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Greene L, Crotty M, Whitehead C, Rahja M, Murad J, Dang K, Partington A, Laver K. Assessing the reach and safety of an innovative urgent care service tailored to older adults. Australas J Ageing 2024; 43:387-393. [PMID: 38268230 DOI: 10.1111/ajag.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Abstract
Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician-led treatment pathways consisting of a ward-based treatment centre and an in-home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians.
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Affiliation(s)
- Leanne Greene
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Javaria Murad
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kwok Dang
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Andrew Partington
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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Farimani RM, Karim H, Atashi A, Tohidinezhad F, Bahaadini K, Abu-Hanna A, Eslami S. Models to predict length of stay in the emergency department: a systematic literature review and appraisal. BMC Emerg Med 2024; 24:54. [PMID: 38575857 PMCID: PMC10996208 DOI: 10.1186/s12873-024-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Prolonged Length of Stay (LOS) in ED (Emergency Department) has been associated with poor clinical outcomes. Prediction of ED LOS may help optimize resource utilization, clinical management, and benchmarking. This study aims to systematically review models for predicting ED LOS and to assess the reporting and methodological quality about these models. METHODS The online database PubMed, Scopus, and Web of Science (10 Sep 2023) was searched for English language articles that reported prediction models of LOS in ED. Identified titles and abstracts were independently screened by two reviewers. All original papers describing either development (with or without internal validation) or external validation of a prediction model for LOS in ED were included. RESULTS Of 12,193 uniquely identified articles, 34 studies were included (29 describe the development of new models and five describe the validation of existing models). Different statistical and machine learning methods were applied to the papers. On the 39-point reporting score and 11-point methodological quality score, the highest reporting scores for development and validation studies were 39 and 8, respectively. CONCLUSION Various studies on prediction models for ED LOS were published but they are fairly heterogeneous and suffer from methodological and reporting issues. Model development studies were associated with a poor to a fair level of methodological quality in terms of the predictor selection approach, the sample size, reproducibility of the results, missing imputation technique, and avoiding dichotomizing continuous variables. Moreover, it is recommended that future investigators use the confirmed checklist to improve the quality of reporting.
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Affiliation(s)
| | - Hesam Karim
- Department of Health Information Management, Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Atashi
- E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kambiz Bahaadini
- Department of Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Ameen Abu-Hanna
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands.
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Eccleston C, Marsden E, Craswell A, Sweeny A, Howell N, Wallis M, Crilly J. Impact of COVID-19 state-wide lockdown on older adult presentations to Queensland emergency departments. Emerg Med Australas 2023; 35:799-808. [PMID: 37160322 DOI: 10.1111/1742-6723.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/25/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To determine the impact of the COVID-19 state-wide lockdown on ED presentations for older adults in Queensland, Australia. METHODS A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre-pandemic average), 2020 (COVID-19 state-wide lockdown) and 2021 (post-state-wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. RESULTS There was 380 854 older adult presentations. During the COVID-19 state-wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867-0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post-state-wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21-1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre-pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. CONCLUSION There was a significant decrease in presentation rates to EDs during the COVID-19 state-wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post-state-wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic.
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Affiliation(s)
- Cassanne Eccleston
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Elizabeth Marsden
- RADAR Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Craswell
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Amy Sweeny
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Faculty of Medicine, Griffith University, Brisbane, Queensland, Australia
- School of Dentistry and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Naomi Howell
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Marianne Wallis
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Greene L, Lane R, Crotty M, Whitehead C, Potter E, Bierer P, Laver K. Evaluating a new emergency department avoidance service for older people: patient and relative experiences. Emerg Med J 2023; 40:641-645. [PMID: 37400224 PMCID: PMC10447360 DOI: 10.1136/emermed-2022-212949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND High emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged 65 and above, the Southern Adelaide Local Health Network introduced an innovative ED avoidance service. This study assessed the acceptability of the service among its users. METHOD The Complex And RestorativE (CARE) Centre is a six-bed unit staffed by a multidisciplinary geriatric team. Patients are transported directly to CARE after calling for an ambulance and being triaged by a paramedic. The evaluation took place between September 2021 and September 2022. Semi-structured interviews were conducted with patients and relatives who had accessed the service. Data analysis was performed using a six-step thematic analysis. RESULTS Seventeen patients and 15 relatives were interviewed, who described the experience of 32 attendances to the urgent CARE centre between them. Patients accessed the service for several reasons but over half were associated with falls. There was a hesitation to call emergency services for several reasons, the primary being long wait times in ED and/or the prospect of an overnight stay in hospital. Some individuals attempted to contact their General Practitioner (GP) for the presenting problem but were unable to get a timely appointment. Most participants had previously attended a local ED and had a negative experience. All individuals reported favouring the CARE centre over the traditional ED for numerous reasons including a quieter and safer environment and specially trained geriatric staff who were less rushed than ED staff. Several participants would have appreciated a standardised follow-up process after discharge. CONCLUSION Our findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience.
