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Deng C, Li Q, Hu L, Lin J, Wu Y, Zheng R, Guo Q. Nurses' lived experience of providing hospice care in the emergency department in mainland China: A qualitative study. Int Emerg Nurs 2024; 75:101464. [PMID: 38823289 DOI: 10.1016/j.ienj.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/28/2024] [Accepted: 05/18/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Chanjuan Deng
- School of Nursing, Capital Medical University, Beijing, 100069 China
| | - Qianqian Li
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020 China
| | - Lei Hu
- Department of Outpatient, Peking University Shougang Hospital, Beijing, 100144 China
| | - Junyi Lin
- School of Nursing, Capital Medical University, Beijing, 100069 China
| | - Yanchao Wu
- School of Nursing, Capital Medical University, Beijing, 100069 China
| | - Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, 100069 China.
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Blandin M, Gallet M, Volteau C, Le Conte P, Rulleau T, Le Sant G. Effects of the delivery of physiotherapy on the treatment course of elderly fallers presenting to the emergency department: Protocol for a randomized clinical trial. PLoS One 2024; 19:e0303362. [PMID: 38718002 PMCID: PMC11078381 DOI: 10.1371/journal.pone.0303362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
The use of physiotherapy (PT) in the hospital emergency department (ED) has shown positive results including improvements in patient waiting time, treatment initiation, discharge type, patient outcomes, safety and acceptability of the intervention by medical staffs. These findings originate from studies that primarily focus on musculoskeletal and orthopaedic conditions. Despite a significant number of people visiting the ED, there is a shortage of literature evaluating PT in the ED for elderly populations. The objective of this study is the evaluate the effect of delivering PT in the ED (versus no delivery) in patients aged 75 and over with 'falls' complaints. The main objective is the evaluate the effect on the discharge disposition (discharge home, hospitalization). Secondarily, we will evaluate the effect delivering PT on patient-length of stay, the number of falls at 7 days after admission to the ED, changes between the initial and final medical decision regarding patient orientation, and medical staff satisfaction. This study will follow a prospective longitudinal design involving participants aged 75 years and over. We plan to recruit a total n = 336 patients admitted to the ED with a 'fall' chief complaint. After consent, participants will be randomized into either the 'PT-group' (receiving a prescription and execution of PT within the ED), or to the 'no-PT group' (no delivery of PT within the ED). The PT intervention will involve a standardized assessment of motor capacities using validated clinical examinations, and the delivery of rehabilitative exercises based on individual needs. Outcomes will be recorded from the patient's medical record, and a phone call at 7 days. A questionnaire will be sent to medical staff. The results of this study will help to determine whether PT might be beneficial for the management of this increasing proportion of individuals who come to the ED. Trial registration: (Trial registration number: ClinicalTrials.gov NCT05753319). https://classic.clinicaltrials.gov/ct2/show/NCT05753319.
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Affiliation(s)
- Marie Blandin
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
| | - Marie Gallet
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
| | - Christelle Volteau
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
| | - Philippe Le Conte
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
| | - Thomas Rulleau
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
| | - Guillaume Le Sant
- Nantes Université, CHU Nantes, Movement – Interactions - Performance, MIP, UR 4334, Nantes, France
- IFM3R, School of Physiotherapy, St-Sebastien-sur-Loire, France
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Marie P, Romain-Scelle N, Potinet V, Schott AM, Douplat M. Assessment of health literacy in a French emergency department. BMC Health Serv Res 2024; 24:493. [PMID: 38649979 PMCID: PMC11034065 DOI: 10.1186/s12913-024-11003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Health literacy (HL) has become a subject of major interest in public health worldwide. It is known to be linked to self-efficacy in care use and to global health status, and a non-negligible frequency of problematic or inadequate levels of HL in populations worldwide is reported. As this has yet to be evaluated in France, the present study aimed to evaluate the HL level of patients in a French emergency department (ED). METHODS We conducted a descriptive, cross-sectional observational, single center study in the ED of the Lyon Sud hospital (Hospices civils de Lyon, Lyon, France). The primary endpoint was the HL level of the patients determined according to the score obtained using the 16-item European Health Literacy Survey Questionnaire. The secondary endpoint was the identification of sociodemographic factors associated with the HL level. RESULTS A total of 189 patients were included for analysis. 10% (95% CI [3%; 17%]) of the patients had an inadequate HL, 38% (95% CI [31%; 45%]) had a problematic HL, and 53% (95% CI [46%; 61%] had an adequate HL. In multivariate analysis, age and perceived health status were independent predictors of the HL level; OR =0.82 (95% CI [0.69; 0.97]; p=0.026) for a 10-year increase in age, and OR =1.84 (95% CI [1.22; 2.82]; p=0.004]). CONCLUSIONS The HL level of the patients in the ED studied herein was similar to that found in the population of France and other European countries and was influenced by age and perceived health status, which are both associated with care needs. It may be therefore interesting to explore in future studies how taking into consideration HL in the general population may lead to a better self-efficacy in care and optimize the use of the healthcare system.
