) heart rate (HR) values that identify children at elevated risk of ED revisit with admission. METHODS We performed a retrospective cohort study of patients 0 to 18 years old discharged from a tertiary-care pediatric ED from January 2013 to December 2014. We created percentile curves for the last recorded HR for age using data from calendar year 2013 and used receiver operating characteristic (ROC) curves to characterize the performance of the percentiles for predicting ED revisit with admission within 72 hours. In a held-out validation data set (calendar year 2014 data), we evaluated test characteristics of last-recorded HR-for-age cut points identified as promising on the ROC curves, as well as those identifying the highest 5% and 1% of last recorded HRs for age. RESULTS We evaluated 183,433 eligible ED visits. Last recorded HR for age had poor discrimination for predicting revisit with admission (area under the curve, 0.61; 95% confidence interval, 0.58-0.63). No promising cut points were identified on the ROC curves. Cut points identifying the highest 5% and 1% of last recorded HRs for age showed low sensitivity (10.1% and 2.5%) with numbers needed to evaluate of 62 and 50, respectively, to potentially prevent 1 revisit with admission. CONCLUSIONS Last recorded ED HR discriminates poorly between children who are and are not at risk of revisit with admission in a pediatric ED. The use of single-parameter HR in isolation as an automated trigger for mandatory reevaluation prior to discharge may not improve revisit outcomes.
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Affiliation(s)
- Carrie Daymont
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Fran Balamuth
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Halden F Scott
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher P Bonafide
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Holly Depinet
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Qureshi RS, Qureshi I, Abbasy M, Malik WA, Ponnapan B, Gauhar A, Chaudhry S, Pathan S, Jenkins D, Thomas SH. Unexpected return visits to emergency department: A healthcare quality management challenge. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2018.1500223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Curcio J, Little A, Bolyard C, Gupta A, Secic M, Sharkey M. Emergency Department "Bounce-Back" Rates as a Function of Emergency Medicine Training Year. Cureus 2020; 12:e10503. [PMID: 33094046 PMCID: PMC7571604 DOI: 10.7759/cureus.10503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Since the 1990s, the emergency department (ED) unscheduled return visit (URV), or “bounce-back,” has been used as a quality of care measurement. During that time, resident training was also scrutinized and uncovered a need for closer resident supervision, especially of second-year residents. Over the years, bounce-backs have continued to be analyzed with vigor, but research on residency training and supervision has lagged with few studies concurrently investigating residency supervision and bounce-backs. Other literature on resident supervision suggests that with adequate attending supervision, resident performance is equivalent to attending performance. With that in mind, it was hypothesized that resident bounce-back rates will be equivalent to attending bounce-back rates, and there will be no change among residency years. The primary objective of this study was to determine the rate at which patients are seen as a bounce-back visit within 72 hours of their initial visit to a community hospital ED during the study time frame. The secondary aims were to evaluate if the ED bounce-back rate is impacted by training level (residents or attending) and to describe bounce-back patient characteristics, including primary complaint/disease, age, comorbidities and issues with compliance. Methods: A retrospective chart review of 1000 charts was conducted from September 2015 to September 2017. Charts were randomly selected by the Quality & Patient Safety (QPS) team and, after applying inclusion/exclusion criteria, 732 charts were analysed. Inclusion criteria included age ≥ 18 years, patients treated by an Emergency Medicine (EM) resident during their initial visit and patients with a “discharge” disposition. Exclusion criteria included patients seen as a scheduled return visit (e.g., two-day return for blood pregnancy recheck, wound check, etc.). Demographics, initial visit variables, comorbidities and bounce-back data were collected based on electronic record query or chart review. Data was analysed using means, standard deviations, medians and ranges for continuous variables. Logistic regression modelling techniques were used to examine factors that affect whether the patient had a bounce-back visit. Results: The rate of URVs within 72 hours of the patient's initial visit was 4.65%. PGY1 and PGY2's bounce-back rate was 3.8% and 3.6%, respectively, and PGY3 and PGY4's bounce-back rate was 5.7% and 5.6%, respectively (p-value=.63). There was no statistically significant change among residency years. Most bounce-back characteristics analysed including primary complaint, age, and comorbidities demonstrated no statistical significance in the increased rate of bounce-back except for patients with a history of tobacco abuse, alcohol abuse and chronic pain. Current smokers were 6.5 times more likely to bounce back than former smokers (odds ratio=6.485, 95% confidence interval = 2.089 to 20.133, p-value=0.0012) and those with chronic pain were 2.5 times more likely to bounce back than those without chronic pain (odds ratio=2.518, 95% confidence interval =1.029 to 6.164, p=0.0431). Conclusion: EM residency training year does not increase the frequency of bounce-backs in a community hospital ED. Finally, patients with substance abuse and chronic pain were more likely to bounce back.
