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Le LKD, Thai T, Cameron PA, Sri-Ganeshan M, O'Reilly GM, Mitra B, Nehme Z, Brichko L, Underhill A, Charteris C, Egerton-Warburton D, Mihalopoulos C. Modelled economic evaluation of a virtual emergency department in Victoria. Emerg Med Australas 2023; 35:1020-1025. [PMID: 37766421 DOI: 10.1111/1742-6723.14319] [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: 07/27/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Virtual ED (VED) can potentially alleviate ED overcrowding which has been a public health challenge. The aim of the present study was to conduct a return-on-investment analysis of a VED programme developed in response to changing healthcare needs in Australia. METHODS An economic model was developed based on initial patient outcome data to assess the healthcare costs, potential costs saved and return on investment (ROI) from the VED. The VED programme operating as part of Alfred Health Emergency Services. The participants were the first 188 patients accessing the Alfred Health VED. VED is the delivery of emergency assessment and management of specific patients virtually via audio-visual teleconferencing. ROI ratios that compare cost savings with intervention costs. RESULTS The mean total operational cost of VED for 79 days for 188 patients was A$344 117 (95% uncertainty interval [UI] $296 800-$392 088). The VED led to a potential A$286 779 (95% UI $241 688-$330 568) healthcare cost saving from reductions in emergency visits and A$97 569 (95% UI $74 233-$123 117) cost saving in ambulance services. The ROI ratio was estimated at 1.12 (95% UI 0.96-1.32). CONCLUSIONS The VED was cost neutral in a conservatively modelled scenario but promising if any hospital admission could be saved. Ongoing research examining a larger cohort with community follow up is required to confirm this promising result.
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Affiliation(s)
- Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thao Thai
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Muhuntha Sri-Ganeshan
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard M O'Reilly
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Lisa Brichko
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew Underhill
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Claire Charteris
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Diana Egerton-Warburton
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ragab M, Kateb F, Al-Rabia MW, Hamed D, Althaqafi T, AL-Ghamdi ASALM. A Machine Learning Approach for Monitoring and Classifying Healthcare Data-A Case of Emergency Department of KSA Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4794. [PMID: 36981702 PMCID: PMC10049583 DOI: 10.3390/ijerph20064794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The Emergency Departments (EDs), in hospitals located in a few important areas in Saudi Arabia, experience a heavy inflow of patients due to viral illnesses, pandemics, and even on a few special occasions events such as Hajj or Umrah, when pilgrims travel from one region to another with severe disease conditions. Apart from the EDs, it is critical to monitor the movements of patients from EDs to other wards inside the hospital or in the region. This is to track the spread of viral illnesses that require more attention. In this scenario, Machine Learning (ML) algorithms can be used to classify the data into many classes and track the target audience. The current research article presents a Machine Learning-based Medical Data Monitoring and Classification Model for the EDs of the KSA hospitals and is named MLMDMC-ED technique. The most important aim of the proposed MLMDMC-ED technique is to monitor and track the patient's visits to the EDs, the treatment given to them based on the Canadian Emergency Department Triage and Acuity Scale (CTAS), and their Length Of Stay (LOS) in the hospital, based on their treatment requirements. A patient's clinical history is crucial in terms of making decisions during health emergencies or pandemics. So, the data should be processed so that it can be classified and visualized in different formats using the ML technique. The current research work aims at extracting the textual features from the patients' data using the metaheuristic Non-Defeatable Genetic Algorithm II (NSGA II). The data, collected from the hospitals, are classified using the Graph Convolutional Network (GCN) model. Grey Wolf Optimizer (GWO) is exploited for fine-tuning the parameters to optimize the performance of the GCN model. The proposed MLMDMC-ED technique was experimentally validated on the healthcare data and the outcomes indicated the improvements of the MLMDMC-ED technique over other models with a maximum accuracy of 91.87%.
