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Sample records for department ed visits

  1. Rethinking emergency department visits.

    Science.gov (United States)

    Resar, Roger K; Griffin, Frances A

    2010-01-01

    Efforts to date have been unable to reverse the trend of increased emergency department utilization. The Institute for Healthcare Improvement has developed a framework for reducing avoidable emergency department visits on the basis of the formation of local coalitions. These coalitions include interested partners approaching improvement by integrating community resources and nonmedical solutions. Targeted patient populations are identified via homogeneous characteristics. Open-ended interview questions are used to identify possible community and nonmedical solutions to complement medical strategies. This article describes the framework and process of testing. If validated, this approach will have significant policy implications.

  2. Ed Deutschman Visit Images, May 2, 2011

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  3. Forecasting emergency department visits using internet data.

    Science.gov (United States)

    Ekström, Andreas; Kurland, Lisa; Farrokhnia, Nasim; Castrén, Maaret; Nordberg, Martin

    2015-04-01

    Using Internet data to forecast emergency department (ED) visits might enable a model that reflects behavioral trends and thereby be a valid tool for health care providers with which to allocate resources and prevent crowding. The aim of this study is to investigate whether Web site visits to a regional medical Web site, the Stockholm Health Care Guide, a proxy for the general public's concern of their health, could be used to predict the ED attendance for the coming day. In a retrospective, observational, cross-sectional study, a model for forecasting the daily number of ED visits was derived and validated. The model was derived through regression analysis, using visits to the Stockholm Health Care Guide Web site between 6 pm and midnight and day of the week as independent variables. Web site visits were measured with Google Analytics. The number of visits to the ED within the region was retrieved from the Stockholm County Council administrative database. All types of ED visits (including adult, pediatric, and gynecologic) were included. The period of August 13, 2011, to August 12, 2012, was used as a training set for the model. The hourly variation of visits was analyzed for both Web site and the ED visits to determine the interval of hours to be used for the prediction. The model was validated with mean absolute percentage error for August 13, 2012, to October 31, 2012. The correlation between the number of Web site visits between 6 pm and midnight and ED visits the coming day was significant (r=0.77; Pforecasting results for ED visits were achieved for the entire county, with a mean absolute percentage error of 4.8%. The result for the individual hospitals ranged between mean absolute percentage error 5.2% and 13.1%. Web site visits may be used in this fashion to predict attendance to the ED. The model works both for the entire region and for individual hospitals. The possibility of using Internet data to predict ED visits is promising. Copyright © 2014

  4. Factors Associated With Emergency Department Visits

    Directory of Open Access Journals (Sweden)

    Parul Agarwal

    2016-05-01

    Full Text Available Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED visits among adult fee-for-service (FFS Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47, Hispanics (IRR = 1.63, polypharmacy (IRR = 1.89, and tobacco use (IRR = 2.23. Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33. The county-level factors associated with ED visits were unemployment rate (IRR = 0.94 and number of urgent care clinics (IRR = 0.96. Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

  5. Health care utilization before and after an outpatient ED visit in older people.

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S Nicole

    2012-01-01

    Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. Published by Elsevier Inc.

  6. Impact of newborn follow-up visit timing on subsequent ED visits and hospital readmissions: an instrumental variable analysis.

    Science.gov (United States)

    O'Donnell, Heather C; Colman, Gregory; Trachtman, Rebecca A; Velazco, Nerissa; Racine, Andrew D