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Affiliation(s)
- Janine Curcio
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Andrew Little
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | | | - Anand Gupta
- Biostatistics, OhioHealth Research Institute, Columbus, USA
| | - Michelle Secic
- Biostatistics, OhioHealth Research Institute, Columbus, USA
| | - Meenal Sharkey
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
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Abstract
Emergency department crowding is a multifactorial issue with causes intrinsic to the emergency department and to the health care system. Understanding that the causes of emergency department crowding span this continuum allows for a more accurate analysis of its effects and a more global consideration of potential solutions. Within the emergency department, boarding of inpatients is the most appreciable effect of hospital-wide crowding, and leads to further emergency department crowding. We explore the concept of emergency department crowding, and its causes, effects, and potential strategies to overcome this problem.
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Affiliation(s)
- James F Kenny
- Milstein Adult Emergency Department, NewYork-Presbyterian Hospital, Department of Emergency Medicine, Columbia University Irving Medical Center, 622 West 168th Street, Suite VC2-260, New York, NY 10032, USA.
| | - Betty C Chang
- Milstein Adult Emergency Department, NewYork-Presbyterian Hospital, Department of Emergency Medicine, Columbia University Irving Medical Center, 622 West 168th Street, Suite VC2-260, New York, NY 10032, USA
| | - Keith C Hemmert
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Ground Floor Ravdin, Philadelphia PA 19104, USA
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Rasouli HR, Aliakbar Esfahani A, Abbasi Farajzadeh M. Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study. BMC Emerg Med 2019; 19:62. [PMID: 31666023 PMCID: PMC6822347 DOI: 10.1186/s12873-019-0275-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Emergency Department (ED) overcrowding adversely affects patients’ health, accessibility, and quality of healthcare systems for communities. Several studies have addressed this issue. This study aimed to conduct a systematic review study concerning challenges, lessons and way outs of clinical emergencies at hospitals. Methods Original research articles on crowding of emergencies at hospitals published from 1st January 2007, and 1st August 2018 were utilized. Relevant studies from the PubMed and EMBASE databases were assessed using suitable keywords. Two reviewers independently screened the titles, abstracts and the methodological validity of the records using data extraction format before their inclusion in the final review. Discussions with the senior faculty member were used to resolve any disagreements among the reviewers during the assessment phase. Results Out of the total 117 articles in the final record, we excluded 11 of them because of poor quality. Thus, this systematic review synthesized the reports of 106 original articles. Overall 14, 55 and 29 of the reviewed refer to causes, effects, and solutions of ED crowding, respectively. The review also included four articles on both causes and effects and another four on causes and solutions. Multiple individual patients and healthcare system related challenges, experiences and responses to crowding and its consequences are comprehensively synthesized. Conclusion ED overcrowding is a multi-facet issue which affects by patient-related factors and emergency service delivery. Crowding of the EDs adversely affected individual patients, healthcare delivery systems and communities. The identified issues concern organizational managers, leadership, and operational level actions to reduce crowding and improve emergency healthcare outcomes efficiently.
