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Adania ET, Faria Junior GSDE, Franzoni NR, Pimentel SK. Emergency room readmission, an avoidable problem? Analysis and stratification of readmissions in a trauma reference center. Rev Col Bras Cir 2024; 51:e20243704. [PMID: 38985037 DOI: 10.1590/0100-6991e-20243704-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/31/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Hospital readmission is a common way to assess the quality of care provided in an emergency service. In this context, the aim of this study is to quantify and stratify readmissions in a trauma reference emergency service. METHODS A retrospective longitudinal study was conducted with patients readmitted, twice or more, in the emergency service within a maximum period of 30 days from the initial admission - hospitalized or not. Clinical and demographic data were obtained from electronic medical records. RESULTS The readmission rate for the service was 4.11% for all readmissions and 2.23% for avoidable readmissions. Within this group, 61.19% were likely avoidable, 19.47% possibly avoidable, and 19.34% eventually avoidable. Regarding time, 48.16% occurred within one week of the initial readmission. Furthermore, no statistically significant association was found in the analysis of biological sex, occupational accident, and comorbidities. A statistically significant association was found in the analysis of age and ambulance transport (OR 1.37; 95% CI 1.17-1.59). CONCLUSION The study highlighted that there are still readmissions in the emergency department that could be avoided. A significant relationship was observed between readmissions and patient ages, and ambulance transport.
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Hsu CC, Chu CCJ, Ng CJ, Lin CH, Lo HY, Chen SY. Machine learning models for predicting unscheduled return visits of patients with abdominal pain at emergency department and validation during COVID-19 pandemic: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e37220. [PMID: 38394532 DOI: 10.1097/md.0000000000037220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Machine learning (ML) models for predicting 72-hour unscheduled return visits (URVs) for patients with abdominal pain in the emergency department (ED) were developed in a previous study. This study refined the data to adjust previous prediction models and evaluated the model performance in future data validation during the COVID-19 era. We aimed to evaluate the practicality of the ML models and compare the URVs before and during the COVID-19 pandemic. We used electronic health records from Chang Gung Memorial Hospital from 2018 to 2019 as a training dataset, and various machine learning models, including logistic regression (LR), random forest (RF), extreme gradient boosting (XGB), and voting classifier (VC) were developed and subsequently used to validate against the 2020 to 2021 data. The models highlighted several determinants for 72-hour URVs, including patient age, prior ER visits, specific vital signs, and medical interventions. The LR, XGB, and VC models exhibited the same AUC of 0.71 in the testing set, whereas the VC model displayed a higher F1 score (0.21). The XGB model demonstrated the highest specificity (0.99) and precision (0.64) but the lowest sensitivity (0.01). Among these models, the VC model showed the most favorable, balanced, and comprehensive performance. Despite the promising results, the study illuminated challenges in predictive modeling, such as the unforeseen influences of global events, such as the COVID-19 pandemic. These findings not only highlight the significant potential of machine learning in augmenting emergency care but also underline the importance of iterative refinement in response to changing real-world conditions.
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Affiliation(s)
- Chun-Chuan Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Cheng-C J Chu
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Ching-Heng Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan City 333, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
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Lee YC, Ng CJ, Hsu CC, Cheng CW, Chen SY. Machine learning models for predicting unscheduled return visits to an emergency department: a scoping review. BMC Emerg Med 2024; 24:20. [PMID: 38287243 PMCID: PMC10826225 DOI: 10.1186/s12873-024-00939-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Unscheduled return visits (URVs) to emergency departments (EDs) are used to assess the quality of care in EDs. Machine learning (ML) models can incorporate a wide range of complex predictors to identify high-risk patients and reduce errors to save time and cost. However, the accuracy and practicality of such models are questionable. This review compares the predictive power of multiple ML models and examines the effects of multiple research factors on these models' performance in predicting URVs to EDs. METHODS We conducted the present scoping review by searching eight databases for data from 2010 to 2023. The criteria focused on eligible articles that used ML to predict ED return visits. The primary outcome was the predictive performances of the ML models, and results were analyzed on the basis of intervals of return visits, patient population, and research scale. RESULTS A total of 582 articles were identified through the database search, with 14 articles selected for detailed analysis. Logistic regression was the most widely used method; however, eXtreme Gradient Boosting generally exhibited superior performance. Variations in visit interval, target group, and research scale did not significantly affect the predictive power of the models. CONCLUSION This is the first study to summarize the use of ML for predicting URVs in ED patients. The development of practical ML prediction models for ED URVs is feasible, but improving the accuracy of predicting ED URVs to beyond 0.75 remains a challenge. Including multiple data sources and dimensions is key for enabling ML models to achieve high accuracy; however, such inclusion could be challenging within a limited timeframe. The application of ML models for predicting ED URVs may improve patient safety and reduce medical costs by decreasing the frequency of URVs. Further research is necessary to explore the real-world efficacy of ML models.