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Affiliation(s)
- Pauline Marie
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - Nicolas Romain-Scelle
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR, 5558, Villeurbanne, France
| | - Veronique Potinet
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France
| | - Anne Marie Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290, Lyon, France
| | - Marion Douplat
- Hospices Civils of Lyon, Hôpital Lyon Sud, Emergency department, Université Claude Bernard Lyon 1, 69495, Pierre-Bénite, France.
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM, U1290, Lyon, France.
- UMR ADéS 7268, Aix-Marseille Université/ EFS / CNRS, Espace éthique méditerranéen, Marseille, France.
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Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, Bloom B, Catoire P, Berard L, Cachanado M, Simon T, Laribi S, Freund Y. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med 2023; 183:1378-1385. [PMID: 37930696 PMCID: PMC10628833 DOI: 10.1001/jamainternmed.2023.5961] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/26/2023] [Indexed: 11/07/2023]
Abstract
Importance Patients in the emergency department (ED) who are waiting for hospital admission on a wheeled cot may be subject to harm. However, mortality and morbidity among older patients who spend the night in the ED while waiting for a bed in a medical ward are unknown. Objective To assess whether older adults who spend a night in the ED waiting for admission to a hospital ward are at increased risk of in-hospital mortality. Design, Settings, and Participants This was a prospective cohort study of older patients (≥75 years) who visited the ED and were admitted to the hospital on December 12 to 14, 2022, at 97 EDs across France. Two groups were defined and compared: those who stayed in the ED from midnight until 8:00 am (ED group) and those who were admitted to a ward before midnight (ward group). Main Outcomes and Measures The primary end point was in-hospital mortality, truncated at 30 days. Secondary outcomes included in-hospital adverse events (ie, falls, infection, bleeding, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia) and hospital length of stay. A generalized linear-regression mixed model was used to compare end points between groups. Results The total sample comprised 1598 patients (median [IQR] age, 86 [80-90] years; 880 [55%] female and 718 [45%] male), with 707 (44%) in the ED group and 891 (56%) in the ward group. Patients who spent the night in the ED had a higher in-hospital mortality rate of 15.7% vs 11.1% (adjusted risk ratio [aRR], 1.39; 95% CI, 1.07-1.81). They also had a higher risk of adverse events compared with the ward group (aRR, 1.24; 95% CI, 1.04-1.49) and increased median length of stay (9 vs 8 days; rate ratio, 1.20; 95% CI, 1.11-1.31). In a prespecified subgroup analysis of patients who required assistance with the activities of daily living, spending the night in the ED was associated with a higher in-hospital mortality rate (aRR, 1.81; 95% CI, 1.25-2.61). Conclusions and Relevance The findings of this prospective cohort study indicate that for older patients, waiting overnight in the ED for admission to a ward was associated with increased in-hospital mortality and morbidity, particularly in patients with limited autonomy. Older adults should be prioritized for admission to a ward.