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Affiliation(s)
- Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Ali Aliakbar Esfahani
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Montoy JCC, Tamayo-Sarver J, Miller GA, Baer AE, Peabody CR. Predicting Emergency Department "Bouncebacks": A Retrospective Cohort Analysis. West J Emerg Med 2019; 20:865-874. [PMID: 31738713 PMCID: PMC6860392 DOI: 10.5811/westjem.2019.8.43221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The short-term return visit rate among patients discharged from emergency departments (ED) is a quality metric and target for interventions. The ability to accurately identify which patients are more likely to revisit the ED could allow EDs and health systems to develop more focused interventions, but efforts to reduce revisits have not yet found success. Whether patients with a high number of ED visits are at increased risk of a return visit remains underexplored. METHODS This was a population-based, retrospective, cohort study using administrative data from a large physician partnership. We included patients discharged from EDs from 80 hospitals in seven states from July 2014 - June 2016. We performed multivariable logistic regression of short-term return visits on patient, visit, hospital, and community characteristics. The primary outcome was the proportion of patients who had a return visit within 14 days of an index ED visit. RESULTS Among 6,699,717 index visits, the overall risk of 14-day revisit was 12.6%. Frequent visitors accounted for 18.7% of all visits and 40.2% of all 14-day revisits. Frequent visitor status was associated with the highest odds of a revisit (odds ratio [OR] 3.06; 95% confidence interval [CI], 3.041 - 3.073). Other predictors of revisits were cellulitis (OR 2.131; 95% CI, 2.106 - 2.156), alcohol-related disorders (OR 1.579; 95%CI, 1.548 - 1.610), congestive heart failure (OR 1.175; 95% CI, 1.126 - 1.226), and public insurance (Medicaid OR 1.514; 95% CI, 1.501 - 1.528; Medicare OR 1.601; 95% CI, 1.583 - 1.620). CONCLUSION Previous ED use - even a single previous visit - was a stronger predictor of a return visit than any other patient, hospital, or community characteristic. Clinicians should consider previous ED use when considering treatment decisions and risk of return visit, as should stakeholders targeting patients at risk of a return visit.
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Affiliation(s)
- Juan Carlos C Montoy
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | | | | | - Amy E Baer
- Vituity Healthcare, Emeryville, California
| | - Christopher R Peabody
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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10
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Rasouli HR, Esfahani AA, Nobakht M, Eskandari M, Mahmoodi S, Goodarzi H, Abbasi Farajzadeh M. Outcomes of Crowding in Emergency Departments; a Systematic Review. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e52. [PMID: 31602435 PMCID: PMC6785211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Emergency Department (ED) crowding is a global public health phenomenon affecting access and quality of care. In this study, we seek to conduct a systematic review concerning the challenges and outcomes of ED crowding. METHODS This systematic review utilized original research articles published from 1st January 2007, to 1st January 2019. Relevant articles from the PubMed (MEDLINE), EMBASE, and Google scholar databases were extracted using predesigned keywords. Following the PRISMA guidelines, two reviewers independently evaluated the quality of the studies using Critical Appraisal Skills Programme for cohort studies and qualitative studies, and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument for studies. RESULTS Out of the total of 73 articles in the final record, we excluded 15 of them because of poor quality. This systematic review synthesized the reports of 58 original articles. The outcomes of multiple individual patients and healthcare-related challenges are comprehensively assessed. CONCLUSIONS ED crowding affects individual patients, healthcare systems and communities at large. The negative influences of crowding on healthcare service delivery result in delayed service delivery, poor quality care, and inefficiency; all negatively affecting the emergency patients' healthcare outcomes, in turn.
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Affiliation(s)
- Hamid Reza Rasouli
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Aliakbar Esfahani
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Nobakht
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Eskandari
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sardollah Mahmoodi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hassan Goodarzi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi Farajzadeh
- Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Corresponding author: Mohsen Abbasi Farajzadeh; Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. E-mail: , Tel: +9888053766, Mobile: +989368507054
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Tarumi Y, Harada T, Saito T, Hiroshige J, Dohi K. Usefulness of bounce-back admission in monitoring the quality of practice in the emergency department. Ther Clin Risk Manag 2019; 15:647-658. [PMID: 31190845 PMCID: PMC6511631 DOI: 10.2147/tcrm.s193863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/19/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Recently, unscheduled readmissions after discharge from the emergency department (ED) (bounce-back admissions, BBAs) have been monitored as a hospital performance measure in countries other than Japan. It has been suggested that BBAs may be caused by errors in diagnoses or treatments. Purpose: This retrospective cohort study aimed to evaluate BBAs and improve the quality of medical care in the ED of Showa University Hospital by analyzing the data of adult patients (≥18 years) with index visits to the ED of Showa University Hospital between June 2011 and May 2013 (n=15,069). Patients and methods: Patients were registered and followed up for unscheduled admissions to this hospital within 7 days. In order to understand the reasons for BBAs, individual diagnoses upon BBA were compared to the corresponding diagnoses upon discharge. Results: Among the 11,669 discharged patients, 180 patients were admitted within 3 days after discharge (3-day BBAs), and 257 were admitted within 7 days after discharge (7-day BBAs). The main diagnoses upon admission (BBA) were pneumonia or exacerbation of chronic obstructive pulmonary disease (COPD) or asthma (n=40, 16%), cholecystitis or cholangitis (n=21, 8.2%), and urinary tract infection (n=16, 6.2%). Among the 7-day BBA cases, 117 patients had similar and 110 patients had different diagnoses upon discharge and admission; in the remaining 30 cases, the results could not be ascertained owing to incomplete diagnostic data. In the cases of pneumonia, exacerbation of COPD or asthma, and colitis or enterocolitis, there was a significantly higher “similar” diagnoses than “different”, while the reverse was true for cases of stroke, ileus or bowel obstruction, and meningitis. These results were shared with the ED staff, and similar surveillances were periodically conducted. The frequency of admission within 7 days after discharge continuously declined from 2013 to 2016. Conclusion: Analyzing the discharge and admission diagnoses may help ED staff to understand the reasons for common errors in order to follow the plan-do-check-act cycle of medical care in the ED.