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Affiliation(s)
- Yi-Chih Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan City, 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan City, 333, Taiwan
| | - Chun-Chuan Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan City, 333, Taiwan
| | - Chien-Wei Cheng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, No. 5 Fushing St., Gueishan Shiang, Taoyuan City, 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan City, 333, Taiwan.
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, No. 5 Fushing St., Gueishan Shiang, Taoyuan City, 333, Taiwan.
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Namgung M, Lee DH, Bae SJ, Chung HS, Kim K, Lee CA, Kim DH, Kim EC, Lim JY, Han SS, Choi YH. The impact of COVID-19 pandemic on revisits to emergency department. Australas Emerg Care 2023; 26:221-229. [PMID: 36717326 PMCID: PMC9874043 DOI: 10.1016/j.auec.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
AIM This study presents the impact of COVID-19 on revisits to the emergency department comparing revisit rates and characteristics between the pre-COVID-19 and COVID-19 periods. METHODS This multi-center retrospective study included patients over 18 years of age who visited emergency departments during the pre-COVID-19 period and the COVID-19 pandemic. The revisit rates were analyzed according to five age groups; 18-34, 35-49, 50-64, 65-79, and ≥ 80 years, and three revisit time intervals; 3, 9, and 30 days. Also, we compared the diagnosis and disposition at revisit between the study periods. RESULTS The revisit rates increased with age in both study periods and the revisit rates among all age groups were higher in the COVID-19 period. The proportion of infectious and respiratory diseases decreased during the COVID-19 period. The ICU admission rate and mortality at the revisit among patients aged ≥ 80 years were lower in the COVID-19 period than in the pre-COVID-19 period. CONCLUSION The revisit rates increased with age in both study periods and there were several changes in the diagnosis and disposition at the revisit in the COVID-19 period.
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Affiliation(s)
- Myeong Namgung
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Dong Hoon Lee
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea.
| | - Sung Jin Bae
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Ho Sub Chung
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Keon Kim
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Choung Ah Lee
- Department of emergency medicine, Hallym univ. Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Duk Ho Kim
- Department of Emergency Medicine, Eulji University, Seoul, South Korea
| | - Eui Chung Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jee Yong Lim
- Department of emergency medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sang Soo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
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Lin LT, Lin SF, Chao CC, Lin HA. Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain. Eur J Med Res 2023; 28:288. [PMID: 37592352 PMCID: PMC10433659 DOI: 10.1186/s40001-023-01256-7] [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: 02/26/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality. OBJECTIVE We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission (URVAs) from URVs without admission (URVNAs). METHODS This retrospective study included adult patients who visited the ED of Taipei Medical University Hospital because of abdominal pain and revisited in 72 h over a 5-year period (January 1, 2014, to December 31, 2018). Multivariable logistic regression analysis was employed to identify risk factors for URVAs and receiver operating characteristic (ROC) curve analysis was performed to determine the efficacy of variables predicting URVAs and the optimal cut-off points for the variables. In addition, a classification and regression tree (CART)-based scoring system was used for predicting risk of URVA. RESULTS Of 702 eligible patients with URVs related to abdominal pain, 249 had URVAs (35.5%). In multivariable analysis, risk factors for URVAs during the index visit included execution of laboratory tests (yes vs no: adjusted odds ratio [AOR], 4.32; 95% CI 2.99-6.23), older age (≥ 40 vs < 40 years: AOR, 2.10; 95% CI 1.10-1.34), Level 1-2 triage scores (Levels 1-2 vs Levels 3-5: AOR, 2.30; 95% CI 1.26-4.19), and use of ≥ 2 analgesics (≥ 2 vs < 2: AOR, 2.90; 95% CI 1.58-5.30). ROC curve analysis results revealed the combination of these 4 above variables resulted in acceptable performance (area under curve: 0.716). The above 4 variables were used in the CART model to evaluate URVA propensity. CONCLUSIONS Elder patients with abdominal pain who needed laboratory workup, had Level 1-2 triage scores, and received ≥ 2 doses of analgesics during their index visits to the ED had higher risk of URVAs.
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Affiliation(s)
- Li-Tsung Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 501 St Paul St, Baltimore, MD, 21202, USA
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan
| | - Chun-Chieh Chao
- Department of Emergency Medicine, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan.
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
- Graduate Institute of Public Health, College of Public Health, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan.
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Al Ali M, Alfalasi MR, Taimour HA, Ahmed AM, Muhammed Noori OQ. ED Revisits Within 72 Hours to a Tertiary Health Care Facility in Dubai: A Descriptive Study. Cureus 2023; 15:e36807. [PMID: 37123662 PMCID: PMC10135439 DOI: 10.7759/cureus.36807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
Unplanned emergency department (ED) revisit is one of the major challenges faced by emergency care facilities and reflects their quality of care. It is an important key performance indicator (KPI) for emergency medical care. Often, inadequate medical care by physicians is claimed to be the main cause of unplanned ED revisits, yet this assumption is not well studied in the literature. Thus, this study aimed to identify the causes of unplanned ED revisits within 72 hours from the initial visit to the emergency department which could help in developing an action plan and improve quality of care and patient safety. A retrospective study was conducted in Rashid Hospital Trauma Center, from December 2019 to January 2020, using electronic medical records reviewed by two independent investigators. The reasons for the ED revisits were categorized into the following four domains: illness, physician, patient, and system related. A total of 584 revisits were found which accounted for 1.9% of ED attendance from December 2019 to January 2020. Majority of them were male patients, and 63% of the population had a mean age of 33 years. Majority of the ED revisits were due to illness (54%), followed by patient related (20%), physician related (18%), and system related (8%) factors. Most of the patients were discharged on the second visit. The two most common reasons for revisits in the ED department that were seen within the 72 hours were illness related and patient related, followed by physician related. The cause is mainly rooted in suboptimal discharge plans.