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Affiliation(s)
- Melanie Roussel
- Emergency Department, Centre Hospitalier Universitaire (CHU) de Rouen, Rouen, France
| | - Dorian Teissandier
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Youri Yordanov
- Emergency Department, Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Université, Paris, France
| | - Frederic Balen
- Emergency Department, CHU de Toulouse, EQUITY (embodiment, social inequalities, life course epidemiology, cancer, and chronic diseases, interventions, methodology) team, Center for Epidemiology and Research in Population Health, INSERM, Toulouse, France
| | - Marc Noizet
- Emergency Department and Service d’Aide Médicale Urgente (SAMU) 68, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France
| | - Karim Tazarourte
- Emergency Department and SAMU 69, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1 INSERM 1290 reshape, Lyon, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Pierre Catoire
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Laurence Berard
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Paris, France
- Department of Clinical Pharmacology and Clinical Research Platform Paris-East, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Said Laribi
- Emergency Department, CHU Tours, Tours, France
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
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Tarkie K, Altaye KD, Berhe YW. Current patterns of care at adult emergency department in Ethiopian tertiary university hospital. Int J Emerg Med 2023; 16:25. [PMID: 37041467 PMCID: PMC10088255 DOI: 10.1186/s12245-023-00502-3] [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: 01/02/2023] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The complexity and demands of emergency healthcare service are continuously increasing, and it is important to regularly track the patterns of care at the emergency department (ED). METHODOLOGY A retrospective study was conducted at the ED of the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from April 1 to June 30, 2021. Ethical approval was obtained from the Emergency and Critical Care Directorate of UoGCSH. Data was collected from the emergency registry and descriptive analysis was performed. RESULTS A total of 5232 patients have visited and triaged at the ED. All patients who visited the ED have received triage service within 5 min of arrival. The average length of stay at the ED was 3 days. About 79.1% of patients have stayed at the ED beyond 24 h, and the unavailability of beds at admission areas was responsible for 62% of delays. Mortality rate at the ED was 1.4%, and male to female ratio of death was 1.2 to 1. Shock (all types combined), pneumonia with/without COVID-19, and poisoning were the leading causes of death at the ED which were responsible for 32.5%, 15.5%, and 12.7% of deaths respectively. CONCLUSIONS Triage has been done within the recommended time after patient arrival. However, many patients were staying at the ED for an unacceptably prolonged time. Unavailability of beds at the admission areas, waiting long for senior clinicians' decisions, delays in investigation results, and lack of medical equipment were the causes of delayed discharge from the ED. Shock, pneumonia, and poisoning were the leading causes of death. Healthcare administrators should address the lack of medical resources, and clinicians should provide timely clinical decision and investigation results.
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Affiliation(s)
- Kibur Tarkie
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kassaye Demeke Altaye
- Department of Emergency Medicine and Critical Care, University of Gondar, Gondar, Ethiopia
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Naouri D, Panjo H, Moïsi L, El Khoury C, Serre P, Schmidt J, Yordanov Y, Pelletier-Fleury N. The Association Between Age and Admission to an Inappropriate Ward: A Cross-Sectional Survey in France. Health Serv Insights 2023; 16:11786329231174340. [PMID: 37197083 PMCID: PMC10184193 DOI: 10.1177/11786329231174340] [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: 08/25/2022] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
Half of elderly patient hospitalizations are preceded by an emergency department (ED) visit. Hospitalization in inappropriate wards (IWs), which is more frequent in case of ED overcrowding and high hospital occupancy, leads to increased morbidity. Elderly individuals are the most exposed to these negative health care outcomes. Based on a nationwide cross-sectional survey involving all EDs in France, the aim of this study was to explore whether age was associated with admission to an IW after visiting an ED. Among the 4384 patients admitted in a medical ward, 4065 were admitted in the same hospital where the ED was located, among which 17.7% were admitted to an IW. Older age was associated with an increased likelihood of being admitted to an IW (OR = 1.39; 95% CI = 1.02-1.90 for patients aged 85 years and older and OR = 1.40; 95% CI = 1.02-1.91 for patients aged 75-84 years, compared with those under 45 years). ED visits during peak periods and cardio-pulmonary presenting complaint were also associated with an increased likelihood of admission to an IW. Despite their higher vulnerability, elderly patients are more likely to be admitted to an IW than younger patients. This result reinforces the need for special attention to be given to the hospitalization of this fragile population.
