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Lin CY, Lee YC. Effectiveness of hospital emergency department regionalization and categorization policy on appropriate patient emergency care use: a nationwide observational study in Taiwan. BMC Health Serv Res 2021; 21:21. [PMID: 33407444 PMCID: PMC7787133 DOI: 10.1186/s12913-020-06006-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) overcrowding is a health services issue worldwide. Modern health policy emphasizes appropriate health services utilization. However, the relationship between accessibility, capability, and appropriateness of ED use is unknown. Thus, this study aimed to examine the effect of hospital ED regionalization policy and categorization of hospital emergency capability policy (categorization policy) on patient-appropriate ED use. METHODS Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization of hospital emergency capability policies in 2007 and 2009, respectively. We conducted a retrospective observational study on the effect of emergency care policy intervention on patient visit. Between 2005 and 2011, the Taiwan National Health Insurance Research Database recorded 1,835,860 ED visits from 1 million random samples. ED visits were categorized using the Yang-Ming modified New York University-ED algorithm. A time series analysis was performed to examine the change in appropriate ED use rate after policy implementation. RESULTS From 2005 to 2011, total ED visits increased by 10.7%. After policy implementation, the average appropriate ED visit rate was 66.9%. The intervention had no significant effect on the trend of appropriate ED visit rate. CONCLUSIONS Although regionalization and categorization policies did increase emergency care accessibility, it had no significant effect on patient-appropriate ED use. Further research is required to improve data-driven policymaking.
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Affiliation(s)
- Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Taipei, Taiwan
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Master Program in Trans-disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Master Program in Trans-disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan.
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Bashiri A, Alizadeh Savareh B, Ghazisaeedi M. Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges. Clin Exp Emerg Med 2019; 6:288-296. [PMID: 31910499 PMCID: PMC6952626 DOI: 10.15441/ceem.18.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022] Open
Abstract
Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included "clinical decision support system," "decision support system," "decision support tools," "prehospital care," and "emergency medical services." Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.
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Affiliation(s)
- Azadeh Bashiri
- Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrouz Alizadeh Savareh
- Department of Medical Informatics, School of Management & Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Lurie N, Margolis GS, Rising KL. The US emergency care system: meeting everyday acute care needs while being ready for disasters. Health Aff (Millwood) 2015; 32:2166-71. [PMID: 24301401 DOI: 10.1377/hlthaff.2013.0771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life- and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.
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Goodloe JM, Wayne M, Proehl J, Levy MK, Yannopoulos D, Thigpen K, O'Connor RE. Optimizing neurologically intact survival from sudden cardiac arrest: a call to action. West J Emerg Med 2014; 15:803-7. [PMID: 25493121 PMCID: PMC4251222 DOI: 10.5811/westjem.2014.6.21832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function.
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Affiliation(s)
- Jeffrey M Goodloe
- The University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Marvin Wayne
- University of Washington School of Medicine, Emergency Department, PeaceHealth St. Joseph Medical Center, Bellingham, Washington
| | | | | | - Demetris Yannopoulos
- University of Minnesota Medical School, Department of Medicine, Duluth, Minnesota
| | - Ken Thigpen
- St. Dominic Hospital - Jackson Memorial Hospital, Department of Pulmonary Services Jackson, Mississippi
| | - Robert E O'Connor
- University of Virginia School of Medicine, Department of Emergency Medicine Charlottesville, Virginia
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Kurz MC, Wang HE. Improving Postarrest Care Through Evidence-Based Common Sense. Ann Emerg Med 2014; 64:507-8. [DOI: 10.1016/j.annemergmed.2014.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Kang MJ, Lee TR, Shin TG, Sim MS, Jo IJ, Song KJ, Jeong YK. Survival and neurologic outcomes of out-of-hospital cardiac arrest patients who were transferred after return of spontaneous circulation for integrated post-cardiac arrest syndrome care: the another feasibility of the cardiac arrest center. J Korean Med Sci 2014; 29:1301-7. [PMID: 25246751 PMCID: PMC4168186 DOI: 10.3346/jkms.2014.29.9.1301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/26/2014] [Indexed: 01/31/2023] Open
Abstract
It has been proven that safety and efficiency of out-of-hospital cardiac arrest (OHCA) patients is transported to specialized hospitals that have the capability of performing therapeutic hypothermia (TH). However, the outcome of the patients who have been transferred after return of spontaneous circulation (ROSC) has not been well evaluated. We conducted a retrospective observational study between January 2010 to March 2012. There were primary outcomes as good neurofunctional status at 1 month and the secondary outcomes as the survivals at 1 month between Samsung Medical Center (SMC) group and transferred group. A total of 91 patients were enrolled this study. There was no statistical difference between good neurologic outcomes between both groups (38% transferred group vs. 40.6% SMC group, P=0.908). There was no statistical difference in 1 month survival between the 2 groups (66% transferred group vs. 75.6% SMC group, P=0.318). In the univariate and multivariate models, the ROSC to induction time and the induction time had no association with good neurologic outcomes. The good neurologic outcome and survival at 1 month had no significant differences between the 2 groups. This finding suggests the possibility of integrated post-cardiac arrest care for OHCA patients who are transferred from other hospitals after ROSC in the cardiac arrest center.