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Scheuermeyer FX, Lane D, Grunau B, Grafstein E, Miles I, Kestler A, Barbic D, Barbic S, Slvjic I, Duley S, Yu A, Chiu I, Innes G. Risk factors associated with 1-week revisit among emergency department patients with alcohol withdrawal. CAN J EMERG MED 2023; 25:150-156. [PMID: 36645614 DOI: 10.1007/s43678-022-00414-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/11/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Approximately one-quarter of emergency department (ED) visits for alcohol withdrawal result in unscheduled 1-week ED return visits, but it is unclear what patient and clinical factors may impact this outcome METHODS: From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, Canada, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics, ED treatments, and the outcome of an ED return within 1 week of discharge. We used univariable and multivariable Bayesian binomial regression to identify characteristics associated with being in the upper quartile of 1-week ED revisits. RESULTS We collected 935 ED visits among 593 unique patients. Median age was 45 years (interquartile range 34 to 55 years) and 71% were male. The risk of a 1-week ED revisit was 15.0% (IQR 12.3; 19.5%). After adjustment, factors independently associated with a high risk for return included any prior ED visit within 30 days, no fixed address, initial blood alcohol level > 45 mmol/L, and initial Clinical Institute Withdrawal Assessment-alcohol revised score > 23. These factors explained 41% of the overall variance in revisits. CONCLUSION Among discharged ED patients with alcohol withdrawal, we describe high-risk patient characteristics associated with 1-week ED revisits, and these findings may assist clinicians to facilitate appropriate discharge planning with access to integrated follow-up support.
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Affiliation(s)
- Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada. .,Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Daniel Lane
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian Grunau
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,British Columbia Center for Substance Use, Vancouver, BC, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada.,British Columbia Center for Substance Use, Vancouver, BC, Canada
| | - David Barbic
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Igor Slvjic
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shayla Duley
- Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alec Yu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ivan Chiu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Grant Innes
- Department of Emergency Medicine, Rockyview Hospital and The University of Calgary, Calgary, AB, Canada
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Benchmarking emergency department prediction models with machine learning and public electronic health records. Sci Data 2022; 9:658. [PMID: 36302776 PMCID: PMC9610299 DOI: 10.1038/s41597-022-01782-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022] Open
Abstract
The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop prediction models and decision support systems to address these challenges. To date, there is no widely accepted clinical prediction benchmark related to the ED based on large-scale public EHRs. An open-source benchmark data platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. Based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we created a benchmark dataset and proposed three clinical prediction benchmarks. This study provides future researchers with insights, suggestions, and protocols for managing data and developing predictive tools for emergency care.
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A Machine Learning Model for Predicting Unscheduled 72 h Return Visits to the Emergency Department by Patients with Abdominal Pain. Diagnostics (Basel) 2021; 12:diagnostics12010082. [PMID: 35054249 PMCID: PMC8775134 DOI: 10.3390/diagnostics12010082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Seventy-two-hour unscheduled return visits (URVs) by emergency department patients are a key clinical index for evaluating the quality of care in emergency departments (EDs). This study aimed to develop a machine learning model to predict 72 h URVs for ED patients with abdominal pain. Electronic health records data were collected from the Chang Gung Research Database (CGRD) for 25,151 ED visits by patients with abdominal pain and a total of 617 features were used for analysis. We used supervised machine learning models, namely logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGB), and voting classifier (VC), to predict URVs. The VC model achieved more favorable overall performance than other models (AUROC: 0.74; 95% confidence interval (CI), 0.69–0.76; sensitivity, 0.39; specificity, 0.89; F1 score, 0.25). The reduced VC model achieved comparable performance (AUROC: 0.72; 95% CI, 0.69–0.74) to the full models using all clinical features. The VC model exhibited the most favorable performance in predicting 72 h URVs for patients with abdominal pain, both for all-features and reduced-features models. Application of the VC model in the clinical setting after validation may help physicians to make accurate decisions and decrease URVs.