    2014-01-01

    To determine whether newborn first outpatient visit (FOV) within 3 days of discharge is associated with reduced rates of emergency department (ED) visits and hospital readmissions. Retrospective cohort analysis was performed of all newborns who were born and had outpatient follow-up within a large academic medical center to determine whether they had ED visits or hospital readmission within 2 weeks after hospital discharge. Multivariable regression using an instrumental variable for timing of FOV was conducted to estimate the relationship between FOV within 3 days of discharge and ED visits and hospital readmissions within 2 weeks of discharge, adjusting for potential confounders. Stratified analyses assessed this relationship in subpopulations with medical or social risk factors. Of 3282 newborns, 178 (5%) had 1 or more ED visits or hospital readmissions within 2 weeks of hospital discharge. FOV within 3 days was not significantly associated with ED visits and readmissions in the instrumental variable analysis (IVA) (-0.035, P = .11) or the ordinary least squares analysis (OLS) (0.006, P = .52). The difference in coefficients between these analyses, however, suggests that IVA successfully adjusted for some unmeasured bias. In stratified analyses, only newborns born to African American mothers or discharged by family medicine providers demonstrated a significant relationship between FOV within 3 days and reduced odds of ED visits and readmissions. No significant relationship between outpatient visit timing and ED visits and hospital readmissions was found. Further study is needed to assess the impact of early outpatient visits on other newborn outcomes. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  7. A "Patch" to the NYU Emergency Department Visit Algorithm.

    Science.gov (United States)

    Johnston, Kenton J; Allen, Lindsay; Melanson, Taylor A; Pitts, Stephen R

    2017-08-01

    To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a "patch" to the algorithm. The Nationwide Emergency Department Sample. We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes. We updated the algorithm with ICD-9 and ICD-10 codes added since 2001. The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p < .01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p < .01). Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research. © Health Research and Educational Trust.

  8. Injury patterns in children with frequent emergency department visits

    DEFF Research Database (Denmark)

    Laursen, B

    2006-01-01

    OBJECTIVES: To compare injury patterns in children with many and few emergency department (ED) visits in order to reveal the causes for the frequent visits. METHODS: Three cohorts of Danish children (total 579 721 children) were followed for three years when their ages were 0-2, 6-8, and 12...

  9. Referral patterns in elderly emergency department visits

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    2013-12-01

    Full Text Available OBJECTIVE: To assess elderly individuals' demand for emergency department (ED care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648. STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs in 43.1% of cases, 1.4% came from nursing homes (NH, and 55.5% were self-referred (SR. The SR group had a higher adjusted odds ratio (aOR for non-urgent conditions (1.98 CI 1.85-2.12, but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59, and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 € than for those referred by PCPs (mean = 138.14 € ± SD 101.17 € or NH (mean = 143.48 € ± SD 95.28 €. CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.

  10. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  11. Unscheduled return visits to a Dutch inner-city emergency department

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); R. Lindeboom (Robert); R.J. de Haan (Rob); N. van der Linden (Naomi); E.R. de Deckere (Ernie RJT); C. Lucas (Cees); S. Rhemrev (Steven); J.C. Goslings (Carel)

    2014-01-01

    textabstractBackground Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons

  12. Predicting asthma-related emergency department visits using big data.

    Science.gov (United States)

    Ram, Sudha; Zhang, Wenli; Williams, Max; Pengetnze, Yolande

    2015-07-01

    Asthma is one of the most prevalent and costly chronic conditions in the United States, which cannot be cured. However, accurate and timely surveillance data could allow for timely and targeted interventions at the community or individual level. Current national asthma disease surveillance systems can have data availability lags of up to two weeks. Rapid progress has been made in gathering nontraditional, digital information to perform disease surveillance. We introduce a novel method of using multiple data sources for predicting the number of asthma-related emergency department (ED) visits in a specific area. Twitter data, Google search interests, and environmental sensor data were collected for this purpose. Our preliminary findings show that our model can predict the number of asthma ED visits based on near-real-time environmental and social media data with approximately 70% precision. The results can be helpful for public health surveillance, ED preparedness, and targeted patient interventions.

  13. Pediatric psychiatric emergency department visits during a full moon.

    Science.gov (United States)