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Affiliation(s)
- Leanne Greene
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Lane
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Potter
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Petra Bierer
- Rehabilitation, Aged and Extended Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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Belayneh AG, Temachu YZ, Messelu MA, Gebrie MH. Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia. BMC Emerg Med 2023; 23:34. [PMID: 36977998 PMCID: PMC10053138 DOI: 10.1186/s12873-023-00804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Prolonged length of stay at the emergency department interferes with the main goal of emergency care and results in adverse patient outcomes like nosocomial infection, dissatisfaction, morbidity, and mortality. Despite this, little is known about the length of stay and the factors that influence it in Ethiopia’s emergency department.
Methods
An institution-based cross-sectional study was conducted on 495 patients admitted at Amhara region comprehensive specialized hospitals emergency department from May 14 to June 15/2022. A systematic random sampling was employed to select study participants. A pretested structured interview-based questionnaire was used to collect data by using Kobo toolbox software. SPSS version 25 was used for data analysis. Bi-variable logistic regression analysis was carried out to select variables with P-value < 0.25. The significance of association was interpreted using an Adjusted Odds Ratio with a 95% confidence interval. Variables with P-value < 0.05 in the multivariable logistic regression analysis were inferred to be significantly associated with length of stay.
Result
Out of 512 enrolled participants, 495 were participated with a response rate of 96.7%. The prevalence of prolonged length of stay in the adult emergency department was 46.5% (95%CI: 42.1, 51.1). Lack of insurance (AOR: 2.11; 95% CI: 1.22, 3.65), non-communicative presentation (AOR: 1.98; 95% CI: 1.07, 3.68), delayed consultation (AOR: 9.5; 95% CI: 5.00, 18.03), overcrowding (AOR: 4.98; 95% CI: 2.13, 11.68), and shift change experience (AOR: 3.67; 95% CI: 1.30, 10.37) were significantly associated with prolonged length of stay.
Conclusion
The result of this study is found to be high based on Ethiopian target emergency department patient length of stay. Lack of insurance, presentation without communication, delayed consultation, overcrowding, and shift change experience were significant factors for prolonged emergency department length of stay. Therefore, interventions like expansion of organizational setup are needed to decrease the length of stay to an acceptable level.
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Mowbray FI, Heckman G, Hirdes JP, Costa AP, Beauchet O, Eagles D, Perry JJ, Sinha S, Archambault P, Wang H, Jantzi M, Hebert P. Examining the utility and accuracy of the interRAI Emergency Department Screener in identifying high-risk older emergency department patients: A Canadian multiprovince prospective cohort study. J Am Coll Emerg Physicians Open 2023; 4:e12876. [PMID: 36660313 PMCID: PMC9838565 DOI: 10.1002/emp2.12876] [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] [Received: 05/17/2022] [Revised: 11/08/2022] [Accepted: 11/30/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours). Methods We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care. Results A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy. Conclusion The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
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Affiliation(s)
- Fabrice I. Mowbray
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - George Heckman
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada
- Schlegel Research Institute for AgingWaterlooOntarioCanada
| | - John P. Hirdes
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Olivier Beauchet
- Departments of Medicine and Research Center of the Geriatric University Institute of MontrealUniversity of MontrealMontrealQuebecCanada
- Department of MedicineDivision of Geriatric MedicineSir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical ResearchMcGill UniversityMontrealQuebecCanada
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Debra Eagles
- Department of Emergency MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Jeffrey J. Perry
- Department of Emergency MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Samir Sinha
- Department of MedicineDivision of Geriatric MedicineSinai Health and University Health NetworkTorontoOntarioCanada
- Department of MedicineDivision of Geriatric MedicineUniversity of TorontoTorontoOntarioCanada
| | - Patrick Archambault
- Department of Family Medicine and Emergency MedicineUniversité LavalQuébec CityOntarioCanada
- Centre intégré de santé et de services sociaux de Chaudière‐AppalachesSainte‐MarieOntarioCanada
- Department of Anesthesiology and Critical Care MedicineDivision of Critical Care MedicineUniversité LavalQuébec CityOntarioCanada
| | - Hanting Wang
- Department of MedicineDivision of Critical Care MedicineUniversite de MontrealMontrealQuebecCanada
| | - Michaela Jantzi
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Paul Hebert
- Department of MedicineDivision of Palliative CareBruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
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Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea. BMC Emerg Med 2022; 22:183. [PMID: 36411433 PMCID: PMC9677700 DOI: 10.1186/s12873-022-00745-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). METHODS We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. RESULTS Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9-6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16-1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. CONCLUSIONS In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.