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Affiliation(s)
- Yoko Tarumi
- Department of General Medicine, Showa University, Tokyo 142-8555, Japan
| | - Taku Harada
- Department of General Medicine, Showa University, Tokyo 142-8555, Japan
| | - Tsukasa Saito
- Department of General Medicine, Showa University, Tokyo 142-8555, Japan
| | - Juichi Hiroshige
- Department of General Medicine, Showa University, Tokyo 142-8555, Japan
| | - Kenji Dohi
- Department of Emergency, Disaster and Critical Care Medicine, Showa University, Tokyo 142-8555, Japan
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Mataloni F, Pinnarelli L, Perucci CA, Davoli M, Fusco D. Characteristics of ED crowding in the Lazio Region (Italy) and short-term health outcomes. Intern Emerg Med 2019; 14:109-117. [PMID: 29802522 PMCID: PMC6329731 DOI: 10.1007/s11739-018-1881-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
The effect of emergency department (ED) crowding on patient care has been studied for several years in the scientific literature. We evaluate the association between ED crowding and short-term mortality and hospitalization in the Lazio region (Italy) using two different measures. A cohort of visits in the Lazio region ED during 2012-2014 was enrolled. Only discharged patients were selected. ED crowding was estimated using two measures, length of stay (LOS), and Emergency Department volume (EDV). LOS was defined as the interval of time from entrance to discharge; EDV was defined at the time of each new entrance in ED. The outcomes under study were mortality and hospitalization within 7 days from ED discharge. A multivariate logistic model was performed (Odds Ratios, ORs, 95% CI). The cohort includes 2,344,572 visits. ED crowding is associated with an increased risk of short-term hospitalization using both LOS and EDV as exposures (LOS 1-2 h: OR = 1.71, 95% CI 1.66-1.76, LOS 2-5 h: OR = 1.38, 95% CI 1.34-1.43, LOS > 5 h OR = 1.45 95% CI 1.40-1.50 compared to patients with 1 h of LOS; EDV 75°-95° percentile: OR = 1.02, 95% CI 0.99-1.05 and EDV > 95° percentile: OR = 1.06, 95% CI 1.01-1.11 compared to patients with a EDV < 75° percentile upon arrival). Increased risk of short-term mortality is found with increasing level of LOS. High levels of EDV at the time of patients' arrival and longer LOS in ED are associated with greater risks of hospitalization for patients discharged 7 days before. LOS in ED is also associated with an increased risk of mortality.
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Affiliation(s)
- Francesca Mataloni
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Luigi Pinnarelli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147, Rome, Italy
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Stephens AS, Broome RA. Impact of emergency department occupancy on waiting times, rates of admission and representation, and length of stay when hospitalised: A data linkage study. Emerg Med Australas 2018; 31:555-561. [DOI: 10.1111/1742-6723.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandre S Stephens
- Public Health Observatory Sydney Local Health District, Sydney New South Wales Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney Sydney New South Wales Australia
- Research Office, Northern New South Wales Local Health District Lismore New South Wales Australia
| | - Richard A Broome
- Public Health Observatory Sydney Local Health District, Sydney New South Wales Australia
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Hayward J, Hagtvedt R, Ma W, Gauri A, Vester M, Holroyd BR. Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department. West J Emerg Med 2018; 19:912-918. [PMID: 30429921 PMCID: PMC6225947 DOI: 10.5811/westjem.2018.8.38225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/26/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). Methods We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 - December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA. Results Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.