    Kamat, Shyama; Maniaci, Vincenzo; Linares, Marc Yves-Rene; Lozano, Juan M

    2014-12-01

    This study aimed to verify the hypothesis that the lunar cycle influences the number of pediatric psychiatric emergency department (ED) visits. Pediatric psychiatric ED visits between 2009 and 2011 were obtained retrospectively. Patients aged between 4 and 21 years presenting to Miami Children's Hospital ED with a primary psychiatric complaint were included in the study. Patients with a concomitant psychiatric problem and a secondary medical condition were excluded. The number of psychiatric visits was retrieved for the full moon dates, control dates as well as the day before and after the full moon when the moon appears full to the naked eye (full moon effect). A comparison was made using the 2-sample independent t test. Between 2009 and 2011, 36 dates were considered as the true full moon dates and 108 dates as the "full moon effect." A total of 559 patients were included in the study. The 2-sample independent t tests were performed between the actual full moon date and control dates, as well as between the "full moon effect" dates and control dates. Our results failed to show a statistical significance when comparing the number of pediatric psychiatric patients presenting to a children's hospital ED during a full moon and a non-full moon date. Our study's results are in agreement with those involving adult patients. The full moon does not affect psychiatric visits in a children's hospital.

  14. Self-harm, Assault, and Undetermined Intent Injuries Among Pediatric Emergency Department Visits.

    Science.gov (United States)

    Ballard, Elizabeth D; Kalb, Luther G; Vasa, Roma A; Goldstein, Mitchell; Wilcox, Holly C

    2015-12-01

    Although injuries are a known cause of morbidity and mortality among children and adolescents, little is known about the epidemiology of injury-related emergency department (ED) visits in the United States by injury intent. The objective of this analysis was to examine ED outcomes, defined as death in the ED, inpatient admission, and visit cost, among ED visits stratified by injury intent (i.e., self-harm, assault, and injury with undetermined intent, as compared with unintentional injuries). All injury-related ED visits in the United States for children and adolescents, ages 8 to 17 years, were identified using the 2008 Nationwide Emergency Department Sample. Multivariate survey weighted logistic and linear regression analyses were then used to estimate the likelihood of death on ED visit, inpatient admission, and cost across the 4 injury types. In 2008, with the use of weighted estimates, there were 66,895 self-harm, 176,125 assault, 24,144 undetermined injury, and 4,244,589 unintentional injury ED visits among children 8 to 17 years. Visits due to self-harm, assault and undetermined injuries were more likely to result in death during the ED visit compared with visits due to unintentional injuries. Self-harm and undetermined intent were also associated with greater odds of inpatient admission as well as 90% and 60% higher ED visit costs, respectively. Data from this nationwide sample of pediatric ED visits highlight the resource burden of self-harm, undetermined intent, and assault injury visits. Pediatric EDs may provide a window of opportunity for better case identification and intervention with children experiencing violence and injury.

  15. The Relationship Between the Use of a Worksite Medical Home and ED Visits or Hospitalizations

    Directory of Open Access Journals (Sweden)

    Marissa Stroo BS

    2015-10-01

    Full Text Available Worksite medical homes may be a good model for improving employee health. The aim of this study was to compare the likelihood of being seen in the emergency department (ED or being hospitalized by level of use (no use, occasional use, or primary care of a worksite medical home, overall and by type of user (employee, adult dependent, or pediatric dependent. This was a retrospective analysis of claims data, using covariate-adjusted logistic regression models for ED visits and inpatient hospitalizations. Secondary data for the years 2006 to 2008 from a company that offers an on-site health care center (HCC were used. Analyses were based on a data set that combines health plan claims and human resources demographic data. Overall, people who did not use the HCC were more likely to be seen in the ED (adjusted odds ratio [OR] = 1.20, 95% confidence interval or CI [1.06, 1.37], P = .005 or to be hospitalized (adjusted OR = 1.58; 95% CI [1.34, 1.86]; P < .0001 compared with those who used the HCC for primary care. Both ED visits and hospitalizations for employees and dependents in this study were lower among those who used the worksite medical home for primary care. Worksite medical homes can improve chronic disease management and thus reduce ED visits and hospitalizations. These findings contribute to growing evidence that worksite medical homes are potentially cost-effective.