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Machine learning-based triage to identify low-severity patients with a short discharge length of stay in emergency department. BMC Emerg Med 2022; 22:88. [PMID: 35596154 PMCID: PMC9123815 DOI: 10.1186/s12873-022-00632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Overcrowding in emergency departments (ED) is a critical problem worldwide, and streaming can alleviate crowding to improve patient flows. Among triage scales, patients labeled as "triage level 3" or "urgent" generally comprise the majority, but there is no uniform criterion for classifying low-severity patients in this diverse population. Our aim is to establish a machine learning model for prediction of low-severity patients with short discharge length of stay (DLOS) in ED. METHODS This was a retrospective study in the ED of China Medical University Hospital (CMUH) and Asia University Hospital (AUH) in Taiwan. Adult patients (aged over 20 years) with Taiwan Triage Acuity Scale level 3 were enrolled between 2018 and 2019. We used available information during triage to establish a machine learning model that can predict low-severity patients with short DLOS. To achieve this goal, we trained five models-CatBoost, XGBoost, decision tree, random forest, and logistic regression-by using large ED visit data and examined their performance in internal and external validation. RESULTS For internal validation in CMUH, 33,986 patients (75.9%) had a short DLOS (shorter than 4 h), and for external validation in AUH, there were 13,269 (82.7%) patients with short DLOS. The best prediction model was CatBoost in internal validation, and area under the receiver operating cha racteristic curve (AUC) was 0.755 (95% confidence interval (CI): 0.743-0.767). Under the same threshold, XGBoost yielded the best performance, with an AUC value of 0.761 (95% CI: 0.742- 0.765) in external validation. CONCLUSIONS This is the first study to establish a machine learning model by applying triage information alone for prediction of short DLOS in ED with both internal and external validation. In future work, the models could be developed as an assisting tool in real-time triage to identify low-severity patients as fast track candidates.
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Mwakilasa MT, Foley C, O'Carroll T, Flynn R, Rohde D. Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study. J Patient Exp 2021; 8:23743735211065267. [PMID: 34917753 PMCID: PMC8669876 DOI: 10.1177/23743735211065267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.
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Affiliation(s)
- Magreth Thadei Mwakilasa
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Muhimbili University of Health and Allied Sciences, Ilala, Tanzania
| | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
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Yang Z, Song K, Lin H, Li C, Ding N. Factors Associated with Emergency Department Length of Stay in Critically Ill Patients: A Single-Center Retrospective Study. Med Sci Monit 2021; 27:e931286. [PMID: 34333509 PMCID: PMC8336256 DOI: 10.12659/msm.931286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency service. In this study, we aimed to analyze clinical characteristics of critically ill patients admitted to the ED and identify the factors associated with LOS. MATERIAL AND METHODS All patients with level 1 and level 2 of the Emergency Severity Index who were admitted to the ED from January 2018 to December 2019 were included in this retrospective study. The patients were divided into 2 groups: LOS ≥4 h and LOS <4 h. Variables were comprehensively analyzed and compared between the 2 groups. RESULTS A total of 19 616 patients, including 7269 patients in the LOS ≥4 h group and 12 347 patients in the LOS <4 group, were included. Advanced age, admission in winter and during the night shift, and diseases excluding nervous system diseases, cardiovascular diseases, and trauma were associated with higher risk of LOS. Nervous system diseases, cardiovascular diseases, trauma, and procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis were associated with lower risk of LOS. CONCLUSIONS Prolonged LOS in the ED was associated with increased age and admission in winter and during the night shift, while shortened LOS was associated with nervous system diseases, cardiovascular diseases, and trauma, as well as with procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis. Our findings can serve as a guide for ED physicians to individually evaluate patient condition and allocate medical resources more effectively.
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Affiliation(s)
- Zhiwei Yang
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Kun Song
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Hang Lin
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Changluo Li
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
| | - Ning Ding
- Department of Emergency Medicine, Changsha Central Hospital, University of South China, Changsha, Hunan, China (mainland)
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