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Lee YY, Tiew LH, Tay YK, Wong JCM. Importance of telephone follow-up and combined home visit and telephone follow-up interventions in reducing acute healthcare utilization. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-04-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTransitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care needs of a multi-morbid ageing population. This study aims to investigate the impact of transitional care programs (TCPs) on acute healthcare utilization.Design/methodology/approachA retrospective, longitudinal, interventional study was conducted. High-risk patients were enrolled into a transitional care program of local tertiary hospital. Patients received either telephone follow-up (TFU) or home-based intervention (HBI) with TFU. Readmission rates and LOS were assessed for both groups.FindingsThere was no statistically significant difference in readmissions or LOS between TFU and HBI. After excluding demised patients, TFU had statistically significant lower LOS than HBI. Both interventions demonstrated statistically significant reductions in readmissions and LOS in pre–post analyses.Research limitations/implicationsTFU may be more effective than HBI in patients with lower clinical severity, despite both interventions showing statistically significant reductions in acute healthcare utilization. Study findings may be used to inform transitional care practices. Future studies should continue to examine the comparative effectiveness of transitional care interventions and the patient populations most likely to benefit.Originality/valuePrevious studies demonstrated promising outcomes for TFU and HBIs, but few have evaluated their comparative effectiveness on acute healthcare utilization and specific patient populations most likely to benefit. This study evaluated interventional effectiveness of both, which might be useful for informing allocation of resources based on clinical complexity and care needs.
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Rintaari KM, Kimani RW, Musembi HM, Gatimu SM. Characteristics and outcomes of patients with an unscheduled return visit within 72 hours to the Paediatric Emergency Centre at a Private Tertiary Referral Hospital in Kenya. Afr J Emerg Med 2021; 11:242-247. [PMID: 33859926 PMCID: PMC8027518 DOI: 10.1016/j.afjem.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/28/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Patients’ unscheduled return visits (URVs) to the paediatric emergency Centre (PEC) contribute to overcrowding and affect health service delivery and overall quality of care. This study assessed the characteristics and outcomes of paediatric patients with URVs (within 72 hours) to the PEC at a private tertiary hospital in Kenya. Methods We conducted a retrospective chart review of all URVs within 72 hours among paediatric patients aged ≤15 years between 1 July and 31 December 2018 at the tertiary hospital in Nairobi, Kenya. Results During the study period, 1.6% (n=172) of patients who visited the PEC returned within 72 hours, with 4.7% revisiting the PEC more than once. Patients’ median age was 36 months (interquartile range: 42 months); over half were male (51.7%), 55.8% were ambulatory and 84.3% were insured. In addition, 21% (n=36) had chronic diseases and 7% (n=12) had drug allergies. Respiratory (59.5%) and gastrointestinal (21.5%) tract infections were the most common diagnoses. Compared with the first visit, more patients with URVs were classified as urgent (1.7% vs. 5.2%) and were non-ambulatory (44.2% vs. 49.5%, p=<0.001); 18% of these patients were admitted. Of these 58% were male, 83.9% were aged 0–5 years, 12.9% were classified as urgent, 64.5% had respiratory tract infections and 16.1% had gastrointestinal tract infections. Being admitted was associated with patient acuity (p=0.004), laboratory tests (p=<0.001) and ambulatory status (p=0.041). Conclusion The URV rate is low in our setting. Patients who returned to the PEC within 72 hours tended to be male, under 5 years old and insured. Many were non-urgent cases with diagnoses of respiratory and gastrointestinal tract infections. The findings suggest that some URVs were necessary and may have contributed to better care and improved outcomes while others highlight a need for effective patient education and comprehensive initial assessment.
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Dehesa Fontecilla MA, Fernandez N, Aláiz-Moretón H, Sánchez-Valdeón L, Benítez-Andrades JA. [Return rate to the Primary Care Emergency Service for elderly patients over 65 years old and their assistance requirements]. Aten Primaria 2021; 53:102084. [PMID: 33991761 PMCID: PMC8134028 DOI: 10.1016/j.aprim.2021.102084] [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: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/24/2021] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To determine the unexpected return rate to the Primary Care Emergency Service of elderly patients over 65 years old within the following 72h of a previous visit, as well as to determine the clinical and assistance requirements of these patients. PROCEDURE Retrospective and observational epidemiologic study. LOCATION Cotolino's Primary Care Emergency Service in Cantabria, Spain. PARTICIPANTS 1940 elderly patients over 65 years old were included. These patients returned to the Primary Care Emergency Service in 2016. MAIN DATA FOR THE STUDY The dependent variable was the return rate to the Primary Care Emergency Service. The independent variables were socio-demographic characteristics, health details and medical assistance information. All data was collected from the Primary Care Emergency Service Management Office database. All variables were analysed applying Pearson's chi-squared test and Fisher's exact test, with statistical significance P≤.05. RESULTS The rate of unexpected return was 2.3%. The average age was 77.4 years old (standard deviation (SD): 8.4), of which the 37.6% were male. The most frequent range of age was from 75 to 84 years old, with males being the predominant group. A history of polymedication was detected in 54.4% of the cases, as well as a medium cardiovascular risk within this group. Nursing professionals attended the 42.2% of these return cases (P<.001). Patients with dysnea (P=.015), scheduled care or scheduled injection returned with a higher frequency (P<.001). It was as well noticed a higher frequency of return for subsequent attention during the months of December and January (P<.001). CONCLUSIONS The rate of unexpected return is low. The main causes why elderly patients returned to the service requiring urgent assistance were issues categorised as unspecific general health indicators and/or respiratory system illnesses. Our proposal is to develop specific protocols combining the work from both Geriatrics and Gerontology professionals, in order to improve the support to this group of population at every Primary Care Emergency Service.