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Affiliation(s)
- Diane Naouri
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- D Naouri, Centre de recherche en épidémiologie et santé des populations (CESP), Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, Villejuif 94800, France.
| | - Henri Panjo
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | - Laura Moïsi
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Unité de Gériatrie Aigue, Paris, France
| | | | - Patrice Serre
- French Society of Emergency Medicine (SFMU), Paris, France
| | | | - Youri Yordanov
- French Society of Emergency Medicine (SFMU), Paris, France
| | - Nathalie Pelletier-Fleury
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
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Bayuo J, Agbeko AE, Acheampong EK, Abu-Odah H, Davids J. Palliative care interventions for adults in the emergency department: A review of components, delivery models, and outcomes. Acad Emerg Med 2022; 29:1357-1378. [PMID: 35435306 DOI: 10.1111/acem.14508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Existing evidence suggest the emergence of palliative care (PC) services in the emergency department (ED). To gain insight into the nature of these services and provide direction to future actions, there is a need for a comprehensive review that ascertains the components of these services, integration models, and outcomes. METHODS A scoping review design was employed and reported according to the PRISMA extension guidelines for scoping reviews. Extensive searches in peer-reviewed databases (CINAHL, EMBASE, PubMed, Cochrane Library, and Medline) and gray literature sources (Trove, MedNar, OpenGrey, and the Agency for Healthcare Research and Quality) were undertaken and supplemented with hand searching. Titles, abstracts, and full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on a PC intervention implemented in the ED for adults. Codes were formulated across the included studies, which facilitated the conduct of a narrative synthesis. RESULTS Twenty-three studies were retained with the majority (n = 15) emerging from the United States. The components of PC interventions in the ED were categorized as: (1) screening, (2) goals of care discussion and communication, (3) managing pain and other distressing symptoms in the ED, (4) transitions across care settings, (5) end-of-life (EoL) care, (6) family/caregiver support, and (7) ED staff education. Traditional PC consultations and integrated ED-PC services were the main modes of delivery. PC in the ED can potentially improve patient symptoms, facilitate access to relevant services, reduce length of stay, improve care at the EoL, facilitate bereavement and postbereavement support for family members, and improve ED staff confidence in delivering PC. CONCLUSIONS PC implementation in the ED may potentially improve patient and family outcomes. More studies are needed, however, to standardize trigger or screening tools. More prospective studies are also needed to test PC interventions in the ED.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | | | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Jephtah Davids
- College of Health Science, University of Ghana, Legon, Greater Accra, Ghana
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La consultation médicale en urgence dans le parcours du patient en oncologie. Bull Cancer 2022; 109:1277-1286. [DOI: 10.1016/j.bulcan.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
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Wallstab F, Greiner F, Schirrmeister W, Wehrle M, Walcher F, Wrede C, Habbinga K, Behringer W, Brammen D. German emergency department measures in 2018: a status quo based on the Utstein reporting standard. BMC Emerg Med 2022; 22:5. [PMID: 35016633 PMCID: PMC8753932 DOI: 10.1186/s12873-021-00563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Compelling data on clinical emergency medicine is required for healthcare system management. The aim of this survey was to describe the nationwide status quo of emergency care in Germany at the healthcare system level using the Utstein reporting template as the guideline to measure the data collected. METHODS This cross-sectional survey collected standardized data from German EDs in 2018. All 759 of the EDs listed in a previously collected ED Directory were contacted in November 2019 using the online-survey tool SoSci Survey. Exclusively descriptive statistical analyses were performed. Absolute as well as relative frequencies, medians, means, ranges, standard deviations (SD) and interquartile ranges (IQR) were reported depending on distribution. MAIN RESULTS A total of 150 questionnaires of contacted EDs were evaluated (response rate: 19.8%). Hospitals had a median of 403 inpatient beds (n=147). The EDs recorded a median of 30,000 patient contacts (n=136). Eighty-three EDs (55%) had observation units with a median of six beds. The special patient groups were pediatric patients (< 5 years) and older patients (> 75 years) with a median of 1.7% and 25%, respectively. Outpatients accounted for 55%, while 45% were admitted (intensive care unit 5.0%, standard care unit 32.3%, observation unit 6.3%) and 1.2% transferred to another hospital. CONCLUSIONS The use of the Utstein reporting template enabled the collection of ED descriptive parameters in Germany. The data can provide a baseline for upcoming reforms on German emergency medicine, and for international comparisons on admission rates, initial triage categories, and patient populations.