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Affiliation(s)
- Mahmoud Ragab
- Information Technology Department, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Mathematics Department, Faculty of Science, Al-Azhar University, Naser City, Cairo 11884, Egypt
| | - Faris Kateb
- Information Technology Department, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohammed W. Al-Rabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Health Promotion Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Diaa Hamed
- Mineral Resources and Rocks Department, Faculty of Earth Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Geology Department, Faculty of Science, Al-Azhar University, Naser City, Cairo 11884, Egypt
| | - Turki Althaqafi
- Information Systems Department, HECI School, Dar Alhekma University, Jeddah 22246, Saudi Arabia
| | - Abdullah S. AL-Malaise AL-Ghamdi
- Information Systems Department, HECI School, Dar Alhekma University, Jeddah 22246, Saudi Arabia
- Information Systems Department, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Korczak V, Yakubu K, Angell B, Middleton P, Dinh M, Lung T, Jan S. Understanding patient preferences for emergency care for lower triage acuity presentations during GP hours: a qualitative study in Australia. BMC Health Serv Res 2022; 22:1442. [PMID: 36447196 PMCID: PMC9706995 DOI: 10.1186/s12913-022-08857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Low acuity presentations to Australian emergency departments drive long wait times, higher costs and may be better treated in primary care settings. This study sought to understand factors leading these patients to present to emergency departments. METHODS Semi-structured interviews were carried out with patients at two tertiary emergency departments in Sydney during general practitioner opening hours. Nvivo was used to code the interviews and a thematic analysis was carried out to capture the main themes from the interviews. RESULTS Forty-four interviews were included in the analysis across the two sites. They represented a diverse population in terms of ethnicity, education and socioeconomic background. Patient preferences for emergency care were organised into four main themes: (i) patients were referred (either by another health service, work, friend, or family), (ii) emergency department factors (convenience of investigations and severity of symptoms requiring emergency care), (iii) GP factors (does not have a GP, cannot find an appointment with a GP or has previously had a negative experience with a GP) and (iv) personal factors such as their connection to the hospital. CONCLUSION Multiple factors led patients to seek ED care for low acuity presentations during GP hours. Some of these factors could be addressed to meet patient needs in the community, however this is currently not the case. Addressing these factors to improve access to GP clinics and the availability of services outside the hospital setting could reduce ED presentations and likely improve patient experience.
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Affiliation(s)
- Viola Korczak
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.413249.90000 0004 0385 0051The Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kenneth Yakubu
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia
| | - Blake Angell
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
| | - Paul Middleton
- grid.429098.eSouth Western Emergency Research Institute, Ingham Institute, Liverpool, Australia ,grid.1005.40000 0004 4902 0432South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Michael Dinh
- grid.413249.90000 0004 0385 0051The Green Light Institute for Emergency Care, Royal Prince Alfred Hospital, Camperdown, Australia ,NSW Agency of Trauma and Injury Management, PRISM, Agency for Clinical Innovation, St Leonards, Australia
| | - Thomas Lung
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
| | - Stephen Jan
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, University of New South, Sydney, Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine and Health, The University of New South, Sydney, Australia
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Characteristics of Patients Who Visited Emergency Department: A Nationwide Population-Based Study in South Korea (2016-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148578. [PMID: 35886425 PMCID: PMC9316116 DOI: 10.3390/ijerph19148578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
The utilization of the emergency department (ED) has been continuously increasing and has become a burden for ED resources. The aim of this study was to describe the characteristics, outcomes, common diagnoses, and disease classifications of patients who were referred to the ED. This nationwide epidemiologic study examined the data from adult patients (>18 years) who visited EDs from 1 January 2016 to 31 December 2018. Most EDs in Korea provide data from ED patients to the National Emergency Medical Center (NEMC). The disposition of ED patients was classified as discharge, admission, death, and re-transfer. From 2016 to 2018, the proportion of referred patients out of the total ED visits increased from 7.3% to 7.8%. The referred patients were older (61.1 vs. 50.5 years), had worse vital signs, longer ED lengths of stay (409.1 vs. 153.3 min), and higher admission (62.3 vs. 16.9%) and re-transfer rates (4.4 vs. 1.9%) than the direct-visit patients. Among the referred patients in the 3 years, 62.3% were hospitalized, and the most common disease classification was “disease of the digestive system” (19.8%). The most common diagnosis was pneumonia (6.0%), followed by urinary tract infection, gastrointestinal bleeding, and hepatobiliary infection. The number of patients referred to EDs is increasing, and more than 60% of referred patients are hospitalized. Detailed characteristics of these patients will be helpful for improving ED management and the distribution of medical resources.