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Affiliation(s)
| | - Nélida Fernandez
- Área de Farmacología, Departamento de Ciencias Biomédicas, Instituto de Biomedicina (IBIOMED), Universidad de León , León, España
| | - Héctor Aláiz-Moretón
- Grupo de Investigación Salud, Bienestar y Sostenibilidad Sociosanitaria (SALBIS), Departamento de Ingeniería Eléctrica y de Sistemas y Automática, Universidad de León , León, España
| | - Leticia Sánchez-Valdeón
- SECOMUCI Research Group, Facultad de Ciencias de la Salud, Universidad de León, León, España
| | - Jose Alberto Benítez-Andrades
- Grupo de Investigación Salud, Bienestar y Sostenibilidad Sociosanitaria (SALBIS), Departamento de Ingeniería Eléctrica y de Sistemas y Automática, Universidad de León , León, España
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13
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Discharge against medical advice from the emergency department in a university hospital. BMC Emerg Med 2021; 21:31. [PMID: 33726692 PMCID: PMC7962258 DOI: 10.1186/s12873-021-00422-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.
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Todd VF, Swain A, Howie G, Tunnage B, Smith T, Dicker B. Factors Associated with Emergency Medical Service Reattendance in Low Acuity Patients Not Transported by Ambulance. PREHOSP EMERG CARE 2021:1-17. [PMID: 33320722 DOI: 10.1080/10903127.2020.1862943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance.Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance.Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93).There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92).Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.
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Affiliation(s)
- Verity F Todd
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Andy Swain
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Graham Howie
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bronwyn Tunnage
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Tony Smith
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
| | - Bridget Dicker
- Received November 25, 2019 from Clinical Audit and Research Team, St John New Zealand, Auckland, New Zealand (VFT, GH, BT, TS, BD); Paramedicine Department, Auckland University of Technology, Auckland, New Zealand (VFT, AS, GH, BT, BD); Wellington Free Ambulance, Wellington, New Zealand (AS). Revision received December 3, 2020; accepted for publication December 6, 2020
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15
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Liu SW. Risk factors of admission in 72-h return visits to emergency department. Tzu Chi Med J 2020; 33:169-174. [PMID: 33912415 PMCID: PMC8059464 DOI: 10.4103/tcmj.tcmj_155_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/30/2020] [Accepted: 08/30/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Return visit to emergency department (ED) is a common phenomenon and has been a clinical indicator of quality of care in ED. Most of previous articles focused on the characteristics of the patients returning within 72 h after ED discharge, while those on subsequent admission are numbered. This study's purpose is to identify risk factors for admission among 72-h return visit in the ED adult population. Materials and Methods: This retrospective cohort study was conducted at a medical center in Eastern Taiwan. The study period was from January 1, 2013, to December 31, 2013. We excluded patients who left against medical advice or without being seen, who was admitted or transferred at the index ED visit, whose medical records were incomplete, and whose age was below 18 years old. Significant variables were selected based on univariate analysis and later entered into multivariate logistic regression analysis to identify risk factors for 72-h return admission. Results: We identified 1575 eligible visits, and there were 1,119 visits entering into the final analysis. Male gender (odds ratio [OR] = 1.44), ambulance-transport at return visit (OR = 3.68), senior staff (OR = 1.52), work-up (OR = 3.03), and longer length of stay (LOS) were associated with higher risks of admission among ED 72-h return visits. Age, comorbidity, mode of transport at index visit, consultation, triage, type of illness, outpatient department visit between ED visits, and interval between index and return visits were not significantly associated with return admission. Conclusion: Gender, mode of transportation, staff experience, check-up, and LOS are associated with ED return admission.