  16. The effect of tropical cyclones (typhoons) on emergency department visits.

    Science.gov (United States)

    Lin, Chien-Hao; Hou, Sen-Kuang; Shih, Frank Fuh-Yuan; Su, Syi

    2013-09-01

    Case reports have indicated that a tropical cyclone may increase Emergency Department (ED) visits significantly. To examine emergency health care demands across a series of tropical cyclones, and to build a predictive model to analyze a cyclone's potential effect. This was an observational non-concurrent prospective study performed in Taiwan. Twenty hospitals were included. The number of daily ED visits in each hospital was our primary end point, and data were retrieved from the database provided by the National Health Insurance Research Database. Our study examined the period from 2000 to 2008. A total of 22 tropical cyclones (typhoons) that had passed over eastern Taiwan and covered the area under study were included. Multiple linear regression time-series models were employed to estimate the effects of "days since typhoon landfall" and various characteristics of the typhoons on the end point of daily ED visits to each hospital. The final multiple linear regression time-series model showed that the number of daily ED visits increased in areas where a strong typhoon had landed directly, with the increase being evident during the first 2 days since landfall. Our model also indicated that the three most important variables to predict a change in the pattern of daily ED visits were intensity of typhoon, simultaneous heavy rain, and direct landfall. During tropical cyclones, emergency services were under increased demand in selected time periods and areas. Health care authorities should collect information to build local models to optimize their resources allocation in preparation. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  17. Emergency Department Visits by Older Adults for Motor Vehicle Collisions

    Directory of Open Access Journals (Sweden)

    Vogel, Jody A.

    2013-11-01

    Full Text Available Introduction: To describe the epidemiology and characteristics of emergency department (ED visits by older adults for motor vehicle collisions (MVC in the United States (U.S..Methods: We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS. Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years and younger (18-64 years MVC patients and calculated odds ratios (OR and 95% confidence intervals (CIs to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults.Results: From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6-8.3 visits per 1,000 for older adults and 16.4 (95% CI 14.0-18.8 visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46-9.36. Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86, have a high triage acuity (OR 1.56; 95% CI 0.77-3.14, or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42-2.23 as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8-19.2 of older MVC patients and 6.1% (95% CI 4.8-7.5 of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71-4.43, and admission to the ICU if

  18. Parental Language and Return Visits to the Emergency Department After Discharge.

    Science.gov (United States)

    Samuels-Kalow, Margaret E; Stack, Anne M; Amico, Kendra; Porter, Stephen C

    2017-06-01

    Return visits to the emergency department (ED) are used as a marker of quality of care. Limited English proficiency, along with other demographic and disease-specific factors, has been associated with increased risk of return visit, but the relationship between language, short-term return visits, and overall ED use has not been well characterized. This is a planned secondary analysis of a prospective cohort examining the ED discharge process for English- or Spanish-speaking parents of children aged 2 months to 2 years with fever and/or respiratory illness. At 1 year after the index visit, a standardized chart review was performed. The primary outcome was the number of ED visits within 72 hours of the index visit. Multivariable logistic regression was used to examine the relative importance of predictor variables and adjust for confounders. There were 202 parents eligible for inclusion, of whom 23% were Spanish speaking. In addition, 6.9% of the sample had a return visit within 72 hours. After adjustment for confounders, Spanish language was associated with return visit within 72 hours (odds ratio, 3.49; 95% confidence interval, 1.02-11.90) but decreased risk of a second visit within the year (odds ratio, 0.28; 95% confidence interval, 0.12-0.66). Spanish-speaking parents are at an increased risk of 72-hour return ED visit but do not seem to be at increased risk of ED use during the year after their ED visit.

  19. Emergency Department Visits for Drug-Related Suicide Attempts Involving Antidepressants by Adolescents and Young Adults: 2004 to 2008. The DAWN Report

    Science.gov (United States)

    Substance Abuse and Mental Health Services Administration, 2011

    2011-01-01

    In 2008, adolescents made 23,124 visits to the emergency department (ED) for drug-related suicide attempts, and young adults made 38,036 such visits; of these visits, 23.0 percent (5,312 visits) among adolescents and 17.6 percent (6,700 visits) among young adults involved antidepressants. Among ED visits for suicide attempts involving…

  20. The association between office-based provider visits and emergency department utilization among Medicaid beneficiaries.