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Affiliation(s)
- Jake Hayward
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada
| | - Warren Ma
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Aliyah Gauri
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Michael Vester
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Brian R. Holroyd
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
- Alberta Health Services, Emergency Strategic Clinical Network, Edmonton, Alberta, Canada
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Hayward J, Hagtvedt R, Ma W, Gauri A, Vester M, Holroyd B. Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department. West J Emerg Med 2018. [DOI: 10.5811/westjem.2018.38225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jake Hayward
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada
| | - Warren Ma
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Aliyah Gauri
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Michael Vester
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Brian Holroyd
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada; Alberta Health Services, Emergency Strategic Clinical Network, Edmonton, Alberta, Canada
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Abstract
OBJECTIVES Little evidence exists in the pediatric trauma literature regarding what factors are associated with re-presentation to the hospital for patients discharged from the emergency department (ED). METHODS This was a retrospective cohort study of trauma system activations at a pediatric trauma center from June 30, 2007, through June 30, 2013, who were subsequently discharged from the ED or after a brief inpatient stay. Returns within 30 days were reviewed. χ, Student t test, and univariate logistical regression were used to compare predictive factors for those returning and not. RESULTS One thousand eight hundred sixty-three patient encounters were included in the cohort. Seventy-two patients (3.9%) had at least 1 return visit that was related to the original trauma activation. Age, sex, language, race/ethnicity, ED length of stay, arrival mode, level of trauma activation, and transfer from an outside hospital did not vary significantly between the groups. Patients with public insurance were almost 2 times more likely to return compared with those with private insurance (odds ratio, 1.92; 95% confidence interval, 1.11-3.35). Income by zip code was associated with the risk of a return visit, with patients in neighborhoods at less than the 50th percentile income twice as likely to return to the ED (odds ratio, 2.15; 95% confidence interval, 1.30-3.54). CONCLUSIONS Patients with public insurance and those from low-income neighborhoods were significantly more likely to return to the ED after trauma system activation. These data can be used to target interventions to decrease returns in high-risk trauma patients.
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Burokienė S, Raistenskis J, Burokaitė E, Čerkauskienė R, Usonis V. Factors Determining Parents' Decisions to Bring Their Children to the Pediatric Emergency Department for a Minor Illness. Med Sci Monit 2017; 23:4141-4148. [PMID: 28845042 PMCID: PMC5584823 DOI: 10.12659/msm.902639] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The number of children visiting Emergency Departments (EDs) is increasing in Lithuania; therefore, the aim of this study was to determine the factors influencing the parental decision to bring their child to the ED for a minor illness that could be managed in a primary healthcare setting, and to compare parents’ and medical professionals’ attitudes toward a child’s health status and need for urgent care. Material/Methods A prospective observational study was performed at the tertiary-level teaching Children’s Hospital in Vilnius. A total of 381 patients’ parents were interviewed using an original questionnaire based on Andersen’s behavioral model of healthcare utilization; in addition, the medical records of patients were reviewed to identify factors that might have an impact on parental decisions to bring their child to the ED for a minor health problem. The study participants were enrolled from October 1, 2013 to August 31, 2014. The urgency of medical care needed to be provided to the patients was evaluated by a tertiary-level triage system. Results Based on the assessment of the triage nurses, the need for emergency care to patients was distributed as follows: 298 patients (78.2%) needed non-urgent care and 83 patients (21.8%) needed urgent care. More than one-third (38.8%) of the parents reported that they came to the ED due to their child’s urgent care need and worsened child’s health; however, the opinion of ED professionals indicated only a fifth of patients required urgent care. Parents who brought their children to the ED without physician referral were five times more likely to visit the ED during evening hours and on weekends (OR=5.416; 95% CI, 3.259–8.99; p<0.001). The decision to come to the ED without visiting a primary care physician was made more often by parents with a higher income (OR=2.153; 95% CI, 1.167–3.97) and those who came due to children having rash (OR=4.303; 95% CI, 1.089–16.995) or fever (OR=3.463; 95% CI, 1.01–11.876). Older parents were 2.07 (95% CI, 1.1224–3.506) times more likely to evaluate their child’s health unfavorably than younger parents. Conclusions We identified predisposing, enabling, and need factors that influenced the parents’ decision to bring their child to the ED for minor health problems that could be managed by a primary care physician. Parents assessed their child’s condition more critically and thought that their child required urgent medical aid more frequently than healthcare professionals.
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Affiliation(s)
- Sigita Burokienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - Juozas Raistenskis
- Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania.,Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Emilija Burokaitė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantė Čerkauskienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - Vytautas Usonis
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
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