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Baskaran R, Gonski PN, Metz C. Preventable presentations of older adults to emergency departments: General practitioners' perspectives. Emerg Med Australas 2022; 34:725-730. [DOI: 10.1111/1742-6723.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Radheshan Baskaran
- Rehabilitation and Aged Care Services Hornsby Ku‐ring‐gai Hospital Sydney New South Wales Australia
| | - Peter N Gonski
- Aged Care and Rehabilitation The Sutherland Hospital Sydney New South Wales Australia
| | - Colin Metz
- Albemarle Medical Practice Sydney New South Wales Australia
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Yao LH, Leung KC, Tsai CL, Huang CH, Fu LC. A Novel Deep Learning-Based System for Triage in the Emergency Department Using Electronic Medical Records: Retrospective Cohort Study. J Med Internet Res 2021; 23:e27008. [PMID: 34958305 PMCID: PMC8749584 DOI: 10.2196/27008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Emergency department (ED) crowding has resulted in delayed patient treatment and has become a universal health care problem. Although a triage system, such as the 5-level emergency severity index, somewhat improves the process of ED treatment, it still heavily relies on the nurse’s subjective judgment and triages too many patients to emergency severity index level 3 in current practice. Hence, a system that can help clinicians accurately triage a patient’s condition is imperative. Objective This study aims to develop a deep learning–based triage system using patients’ ED electronic medical records to predict clinical outcomes after ED treatments. Methods We conducted a retrospective study using data from an open data set from the National Hospital Ambulatory Medical Care Survey from 2012 to 2016 and data from a local data set from the National Taiwan University Hospital from 2009 to 2015. In this study, we transformed structured data into text form and used convolutional neural networks combined with recurrent neural networks and attention mechanisms to accomplish the classification task. We evaluated our performance using area under the receiver operating characteristic curve (AUROC). Results A total of 118,602 patients from the National Hospital Ambulatory Medical Care Survey were included in this study for predicting hospitalization, and the accuracy and AUROC were 0.83 and 0.87, respectively. On the other hand, an external experiment was to use our own data set from the National Taiwan University Hospital that included 745,441 patients, where the accuracy and AUROC were similar, that is, 0.83 and 0.88, respectively. Moreover, to effectively evaluate the prediction quality of our proposed system, we also applied the model to other clinical outcomes, including mortality and admission to the intensive care unit, and the results showed that our proposed method was approximately 3% to 5% higher in accuracy than other conventional methods. Conclusions Our proposed method achieved better performance than the traditional method, and its implementation is relatively easy, it includes commonly used variables, and it is better suited for real-world clinical settings. It is our future work to validate our novel deep learning–based triage algorithm with prospective clinical trials, and we hope to use it to guide resource allocation in a busy ED once the validation succeeds.
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Affiliation(s)
- Li-Hung Yao
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Ka-Chun Leung
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Chen Fu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
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7
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Tolestam Heyman E, Engström M, Baigi A, Dahlén Holmqvist L, Lingman M. Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission. Int J Health Plann Manage 2020; 36:353-363. [PMID: 33037715 PMCID: PMC8048858 DOI: 10.1002/hpm.3086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022] Open
Abstract
Background The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. Results In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. Conclusions A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances.