    Science.gov (United States)

    Widmer, Andrew J; Basu, Rashmita; Hochhalter, Angela K

    2015-06-01

    The purpose of our study was to describe the relationship between office-based provider visits and emergency department (ED) utilization by adult Medicaid beneficiaries. Data were extracted from the publicly-available Medical Expenditure Panel Survey, a nationally representative sample of the civilian non-institutionalized population in the United States. The sample included 1,497 respondents who had full year Medicaid coverage in 2009. Study variables included insurance coverage type, usual source of care, chronic illnesses, and beneficiary demographics. Multivariate analyses were conducted to describe associations between individual characteristics and (a) likelihood of any ED utilization, and (b) number of ED visits by those who utilized the ED at least once in the study year. The analysis was adjusted for demographic characteristics and chronic health conditions. A greater number of office-based provider visits was associated with a higher likelihood of ED utilization. Among those with at least one ED visit, a greater number of office-based visits was associated with a higher number of ED visits. A respondent's age, history of hypertension or myocardial infarction, and Hispanic/Latino ethnicity were associated with having one or more ED visits; age and Hispanic/Latino ethnicity were associated with total number of ED visits among those with at least one. In this representative sample of adult Medicaid beneficiaries, there was no evidence that office-based provider visits reduced ED utilization. Office visits were associated with higher ED utilization, as were certain chronic conditions, older age, and Hispanic/Latino ethnicity. Findings do not support efforts to reduce ED utilization by increasing office-based visits alone.

  1. Temporal Trends in Emergency Department Visits for Bronchiolitis in the United States, 2006-2010

    Science.gov (United States)

    Hasegawa, Kohei; Tsugawa, Yusuke; Brown, David F.M.; Mansbach, Jonathan M.; Camargo, Carlos A.

    2014-01-01

    Background To examine temporal trends in emergency departments (ED) visits for bronchiolitis among US children between 2006 and 2010. Methods Serial, cross-sectional analysis of the Nationwide Emergency Department Sample, a nationally-representative sample of ED patients. We used ICD-9-CM code 466.1 to identify children bronchiolitis. Primary outcome measures were rate of bronchiolitis ED visits, hospital admission rate, and ED charges. Results Between 2006 and 2010, weighted national discharge data included 1,435,110 ED visits with bronchiolitis. There was a modest increase in the rate of bronchiolitis ED visits, from 35.6 to 36.3 per 1000 person-years (2% increase; Ptrend=0.008), due to increases in the ED visit rate among children from 12 months to 23 months (24% increase; Ptrendbronchiolitis increased from $337 million to $389 million (16% increase; Ptrendbronchiolitis ED visits by age group. Despite a significant increase in associated ED charges, ED-associated hospital admission rates for bronchiolitis significantly decreased over this same period. PMID:23934206

  2. Prospective Multicenter Study of Bronchiolitis: Predictors of an Unscheduled Visit After Discharge From the Emergency Department

    Science.gov (United States)

    Norwood, Agatha; Mansbach, Jonathan M.; Clark, Sunday; Waseem, Muhammad; Camargo, Carlos A.

    2012-01-01

    Objectives There is little evidence about which children with bronchiolitis will have worsened disease after discharge from the emergency department (ED). The objective of this study was to determine predictors of post-ED unscheduled visits. Methods The authors conducted a prospective cohort study of patients discharged from 2004 to 2006 at 30 EDs in 15 U.S. states. Inclusion criteria were diagnosis of bronchiolitis, age bronchiolitis within 2 weeks. Results Of 722 patients eligible for the current analysis, 717 (99%) had unscheduled visit data, of whom 121 (17%; 95% confidence interval [CI] = 14% to 20%) had unscheduled visits. Unscheduled visits were more likely for children age 0.10). Using multivariable logistic regression, independent predictors of unscheduled visits were age bronchiolitis, one of six children had unscheduled visits within 2 weeks of ED discharge. The three predictors of unscheduled visits were age under 2 months, male sex, and previous hospitalization. PMID:20370776

  3. Using Google Flu Trends data in forecasting influenza-like-illness related ED visits in Omaha, Nebraska.

    Science.gov (United States)