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Affiliation(s)
- Sung-Wei Liu
- Department of Emergency, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Alshahrani M, Katbi F, Bahamdan Y, Alsaihati A, Alsubaie A, Althawadi D, Perlas-Asonto L. Frequency, Causes, and Outcomes of Return Visits to the Emergency Department Within 72 Hours: A Retrospective Observational Study. J Multidiscip Healthc 2020; 13:2003-2010. [PMID: 33376340 PMCID: PMC7764850 DOI: 10.2147/jmdh.s282192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Emergency departments (EDs) serve as an accessible gateway to healthcare system wherein numerous patients consider it a prime choice for medical complaints. Frequency of ED revisits, causes, and its burden are necessary to assess quality of care provided to patients and identify factors that leads to revisit. Patients and Methods Electronic and printed medical records of all patients who revisited ED from January to May 2016 within 72 hours of initial visit were reviewed. Patients’ cause of revisit were classified to three categories: patient-, physician- and system-related factors. Common complaints that require revisits were also collected. Descriptive analysis was performed and categorical variables were represented by the frequency; percentages and continuous variables were presented as median, and range if data did not follow normal distribution. Results Of the 79,279 patients who visited ED during the study period, 1.3% (1000) patients revisited within 72 hours; 51.3% (n=513) were males, with a mean age of 31.5 years (SD=17.7 years) where majority (57.1%) had no comorbidity recorded. The most attributed factors for revisit were as follows: patient-related causes 635 patients (63.5%), physician-related factors 167 patients (16.7%), and system-related factors 42 patients (4.2%); 15.6% were found not related to the initial visit. Recurrence of the same complaint was the highest among patient-related factors (80.5%), inadequate management and no improvement of symptoms in 71.3% among the physician-related factors. The most common ED revisit complaint was fever 29.1% (n=291). Outcomes of the revisit were mainly patient discharge 96.7% (n=967), admission 1.2% (n=12) and death in 0.2% (n=2). Conclusion Recurrence of the same complaint with no symptoms improvement and suboptimal management of physicians contributed to most of the ED revisits within 72 hours. Encouraging physicians to provide clear instructions in educating patients on discharge regarding disease progression and its red flags as to when a return to ED, might help in reducing revisit rate.
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Affiliation(s)
- Mohammed Alshahrani
- Departments of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, 31952, Kingdom of Saudi Arabia
| | - Faisal Katbi
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Yazeed Bahamdan
- Department of General Pediatrics, Children's Hospital- King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahrar Alsaihati
- Department of Dermatology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Aisha Alsubaie
- Department of Emergency, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Dana Althawadi
- Department of Emergency, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Laila Perlas-Asonto
- Department of Emergency and Critical Care Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Iacono T, Bigby C, Douglas J, Spong J. A prospective study of hospital episodes of adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:357-367. [PMID: 32173949 PMCID: PMC7216832 DOI: 10.1111/jir.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Previous research has shown poor hospital experiences and dire outcomes for people with intellectual disability. The main objective of this study was to prospectively track episodes for adults with intellectual disability (ID) in Australian hospitals, with a focus on indications of the quality of care provided. METHODS A prospective audit of hospital records over 35 months yielded quantitative data about patient characteristics, frequency and length of hospital episodes, diagnostic assessments and outcomes, post-emergency department (ED) destinations and post-discharge recommendations. Fifty participants were recruited largely by identification on hospital ED entry. An audit of patients' hospital records was conducted towards the end of hospital episodes, using a tool developed for the study. RESULTS Participants were mostly men (70%), aged 42.9 years on average, living mostly with family (46%) or in supported accommodation (44%). Of 157 recorded episodes, 96% started in ED, 85% required urgent or semi-urgent care and 62% were in the first 3 months of study participation. Average time in ED exceeded the 4-h national benchmark, met in 40% of episodes. One or more diagnostic assessments were conducted in 91% episodes and others in short stay units. Almost half (49%) resulted in a ward stay. With an extreme data point removed, <1-35 days were spent in wards. The most frequent diagnosis in 75% of episodes was for digestive problems, followed by nervous system problems then injuries. Median length of bed stays reflected data available for Australian refined diagnosis-related groups. High hospital re-presentations were found: for 67% of episodes in total, 26% (n = 12) of which were within 72 h and 59% (n = 23) within 30 days. CONCLUSIONS Adults with ID presented frequently to ED and often had lengthy stays. We found no indication of poor care practices in terms of hospital staff willingness to keep patients in ED and conduct of diagnostic assessments. Frequent re-presentations, however, indicated failed hospital care at some level.
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Affiliation(s)
- T. Iacono
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
| | - C. Bigby
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Douglas
- Living with Disability Research CentreLa Trobe UniversityMelbourneVic.Australia
| | - J. Spong
- Living with Disability Research CentreLa Trobe UniversityBendigoVic.Australia
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Chiang CY, Chen YL, Lin YR, Cheng FJ, Wu KH, Chiu IM. Characteristics of Febrile Children Admitted to the ICU Following an Unscheduled ED Revisit Within 72 h, a Case-Control Study. Front Pediatr 2020; 8:411. [PMID: 32850531 PMCID: PMC7426702 DOI: 10.3389/fped.2020.00411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: The purpose of this article was to demonstrate related characteristics of intensive care unit (ICU) admission after an unscheduled revisit by febrile children visiting the emergency department (ED). Method: We performed a retrospective study in a tertiary medical center from 2010 to 2016. Patients whose chief complaint was fever and who were admitted to the ICU following a 72-h return visit to the ED were included, and we selected patients who were discharged from the same emergency department for comparison. Results: During the study period, 54 (0.03%) patients met the inclusion criteria, and 216 patients were selected for the matched control group. Regarding clinical variables on initial ED visit, visiting during the night shift (66.7 vs. 46.8%, p = 0.010), shorter length of 1st ED stay (2.5 ± 2.63 vs. 3.5 ± 3.44 h, p = 0.017), and higher shock index (SI) (1.6 ± 0.07 vs. 1.4 ± 0.02, p = 0.008) were associated with ICU admission following a return visit. On the return ED visit, we found that clinical variables such as elevated heart rate, SI, white blood cell count, and C-reactive protein level were all associated with ICU admission. Furthermore, elevated SI and pediatric age-adjusted (SIPA) values were observed in the study group in both the initial (42.2 vs. 20.1%, OR:2.3 (1.37-4.31), p = 0.002) and return ED visits (29.7 vs. 6.9%, OR: 4.6 (2.42-8.26), p < 0.001). Conclusion: For children who visited the emergency department with a febrile complaint, elevated SIPA values on the initial ED visit were associated with ICU admission following an unscheduled ED revisit within 72 h.