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Affiliation(s)
- Ellen Tolestam Heyman
- Emergency Department, Region Halland, Varberg, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Engström
- Department of Healthcare, Region Halland Central Office, Region Halland, Sweden.,Department of Anaesthesia and Intensive Care, Medicine, Lund University, Lund, Sweden
| | - Amir Baigi
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Lina Dahlén Holmqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Emergency Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Lingman
- Halland Hospital Group, Region Halland, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cai X, Wu J, Chen J, Sun J, Li P. The "two-step four-level + " pediatric triage method in a medical center in Southern China. J SPEC PEDIATR NURS 2020; 25:e12305. [PMID: 32702207 DOI: 10.1111/jspn.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Because the quality of medical resources is extremely uneven across China, it is nearly impossible to implement a unified emergency triage program. The aim of the study is to examine triage using the "two-step four-level+ " triage model in a hospital in Southern China, with an emphasis on hand, foot, and mouth disease. DESIGN AND METHODS This was a retrospective study of all patients seen in the pediatric emergency room (ER) between January 1, 2012 and December 31, 2018, at the Guangzhou Women and Children's Medical Center. The "two-step and four-level+ " was manually implemented in 2012, and an electronic triage system was developed and applied since 2015. Emergency quality control indicators were analyzed. RESULTS There were 645,473 patients triaged at the pediatric ER between January 1, 2015 and December 31, 2018. After the first step, 17,444 patients were classified as unstable, including 6546 (1.01%) Level I patients, 10,898 (1.69%) Level II patients, 210,368 (32.5%) Level III patients, and 417,661 (64.8%) Level IV patients. After triage implementation, the stay time of the patient in the pediatric ER decreased each year (all p < .05) and shortened to 20.3 ± 2.2 h in 2018. Compared with 2012-2014, the mortality of 2015-2018 decreased by 21.1%, the rate of unexpected resuscitation was 0%, and the complaints of overcrowding decreased (all p < .05). PRACTICE IMPLICATIONS This "two-step four-level+ " triage method can improve the medical care quality of pediatric ER in China.
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Affiliation(s)
- Xian Cai
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinxia Wu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiechan Chen
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Sun
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Peiqing Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Lower T, Kinsman L, Dinh MM, Lyle D, Cheney R, Allan J, Munro A, Taylor B, Wiggers JH, Bailey A, Weller L, Jacob A, Stephens AS. Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018. Aust J Rural Health 2020; 28:490-499. [DOI: 10.1111/ajr.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Tony Lower
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District Port Macquarie NSW Australia
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Michael M. Dinh
- New South Wales Institute of Trauma and Injury Management Sydney NSW Australia
- Faculty of Medicine and Health Sydney Medical School The University of Sydney Sydney NSW Australia
| | - David Lyle
- Broken Hill University Department of Rural Health Faculty of Medicine and Health School of Medicine The University of Sydney Sydney NSW Australia
| | - Richard Cheney
- Western New South Wales Local Health District Orange NSW Australia
| | - Julaine Allan
- Western New South Wales Local Health District Orange NSW Australia
| | - Alice Munro
- Western New South Wales Local Health District Orange NSW Australia
| | - Barbara Taylor
- Murrumbidgee Local Health District Wagga Wagga NSW Australia
| | - John H. Wiggers
- Faculty of Medicine and Health School of Medicine, and Public Health University of Newcastle Newcastle NSW Australia
- Hunter New England Local Health District New Lambton NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Lauren Weller
- New South Wales Rural Health Research Alliance Port Macquarie NSW Australia
| | - Alycia Jacob
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Alexandre S. Stephens
- Northern New South Wales Local Health District Lismore NSW Australia
- Faculty of Medicine and Health School of Public Health The University of Sydney Sydney NSW Australia
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10
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Yang B, Messom R. Association between potential primary care emergency service and general practitioner care utilisation in New South Wales. Emerg Med Australas 2020; 33:52-57. [PMID: 32596973 DOI: 10.1111/1742-6723.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/18/2020] [Accepted: 05/23/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine patterns of potential primary care (PPC) ED presentations and any association between PPC ED presentations and frequency of general practitioner (GP) care utilisation in New South Wales, Australia. METHODS Retrospective cross-sectional study of 6 221 762 New South Wales patients who had at least one service in public hospitals, EDs or Medical Benefit Schedule claimable for GP service between 2013/2014 and 2014/2015 is conducted to examine association between PPC ED presentations and GP care utilisation using logistic regression adjusting for comorbidity index and a number of other covariates. Data over 2010/2011 to 2014/2015 are included for analyses of trends and patterns in PPC ED and GP care utilisation. RESULTS Forty-one percent of the ED presentations were PPC ED presentations over the 5 years 2010/2011 to 2014/2015. Population rates of PPC ED presentations and GP care both increased over the period, with higher PPC ED presentation rates in regional areas, and higher GP care rates in major cities. GP care utilisation was associated with reduced odds for PPC ED presentations, with the adjusted odds ratios ranging from 0.28 for patients with one GP care service to 0.48 for patients with five or more GP care services compared with patients with none. Increased comorbidity index was also associated with increased risk of PPC ED presentations. CONCLUSION GP care utilisation was associated with reduced risk for any PPC ED presentations after adjusting for comorbidity index and the other factors.