    Araz, Ozgur M; Bentley, Dan; Muelleman, Robert L

    2014-09-01

    Emergency department (ED) visits increase during the influenza seasons. It is essential to identify statistically significant correlates in order to develop an accurate forecasting model for ED visits. Forecasting influenza-like-illness (ILI)-related ED visits can significantly help in developing robust resource management strategies at the EDs. We first performed correlation analyses to understand temporal correlations between several predictors of ILI-related ED visits. We used the data available for Douglas County, the biggest county in Nebraska, for Omaha, the biggest city in the state, and for a major hospital in Omaha. The data set included total and positive influenza test results from the hospital (ie, Antigen rapid (Ag) and Respiratory Syncytial Virus Infection (RSV) tests); an Internet-based influenza surveillance system data, that is, Google Flu Trends, for both Nebraska and Omaha; total ED visits in Douglas County attributable to ILI; and ILI surveillance network data for Douglas County and Nebraska as the predictors and data for the hospital's ILI-related ED visits as the dependent variable. We used Seasonal Autoregressive Integrated Moving Average and Holt Winters methods with3 linear regression models to forecast ILI-related ED visits at the hospital and evaluated model performances by comparing the root means square errors (RMSEs). Because of strong positive correlations with ILI-related ED visits between 2008 and 2012, we validated the use of Google Flu Trends data as a predictor in an ED influenza surveillance tool. Of the 5 forecasting models we have tested, linear regression models performed significantly better when Google Flu Trends data were included as a predictor. Regression models including Google Flu Trends data as a predictor variable have lower RMSE, and the lowest is achieved when all other variables are also included in the model in our forecasting experiments for the first 5 weeks of 2013 (with RMSE = 57.61). Google Flu Trends data

  4. Ambient Ozone and Emergency Department Visits for Cellulitis

    Directory of Open Access Journals (Sweden)

    Mieczysław Szyszkowicz

    2010-11-01

    Full Text Available Objectives were to assess and estimate an association between exposure to ground-level ozone and emergency department (ED visits for cellulitis. All ED visits for cellulitis in Edmonton, Canada, in the period April 1992–March 2002 (N = 69,547 were examined. Case-crossover design was applied to estimate odds ratio (OR, and 95% confidence interval per one interquartile range (IQR increase in ozone concentration (IQR = 14.0 ppb. Delay of ED visit relating to exposure was probed using 0- to 5-day exposure lags. For all patients in the all months (January–December and lags 0 to 2 days, OR = 1.05 (1.02, 1.07. For male patients during the cold months (October-March: OR = 1.05 (1.02, 1.09 for lags 0 and 2 and OR = 1.06 (1.02, 1.10 for lag 3. For female patients in the warm months (April-September: OR = 1.12 (1.06, 1.18 for lags 1 and 2. Cellulitis developing on uncovered (more exposed skin was analyzed separately, observed effects being stronger. Cellulitis may be associated with exposure to ambient ground level ozone; the exposure may facilitate cellulitis infection and aggravate acute symptoms.

  5. Effectiveness of Comprehensive Geriatric Assessment-Based Intervention to Reduce Frequent Emergency Department Visits: A Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Mei-Chen Liao

    2012-06-01

    Full Text Available A small number of clustered visits by emergency department frequent users (EDFUs may over-consume emergency care resources. We report the effectiveness of comprehensive geriatric assessment (CGA-based multidisciplinary team (MDT care for four EDFUs, in reducing ED visits. Case 1 had visited the ED twice/month due to chest discomfort. Her ED visits were significantly reduced to 0.2 visits/month following CGA-based MDT care. Case 2 had failed back surgery syndrome and bipolar disorder. His ED visit was reduced from 2.8 visits to 0.8 visits/month following CGA-based MDT intervention. Case 3 had chronic obstructive pulmonary disease, heart failure, and urinary incontinence, with a urinary catheter in place. He made 31 ED visits (5.1 visits/month before his lung cancer and depression were discovered by CGA. He died 2 months later. Case 4 made 27 ED visits (2.7 visits/month due to dizziness. His problems of early dementia and neglect were identified by CGA, and he visited the ED only once following MDT intervention. In conclusion, CGA-based MDT intervention successfully reduced ED visits among these EDFUs, but further investigation is needed to evaluate the effectiveness of geriatric services in the ED.