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Affiliation(s)
- Charng-Yen Chiang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Lun Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yet-sen University, Kaohsiung, Taiwan
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19
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Evaluating Hospital Readmissions Through the Perspective of the Returning Emergency Department Patient. Qual Manag Health Care 2020; 29:15-19. [DOI: 10.1097/qmh.0000000000000238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Aslaner MA. Acil Servise Geriatrik Hastaların 72 Saat İçerisindeki Tekrar Başvuruları. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.562963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Risk Factors for Emergency Department Unscheduled Return Visits. ACTA ACUST UNITED AC 2019; 55:medicina55080457. [PMID: 31405058 PMCID: PMC6723936 DOI: 10.3390/medicina55080457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.
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Knowles H, Huggins C, Robinson RD, Mbugua R, Laureano-Phillips J, Trivedi SM, Kirby J, Zenarosa NR, Wang H. Status of Emergency Department Seventy-Two Hour Return Visits Among Homeless Patients. J Clin Med Res 2019; 11:157-164. [PMID: 30834037 PMCID: PMC6396788 DOI: 10.14740/jocmr3747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 11/11/2022] Open
Abstract
Background We aim to externally validate the status of emergency department (ED) appropriate utilization and 72-h ED returns among homeless patients. Methods This is a retrospective single-center observational study. Patients were divided into two groups (homeless versus non-homeless). Patients' general characteristics, clinical variables, ED appropriate utilization, and ED return disposition deviations were compared and analyzed separately. Results Study enrolled a total of 63,990 ED visits. Homeless patients comprised 9.3% (5,926) of visits. Higher ED 72-h returns occurred among homeless patients in comparison to the non-homeless patients (17% versus 5%, P < 0.001). Rate of significant ED disposition deviations (e.g., admission, triage to operation room, or death) on return visits were lower in homeless patients when compared to non-homeless patient populations (15% versus 23%, P < 0.001). Conclusions Though ED return rate was higher among homeless patients, return visit case management seems appropriate, indicating that 72-h ED returns might not be an optimal healthcare quality measurement for homeless patients.
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Affiliation(s)
- Heidi Knowles
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Charles Huggins
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Richard D Robinson
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Rosalia Mbugua
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Jessica Laureano-Phillips
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Shrunjal M Trivedi
- Department of Family Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Jessica Kirby
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Nestor R Zenarosa
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
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Ahmed AE, AlBuraikan DA, Almazroa HR, Alrajhi MN, ALMuqbil BI, Albaijan MA, Alsalamah MA, Al-Jahdali H. Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study. Ther Clin Risk Manag 2018; 14:1423-1428. [PMID: 30147326 PMCID: PMC6098417 DOI: 10.2147/tcrm.s168763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the increase in adult emergency department (ED) utilization in Saudi Arabia, no studies have evaluated the 72-hour revisits. This study estimates the rate of 72-hour ED revisits and identifies its reasons and predictive factors among adults with chronic diseases. Patients and methods A hospital-based retrospective study that included 24,206 ED discharges for adults with chronic diseases at the adult ED of King Abdulaziz Medical City, Riyadh between September 13, 2015 and July 29, 2017 was performed. We extracted data on demographic information, reasons for ED visits/revisits, health insurance coverage, weekend ED arrival, and mortality. Results A sample of 24,206 ED discharges for 19,697 adults with at least one chronic disease was included in the analysis. The rate of 72-hour revisits in this study population was high: 3,144/24,206 (13%) had the first revisit and 319/3,144 (10.1%) had the second ED revisit within 72 hours. Diseases of the circulatory (19%) and genitourinary (15.8%) systems were the major reasons for the first ED revisit. The adjusted relative rate (aRR) of 72-hour ED revisits was higher in adults with chronic diseases and aged ≥60 years (aRR=1.360, 95% CI: 1.41–1.83; P=0.001), patients of female gender (aRR=1.24, 95% CI: 1.09–1.41; P=0.001), patients with health insurance coverage (aRR=4.23, 95% CI: 2.60–6.90; P=0.001), patients arriving to ED on a weekend (aRR=2.13, 95% CI: 1.03–4.41; P=0.041), and new patients (aRR=1.47, 95% CI: 1.25–1.73; P=0.001). Conclusion The rate of 72-hour revisits is high among adults with chronic diseases. Advancing age, female gender, health insurance coverage, weekend ED arrival, and new patients are the important predictive factors of the high rate of 72-hour revisits. Continuous quality assessment and monitoring of factors related to patients are needed to reduce the frequency of early ED revisits after discharge.