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Affiliation(s)
- Baohui Yang
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, New South Wales, Australia
| | - Raymond Messom
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, New South Wales, Australia
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11
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Dinh MM, Arce CP, Berendsen Russell S, Bein KJ. Predictors and in‐hospital mortality associated with prolonged emergency department length of stay in New South Wales tertiary hospitals from 2017 to 2018. Emerg Med Australas 2020; 32:611-617. [DOI: 10.1111/1742-6723.13477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Michael M Dinh
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Chantel P Arce
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
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12
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Thibon E, Bobbia X, Blanchard B, Masia T, Palmier L, Tendron L, de La Coussaye JE, Claret PG. Association entre mortalité et attente aux urgences chez les adultes à hospitaliser pour étiologies médicales. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Notre objectif principal est de comparer, dans un centre hospitalier universitaire (CHU) français et chez les patients hospitalisés pour étiologies médicales à partir de la structure des urgences (SU), le taux de mortalité intrahospitalière entre ceux qui n’attendent pas faute de place en service et ceux en attente (boarding).
Méthode : Il s’agit d’une étude quasi expérimentale, monocentrique, observationnelle, rétrospective, par recueil d’informations à partir des dossiers patients informatisés. Nous avons appliqué un score de propension pour ajuster les critères de jugement aux variables mesurées dans les deux groupes, c’est-à-dire les données : 1) démographiques (âge et sexe) ; 2) médicales (niveau de triage) ; 3) biologiques (numération leucocytaire, hémoglobinémie, natrémie, kaliémie, taux sérique de CRP, créatininémie) ; 4) d’imageries (réalisation ou non de radiographie, d’échographie, d’imagerie par résonance magnétique, de tomodensitométrie).
Résultats : En 2017, la SU du CHU a admis 60 062 patients adultes. Sur les 15 496 patients hospitalisés après admission en SU, 6 997 l’ont été pour une étiologie médicale, dont 2 546 (36 %) sans attente et 4 451 (64 %) après une attente. Après pondération, le taux de mortalité intrahospitalière était plus important dans le groupe en attente : 7,8 vs 6,3 % ; p < 0,05. De même, la durée médiane d’hospitalisation était plus importante dans le groupe en attente : 7,6 [4,7– 12,0] vs 7,1 j [4,3–11,5] ; p < 0,01.
Discussion : Les taux de mortalité et de la durée de séjour intrahospitaliers sont plus importants chez les patients étudiés qui attendent en SU faute de place en service. Nos résultats sont concordants avec la littérature internationale. Il est nécessaire de trouver des solutions pour réduire cette surmortalité.
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Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018; 13:e0203316. [PMID: 30161242 PMCID: PMC6117060 DOI: 10.1371/journal.pone.0203316] [Citation(s) in RCA: 561] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/17/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Emergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions. AIM The aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439). RESULTS From 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions. CONCLUSIONS The negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.