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Affiliation(s)
- Florian Wallstab
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Felix Greiner
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Markus Wehrle
- Department of Anesthesiology and Intensive Therapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Wrede
- Department of Emergency Medicine, Hospital Berlin-Buch, Berlin, Germany
| | - Kirsten Habbinga
- Department of Interdisciplinary Emergency Medicine, Pius-Hospital, Oldenburg, Germany
| | - Wilhelm Behringer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Brammen
- Department of Anesthesiology and Intensive Therapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Effectiveness of a Multifaceted Informational-Based and Text Message Reminders on Pneumococcal and Influenza Vaccinations in Hospital Emergency Departments: A Cluster-Randomized Controlled Trial. Vaccines (Basel) 2021; 9:vaccines9090962. [PMID: 34579199 PMCID: PMC8473355 DOI: 10.3390/vaccines9090962] [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: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives. We aimed to evaluate the effectiveness of a multifaceted procedure in improving pneumococcal and influenza vaccinations 6 months after an emergency department (ED) visit among patients aged 65 years and older. Methods. We conducted a cluster-randomized, controlled, parallel-group, open-label implementation trial in 18 EDs in France and Monaco. Participants were recruited from November 2015 to September 2016. EDs were randomly assigned with a 1:1 ratio to provide either a multifaceted procedure that combined structured information about pneumococcal and influenza vaccines and three text message reminders sent to patients every two weeks (intervention arm) or nonstructured information only (control arm). The outcomes were self-reported pneumococcal vaccination and influenza vaccination rates within 6 months of enrollment. Results. A total of 9 EDs were randomized to the intervention arm (n = 780 patients) and 9 to the control arm (n = 695 patients). The median age for all enrolled patients was 74 years (25–75th percentiles, 69 to 82): 50.1% were male, 34.9% had at least one underlying condition, and 30.7% were at risk for invasive pneumococcal infection. In the intention-to-treat analysis, the multifaceted intervention did not alter the pneumococcal vaccination rate (6.4% versus 4.6%, absolute difference: 1.8; 95% CI: [−0.9 to 4.4]; p = 0.19), whereas it improved the influenza vaccination rate (52.1% versus 40.0%, absolute difference: 12.1; 95% CI: [2.4 to 21.8]; p = 0.01). At 12 months, mortality did not differ between the intervention (9.7%) and control (11.2%) arms (p = 0.35). Conclusions. A multifaceted intervention based on text message reminders provides an opportunity to increase anti-influenza vaccination among elderly patients visiting the ED. Efforts are warranted to provide better information on pneumococcal diseases and the benefits of pneumococcal vaccines, especially in the elderly.
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11
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Demont C, Petrica N, Bardoulat I, Duret S, Watier L, Chosidow A, Lorrot M, Kieffer A, Lemaitre M. Economic and disease burden of RSV-associated hospitalizations in young children in France, from 2010 through 2018. BMC Infect Dis 2021; 21:730. [PMID: 34340679 PMCID: PMC8327424 DOI: 10.1186/s12879-021-06399-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the main cause of infant and child hospitalizations. The study objective is to estimate the RSV-associated hospitalizations and economic burden in young children in France to inform future preventive strategies. METHODS We conducted a retrospective analysis of RSV-associated hospitalizations data from the French Hospital database (PMSI-MCO) which covers the entire French population. All children aged < 5 years hospitalized with RSV ICD-10 codes (J210, J219, J45, J121, J205, R062) from 2010 to 2018, were included. Descriptive analyses were conducted by RSV seasons (Oct to March), by respiratory years (July to June) and per age groups. RESULTS On average 45,225 RSV-associated hospitalizations (range: 43,715 - 54,616) per season was reported in France, 69% among children < 1 year old. This represents 28% of all-cause hospitalizations that occurred among children < 1 year old, and less than 10% of all-cause hospitalizations in older children. Number of RSV-associated hospitalizations were similar for infants born during (Oct-March) or outside (April-September) their first RSV season. The highest risk being reported for infants born from September through November. The associated hospitalization cost increased between 2010 - 11 and 2017-18, from €93.2 million to €124.1 million, respectively, and infants < 1 year old represented 80% of the economic burden. CONCLUSION RSV is an important cause of child hospitalization in France. The burden on healthcare system is mainly driven by < 1 year olds, and preventive strategies should be implemented before the first RSV season.