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Affiliation(s)
- Anwar E Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Doaa A AlBuraikan
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Hend R Almazroa
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Manair N Alrajhi
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Bashayr I ALMuqbil
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Monirah A Albaijan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia,
| | - Majid A Alsalamah
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Hamdan Al-Jahdali
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia,
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Pellerin G, Gao K, Kaminsky L. Predicting 72-hour emergency department revisits. Am J Emerg Med 2017; 36:420-424. [PMID: 28855065 DOI: 10.1016/j.ajem.2017.08.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To develop a predictive model that hospitals or healthcare systems can use to identify patients at high risk of revisiting the ED within 72h so that appropriate interventions can be delivered. METHODS This study employed multivariate logistic regression in developing the predictive model. The study data were from four Veterans medical centers in Upstate New York; 21,141 patients in total with ED visits were included in the analysis. Fiscal Year (FY) 2013 data were used to predict revisits in FY 2014. The predictive variables were patient demographics, prior year healthcare utilizations, and comorbidities. To avoid overfitting, we validated the model by the split-sample method. The predictive power of the model is measured by c-statistic. RESULTS In the first model using only patient demographics, the c-statistics were 0.55 (CI: 0.52-0.57) and 0.54 (95% CI: 0.51-0.56) for the development and validation samples, respectively. In the second model with prior year utilization added, the c-statistics were 0.70 (95% CI: 0.68-0.72) for both samples. In the final model where comorbidities were added, the c-statistics were 0.74 (CI: 0.72-0.76) and 0.73 (95% CI: 0.71-0.75) for the development and validation samples, respectively. CONCLUSIONS Reducing ED revisits not only lowers healthcare cost but also shortens wait time for those who critically need ED care. However, broad intervention for every ED visitor is not feasible given limited resources. In this study, we developed a predictive model that hospitals and healthcare systems can use to identify "frequent flyers" for early interventions to reduce ED revisits.
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Affiliation(s)
- Gene Pellerin
- US Department of Veterans Affairs, Stratton VA Medical Center, 113 Holland Ave., Albany, NY 12208, United States.
| | - Kelly Gao
- US Department of Veterans Affairs, Stratton VA Medical Center, 113 Holland Ave., Albany, NY 12208, United States.
| | - Laurence Kaminsky
- US Department of Veterans Affairs, Stratton VA Medical Center, 113 Holland Ave., Albany, NY 12208, United States.
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Lauque D, Fernandez S, Lecoules N, Charpentier S, Azéma O, Edlow J, Bellou A. Revue de la littérature sur les retours précoces aux urgences pour améliorer la qualité et la sécurité des soins. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kilicaslan O, Sönmez FT, Gunes H, Temizkan RC, Kocabay K, Saritas A. Short Term Unscheduled Revisits to Paediatric Emergency Department - A Six Year Data. J Clin Diagn Res 2017; 11:SC12-SC15. [PMID: 28511472 DOI: 10.7860/jcdr/2017/25098.9484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Reviewing the reasons for return visits within 24 hours is a very important method of determining possible problems of emergency health care. Several causes stay behind unscheduled emergency return visits. Therefore, identifying these factors is crucial to set strategies in order to decrease the number of unnecessary visits. AIM To define the characteristics of the patients returning to the Paediatric Emergency Department (PED) within 24 hours via determining rate, number and demographic data of patients. MATERIALS AND METHODS The present study design involves retrospective data collection of patients who returned to PED within 24 hours after being discharged. Data was included over six year period and was collected from July 1, 2010 to June 30, 2016. The data was analysed with SPSS17.0 statistical package for windows. RESULTS A total of 1994 patients returned to PED within 24 hours from July 1, 2010 to June 30, 2016. The most common group of revisiting patients were toddlers (aged 0-2-year old), n=1168 (58.5%), and the least number represented young adolescents (aged 15-18-year old), n=82 (4.1%). Number of patients returning to PED in 24 hours has significantly increased within years from approximately 90 patients to 720 (p<0.05). This increase in number was observed in all and each age group (from 0-18 years of age) without any exception. Seasonal distribution of the patients showed no significant difference (p>0.05) for each age, but again, presented definite negative correlation with age (the older is the patient group, the less is the number of revisits). The most common time for revisits was 17-24 hours after first discharge from PED, n=1277 (64.04%). CONCLUSION The number of return visits is increasing over the years. The younger the patient is, more likely is the risk of unscheduled revisit to PED. Most of the patients returned to PED in 17 to 24 hours after discharge.
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Affiliation(s)
- Onder Kilicaslan
- Faculty, Department of Pediatric Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Feruza Turan Sönmez
- Faculty, Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Harun Gunes
- Faculty, Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Ramazan Cahit Temizkan
- Faculty, Department of Pediatric Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Kenan Kocabay
- Faculty, Department of Pediatric Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Ayhan Saritas
- Faculty, Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
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