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Affiliation(s)
- Claire Morley
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Maria Unwin
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Tasmanian Health Service–North, Launceston, Tasmania, Australia
| | - Gregory M. Peterson
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jim Stankovich
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Leigh Kinsman
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Tasmanian Health Service–North, Launceston, Tasmania, Australia
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14
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Reyes JF, Wood JG, Beutels P, Macartney K, McIntyre P, Menzies R, Mealing N, Newall AT. Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia. Vaccine 2017; 35:345-352. [PMID: 27916411 DOI: 10.1016/j.vaccine.2016.11.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction. METHODS We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations. RESULTS Relative to the baseline period (1997-2006), over the 6years (2007-2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program. CONCLUSION The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted bypre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs.
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Affiliation(s)
- J F Reyes
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J G Wood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - K Macartney
- Discipline of Child and Adolescent Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - P McIntyre
- Discipline of Child and Adolescent Health and School of Public Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - R Menzies
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - N Mealing
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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15
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Morris T, Mason SM, Moulton C, O'Keeffe C. Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine's Sentinel Site Survey data. Emerg Med J 2017; 35:114-119. [PMID: 29084730 DOI: 10.1136/emermed-2017-206846] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/06/2017] [Accepted: 08/28/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Avoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs have been estimated to constitute 10%-90% of ED attendances, with the UK 2013 Urgent and Emergency Care Review suggesting a figure of 40%. METHODS This pilot study used data from the Royal College of Emergency Medicine's Sentinel Site Survey to estimate the proportion of AAs in 12 EDs across England on a standard day (20 March 2014). AAs were defined by an expert panel using questions from the survey. All patients attending the EDs were recorded with details of investigations and treatments received, and the proportion of patients meeting criteria for AA was calculated. RESULTS Visits for 3044 patients were included. Based on these criteria, a mean of 19.4% (95% CI 18.0% to 20.8%) of attendances could be deemed avoidable. The lowest proportion of AAs reported was 10.7%, while the highest was 44.3%. Younger age was a significant predictor of AA with mean age of 38.6 years for all patients attending compared with 24.6 years for patients attending avoidably (p≤0.001). DISCUSSION The proportion of AAs in this study was lower than many estimates in the literature, including that reported by the 2013 Urgent and Emergency Care Review. This suggests the ED is the most appropriate healthcare setting for many patients due to comprehensive investigations, treatments and capability for urgent referrals.The proportion of AAs is dependent on the defining criteria used, highlighting the need for a standardised, universal definition of an appropriate/avoidable ED attendance. This is essential to understanding how AAs contribute to the overall issue of crowding.
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Affiliation(s)
- Toby Morris
- Medical School, University of Sheffield, Sheffield, UK
| | - Suzanne M Mason
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chris Moulton
- Department of Emergency, Royal Bolton Hospital, Bolton, UK
| | - Colin O'Keeffe
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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16
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Muscatello DJ, Bein KJ, Dinh MM. Influenza-associated delays in patient throughput and premature patient departure in emergency departments in New South Wales, Australia: A time series analysis. Emerg Med Australas 2017; 30:77-80. [PMID: 28544364 DOI: 10.1111/1742-6723.12808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 04/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Influenza outbreaks cause overcrowding in EDs. We aimed to quantify the impact of influenza on the National Emergency Access Targets and premature patient departure in New South Wales, Australia. METHODS This was a retrospective observational study of 11 million presentations to 115 hospitals during 2010-2014, using routinely collected administrative records. A time series generalised additive regression model was used to assess the correlation between weekly influenza activity and the weekly proportion of patients leaving the ED in >4 h and the proportion that departed before commencing or completing treatment ('did not wait'), after controlling for background winter and holiday effects. RESULTS During 2011-2014, peak annual circulating influenza was associated with the peak weekly proportion of presentations that left in >4 h. The maximum estimated absolute weekly change in that proportion was 3.88 (95% confidence interval 3.02-4.74) percentage points in 2014. For presentations that did not wait, influenza circulation was associated with statistically significant increases in all years, with a maximum weekly value of 2.68 (95% confidence interval 2.31-3.06) percentage points in 2012. CONCLUSIONS Circulating influenza was associated with sustained increases and peaks in delayed patient throughput and premature patient departures. Influenza surveillance information may assist with development of health system and hospital workforce planning and bed management activities.