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Affiliation(s)
- Mun Ju Kang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tae Rim Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun Jeong Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Kwon Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tisherman MSA, Ornato PJP, Peberdy MA, Tisherman SA. Managing hypothermia during organ transplantation and cardiac arrest. Ther Hypothermia Temp Manag 2014; 3:7-10. [PMID: 24837633 DOI: 10.1089/ther.2013.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Moderator Samuel A Tisherman
- 1 Department of Critical Care Medicine and Surgery, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
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Kill C, Frey N, Scholz J, Scholz K, Andresen D, Busch H, Lunz D, Prückner S, Skorning M, von Kaufmann F, Fischer M, Kreimeier U, Lemke H, Strauss J. Die spezialisierte Krankenhausbehandlung nach erfolgreicher Wiederbelebung ist überlebenswichtig. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Johnson NJ, Salhi RA, Abella BS, Neumar RW, Gaieski DF, Carr BG. Emergency department factors associated with survival after sudden cardiac arrest. Resuscitation 2013; 84:292-7. [DOI: 10.1016/j.resuscitation.2012.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 10/13/2012] [Accepted: 10/15/2012] [Indexed: 01/17/2023]
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Jena AB, Romley JA, Newton-Cheh C, Noseworthy P. Therapeutic hypothermia for cardiac arrest: real-world utilization trends and hospital mortality. J Hosp Med 2012; 7:684-9. [PMID: 23023977 PMCID: PMC3515738 DOI: 10.1002/jhm.1974] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/11/2012] [Accepted: 07/25/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Therapeutic hypothermia (TH) improves outcomes following cardiac arrest in small clinical trials. OBJECTIVE To study real-world utilization and outcomes in US hospitals. DESIGN Retrospective cohort study. SETTING California hospitals. PATIENTS Patients eligible for therapeutic hypothermia after cardiac arrest. INTERVENTIONS We analyzed all discharges from California (1999-2008) to identify patients eligible for TH after cardiac arrest. Patients were considered eligible for TH if both cardiac arrest and anoxic brain injury were among the administrative diagnoses (n = 46,833). Patients undergoing TH (n = 204) were identified through billing codes. MEASUREMENTS TH utilization and in-hospital mortality. RESULTS Use of TH increased over the study period with 87.3% (178/204) of TH occurring between 2006 and 2008. Few hospitals appeared to perform TH over the study period (47/419, 11.2%). Utilization of TH was concentrated in a few centers, with the top 3 of 419 centers accounting for 31.4% (64/204) of cases. Patients undergoing TH were younger, less likely to be male, more likely to be treated at teaching centers, and had similar comorbidities compared to eligible individuals who did not undergo TH. The adjusted odds ratio for hospital mortality among patients undergoing TH was 0.80 (95% confidence interval [CI] 0.60-1.06, P = 0.11). CONCLUSIONS TH utilization appears low, but implementation is increasing. Case selection and referral biases limit the analysis of the relationship between center TH volume and in-hospital mortality.
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Affiliation(s)
- Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; and Department of Medicine, Massachusetts General Hospital; and National Bureau of Economic Research, Cambridge, MA; Tel: 617-432-8322;
| | - John A. Romley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA 90089-0626. Tel: 213-821-7965; Fax: 213-740-3460;
| | - Christopher Newton-Cheh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Cardiovascular Research Center and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, CPZN 5.242, Boston, Massachusetts 02114; Tel: 643-3615, Fax: 617-249-0127;
| | - Peter Noseworthy
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Center for Human Genetic Research, Cardiovascular Research Center, 185 Cambridge St, CPZN 5.814, Boston, Massachusetts 02114. Tel: 617-643-6328; Fax: 617-507-7766;
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Bullock R, Foreman M, Conterato M. Temperature and Trauma in Accidental Hypothermia. Ther Hypothermia Temp Manag 2011; 1:179-83. [DOI: 10.1089/ther.2011.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ross Bullock
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Foreman
- Department of Surgery, Baylor University Medical Center, Dallas, Texas
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Leary M, Vanek F, Abella BS. Prehospital Use of Therapeutic Hypothermia After Resuscitation from Cardiac Arrest. Ther Hypothermia Temp Manag 2011; 1:69-75. [DOI: 10.1089/ther.2011.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marion Leary
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Florence Vanek
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Benjamin S. Abella
- Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Martin-Gill C, Dilger CP, Guyette FX, Rittenberger JC, Callaway CW. Regional impact of cardiac arrest center criteria on out-of-hospital transportation practices. PREHOSP EMERG CARE 2011; 15:381-7. [PMID: 21463201 DOI: 10.3109/10903127.2011.561409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols have been associated with improved outcomes. Objectives. This study aimed 1) to identify the PCA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation and 2) to determine the proportion of PCA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria. METHODS We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PCA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, nontrauma cardiac arrest patients transported with a pulse from 2006 to 2008 for 16 EMS agencies. The proportions of patients transported to hospitals meeting three CAC criteria were compared: criteria A (availability of CATH and TH), criteria B (criteria A, >200 CATHs per year, and a PCA protocol), and criteria C (criteria B and a 24-hour intensivist). RESULTS Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met criteria A, seven (22.6%) met criteria B, and six (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded because of transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 patients (66.1%) transported to hospitals meeting criteria C. CONCLUSIONS In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH), but those facilities receive 81% of PCA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.
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Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Affiliation(s)
- Chris Kahn
- Department of Emergency Medicine, University of California-Irvine, Orange, USA
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Shin SD, Suh GJ, Ahn KO, Song KJ. Cardiopulmonary resuscitation outcome of out-of-hospital cardiac arrest in low-volume versus high-volume emergency departments: An observational study and propensity score matching analysis. Resuscitation 2011; 82:32-9. [DOI: 10.1016/j.resuscitation.2010.08.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 08/03/2010] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
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