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Affiliation(s)
- C. Demont
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - N. Petrica
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | | | - S. Duret
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | - L. Watier
- grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - A. Chosidow
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - M. Lorrot
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - A. Kieffer
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - M. Lemaitre
- grid.434277.1IQVIA, 92400 Courbevoie, France
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Gallien Y, Martin A, Caserio-Schönemann C, Le Strat Y, Thiam MM. Epidemiological study of opioid use disorder in French emergency departments, 2010-2018 from OSCOUR database. BMJ Open 2020; 10:e037425. [PMID: 33127629 PMCID: PMC7604823 DOI: 10.1136/bmjopen-2020-037425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Opioid consumption in France has remained stable over the last 15 years, with much lower levels than in the USA. However, few data are available on patients who consume opioids and their use of the health system. Emergency department (ED) data has never been used as a source to investigate opioid use disorder (OUD) in France. DESIGN/SETTINGS/PARTICIPANTS We used the OSCOUR national surveillance network, collecting daily ED data from 93% of French ED, to select and describe visits and hospitalisations after an OUD-related ED visit between 2010 and 2018 using International Classification of Diseases, version 10 (ICD10) codes. We described the population of interest and used binomial negative regressions to identify factors significantly associated with OUD such as gender, age, administrative region, year of admission and ICD10 codes. We also analysed the related diagnoses. PRIMARY OUTCOME MEASURE Trend in ED visits for an OUD-related ED visit. RESULTS We recorded 34 362 OUD-related visits out of 97 892 863 ED visits (36.1/100 000 visits). OUD-related visits decreased from 39.2/100 000 visits in 2010 to 32.9/100 000 visits in 2018, resulting in an average yearly decrease of 2.1% (95% CI 1.5% to 2.7%) after multivariate analysis. We recorded 15 966 OUD-related hospitalisations out of 20 359 574 hospitalisations after ED visits (78.4/100 000 hospitalisations) with an increase from 74.0/100 000 hospitalisations in 2010 to 81.4/100 000 hospitalisations in 2018. The analysis of related diagnoses demonstrated mostly polydrug abuse in this population. CONCLUSIONS While the proportion of OUD visits decreased in the time frame, the hospitalisation proportion increased. The implementation of a nationwide surveillance system for OUD in France using ED visits would provide prompt detection of changes over time.
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Affiliation(s)
- Yves Gallien
- Data Science Division, Santé publique France, Saint-Maurice, France
- SBIM, APHP, Paris, France
| | - Adrien Martin
- Data Science Division, Santé publique France, Saint-Maurice, France
| | | | - Yann Le Strat
- Data Science Division, Santé publique France, Saint-Maurice, France
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Oslislo S, Heintze C, Möckel M, Schenk L, Holzinger F. What role does the GP play for emergency department utilizers? A qualitative exploration of respiratory patients' perspectives in Berlin, Germany. BMC FAMILY PRACTICE 2020; 21:154. [PMID: 32731862 PMCID: PMC7393893 DOI: 10.1186/s12875-020-01222-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND While motives for emergency department (ED) self-referrals have been investigated in a number of studies, the relevance of general practitioner (GP) care for these patients has not been comprehensively evaluated. Respiratory symptoms constitute an important utilization trigger in both EDs and in primary care. In this qualitative study, we aimed to explore the role of GP care for patients visiting EDs as outpatients for respiratory complaints and the relevance of the relationship between patient and GP in the decision making process leading up to an ED visit. METHODS Qualitative descriptive study. Semi-structured, face-to-face interviews with a sample of 17 respiratory ED patients in Berlin, Germany. Interviews were recorded and transcribed verbatim. Qualitative content analysis was performed. The study was embedded into the EMACROSS (Emergency and Acute Care for Respiratory Diseases beyond Sectoral Separation) cohort of ED patients with respiratory symptoms, which is part of EMANet (Emergency and Acute Medicine Network for Health Care Research). RESULTS Three patterns of GP utilization could be differentiated: long-term regular consulters, sporadic consulters and patients without GP. In sporadic consulters and patients without GP, an ambivalent or even aversive view of GP care was prevalent, with lack of confidence in GPs' competence and a deficit in trust as seemingly relevant influencing factors. Regardless of utilization or relationship type, patients frequently made contact with a GP before visiting an ED. CONCLUSIONS With regard to respiratory symptoms, our qualitative data suggest a hypothesis of limited relevance of patients' primary care utilization pattern and GP-patient relationship for ED consultation decisions.