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Affiliation(s)
- David J Muscatello
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
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17
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Stephens AS, Broome RA. Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia. Emerg Med Australas 2017; 29:283-290. [PMID: 28320067 DOI: 10.1111/1742-6723.12767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the patterns of low acuity patient (LAP) presentations to EDs in New South Wales (NSW), Australia. METHODS Retrospective study of NSW public hospital ED presentations between January 2013 and December 2014 that were registered in the NSW Emergency Department Data Collection (n = 409 035). LAPs were defined according to the Australian Institute of Health and Welfare (AIHW), Sprivulis and multiple ACEM methods. Multivariable logistic regression was used to assess the adjusted odds of LAP ED presentation by a suite of sociodemographic factors. RESULTS The percentage of LAPs varied considerably by definition, being as high as 54.7% (inner regional areas) and as low as 3.2% (major cities) using revised ACEM methods modified to contain unlimited consultation times or consultation times of 15 min or less, respectively. For each method, higher proportions of LAPs were observed in inner regional and remote/very remote areas relative to major cities. LAP ED presentations, based on ACEM definition with 1 h or 15 min consultation times, were greater in younger patients, increased during out of business hours and weekends, and decreased with increasing general practitioner (GP) density. CONCLUSION The percentage of LAPs varied substantially by definition, and further work is required to validate the methods, particularly around the appropriateness of length of consultation time with ACEM, between different hospitals and remoteness areas. Age was strongly associated with low acuity, with substantial effects also observed for GP density, and attendances during out of hours and weekends.
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Affiliation(s)
- Alexandre S Stephens
- Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Richard A Broome
- Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia
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18
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Dinh MM, Russell SB, Bein KJ, Rogers K, Muscatello D, Paoloni R, Hayman J, Chalkley DR, Ivers R. The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia. BMC Emerg Med 2016; 16:46. [PMID: 27912757 PMCID: PMC5135778 DOI: 10.1186/s12873-016-0111-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. Methods This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration. Results 1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82). Conclusion By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.
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Affiliation(s)
- Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia. .,Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Saartje Berendsen Russell
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Nursing, The University of Sydney, Sydney, NSW, Australia
| | - Kendall J Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - David Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Jon Hayman
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Health Education and Training Institute, New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Dane R Chalkley
- Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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19
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley DR, Muscatello D, Paoloni R, Ivers R. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open 2016; 6:e010964. [PMID: 27165649 PMCID: PMC4874101 DOI: 10.1136/bmjopen-2015-010964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. DESIGN AND SETTING This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. PARTICIPANTS Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. RESULTS There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). CONCLUSIONS Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, School of Nursing, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, New South Wales, Australia
| | | | - David Muscatello
- University of New South Wales, School of Public Health and Community Medicine, New South Wales, Australia
| | - Richard Paoloni
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, The University of Sydney, New South Wales, Australia
- Flinders University, School of Nursing and Midwifery, South Australia, Australia
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20
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Dinh MM, Bein KJ. The end of emergency medicine as we know it. Emerg Med Australas 2016; 28:242-3. [DOI: 10.1111/1742-6723.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael M Dinh
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency Department; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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21
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley D, Muscatello D, Paoloni R, Ivers R. Understanding drivers of Demand for Emergency Service Trends in Years 2010-2014 in New South Wales: An initial overview of the DESTINY project. Emerg Med Australas 2016; 28:179-86. [DOI: 10.1111/1742-6723.12542] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- School of Nursing; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - David Muscatello
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Rebecca Ivers
- The George Institute for Global Health; The University of Sydney; Sydney New South Wales Australia
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
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