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Affiliation(s)
- Sarah Oslislo
- Institute of General Practice, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Christoph Heintze
- Institute of General Practice, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Möckel
- Division of Emergency Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Medical and Veterinary Sciences, James Cook University, The College of Public Health, 1 James Cook Dr, Townsville, Douglas, QLD, 4814, Australia
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Holzinger
- Institute of General Practice, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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Economos G, Cavalli P, Guérin T, Filbet M, Perceau-Chambard E. Quality of end-of-life care in the emergency department. Turk J Emerg Med 2019; 19:141-145. [PMID: 31687613 PMCID: PMC6819706 DOI: 10.1016/j.tjem.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To assess appropriateness of end-of-life treatments provided to actively dying patients attending the emergency department of a primary care hospital. Methods Retrospective cohort study of patients who died in the emergency department of a French primary care hospital between January 2014 and January 2017. The deceased were identified through the admissions register. Then, electronic medical records were screened for bio-demographic data, data relative to decisions to withhold or withdraw treatments, to diagnosis and to the care provided. Patients were clustered into two categories, actively dying or non-actively dying, using clinical opinion based on their medical records. Appropriateness of care was appraised following French guidelines. Results One hundred and forty-six deaths were recorded. Actively dying patients mostly suffered from vascular conditions (29.4%). When compared to the overall sample, they were more likely to have decisions to withhold or withdraw treatments (OR = 5.3 [1.56; 20.7], p-value = 0.003), to have strong opioids (OR = 5.32 [2.1; 13.9], p-value <0.0001), hypnotics (OR = 2.6 [0.95; 8.39], p-value = 0.05), and scopolamine (OR = 2.5 [1.1; 6.13], p-value = 0.03). Moreover, they were less likely to have unbeneficial treatments in terminal conditions, such as resuscitation care (OR = 0.06 [0.001; 0.52], p = 0.002) and antibiotics (OR = 0.42 [0.19; 0.92], p-value = 0.022). There were no differences in rate of hydration, venous access and use of tracheal aspirations. Conclusions Overall, actively dying patients were appropriately supported. However, several issues regarding hydration management, drug administration routes, and broncho-pulmonary secretions management remain to be addressed.
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Affiliation(s)
| | | | - Thomas Guérin
- Emergency Departement, Centre hospitalier de Roanne, France
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Naouri D, Ranchon G, Vuagnat A, Schmidt J, El Khoury C, Yordanov Y. Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France. BMJ Qual Saf 2019; 29:449-464. [PMID: 31666304 PMCID: PMC7323738 DOI: 10.1136/bmjqs-2019-009396] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/03/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France. METHOD The French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs. RESULTS Among the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density. CONCLUSION Inappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.
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Affiliation(s)
- Diane Naouri
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
| | | | - Albert Vuagnat
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France
| | - Jeannot Schmidt
- Emergency Department, Clermont-Ferrand University Hospital, Clermont Ferrand, France
- EA 4679, Université Clermont Auvergne, Clermont Ferrand, France
| | - Carlos El Khoury
- Emergency Department, Médipôle, Villeurbanne, France
- RESCUe-RESUVal, INSERM, HESPER EA 7425, Lyon, France
| | - Youri Yordanov
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
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