  6. Increasing prevalence of emergency department visits for pediatric dental care, 1997-2001.

    Science.gov (United States)

    Ladrillo, Teresita E; Hobdell, Martin H; Caviness, A Chantal

    2006-03-01

    Hospital emergency department (ED) visits for non-urgent care have been increasing since the late 1950s. This study investigated the prevalence and characteristics of pediatric ED visits for dental problems during a five-year period. This retrospective study included newborns through 17-year-olds with dental complaints identified from the electronic register of the ED of Texas Children's Hospital, Houston, between January 1997 and December 2001. The authors described patient characteristics, diagnoses, factors associated with ED use for nontraumatic problems and annual changes in ED visits for dental and nondental complaints. Of the 1,102 subjects, 809 (73.4 percent) had nontraumatic and 293 (26.6 percent) had traumatic dental complaints. The study revealed a 121 percent increase in ED visits for dental complaints and a 66-fold increase in admissions between 1997 and 2001. Of the inpatient admissions, 68 percent were the result of caries and its sequelae. This study revealed a substantial increase in ED visits and hospital admissions for dental problems during the study period. The majority of dental problems were nontraumatic in nature. Dental care experts should be available in ED settings in which increases in such visits are seen. Studies must be conducted to explore ways of keeping patients from seeking care in EDs inappropriately.

  7. Health Care Utilization before and after an Outpatient Emergency Department Visit in Older People

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S. Nicole

    2010-01-01

    Background Older adults in the U.S. receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization has not been adequately studied in this population. Objectives The goal of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods This retrospective cohort study examined health care use among 308 patients ≥ 65 years old discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician (PCP), specialist, ED and hospital) and risk of return ED visits. Results Older ED patients in this study had visited other types of providers frequently in the previous year (median number of primary care physician (PCP) and specialist visits = 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits 7.0 vs 4.0, p<.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (HR 2.20, 95% CI 1.15–4.21), in models adjusted for demographics and health status. Conclusion Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. PMID:21216555

  8. Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005-2010.

    Science.gov (United States)

    Fechter-Leggett, Ethan D; Vaidyanathan, Ambarish; Choudhary, Ekta

    2016-02-01

    Variability of heat stress illness (HSI) by urbanicity and climate region has rarely been considered in previous HSI studies. We investigated temporal and geographic trends in HSI emergency department (ED) visits in CDC Environmental Public Health Tracking Network (Tracking) states for 2005-2010. We obtained county-level HSI ED visit data for 14 Tracking states. We used the National Center for Health Statistics Urban-Rural Classification Scheme to categorize counties by urbanicity as (1) large central metropolitan (LCM), (2) large fringe metropolitan, (3) small-medium metropolitan, or (4) nonmetropolitan (NM). We also assigned counties to one of six US climate regions. Negative binomial regression was used to examine trends in HSI ED visits over time across all counties and by urbanicity for each climate region, adjusting for pertinent variables. During 2005-2010, there were 98,462 HSI ED visits in the 14 states. ED visits for HSI decreased 3.0% (p < 0.01) per year. Age-adjusted incidence rates of HSI ED visits increased from most urban to most rural. Overall, ED visits were significantly higher for NM areas (IRR = 1.41, p < 0.01) than for LCM areas. The same pattern was observed in all six climate regions; compared with LCM, NM areas had from 14 to 90% more ED visits for HSI. These findings of significantly increased HSI ED visit rates in more rural settings suggest a need to consider HSI ED visit variability by county urbanicity and climate region when designing and implementing local HSI preventive measures and interventions.

  9. Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005–2010

    Science.gov (United States)

    Fechter-Leggett, Ethan D.; Vaidyanathan, Ambarish; Choudhary, Ekta

    2015-01-01

    Variability of heat stress illness (HSI) by urbanicity and climate region has rarely been considered in previous HSI studies. We investigated temporal and geographic trends in HSI emergency department (ED) visits in CDC Environmental Public Health Tracking Network (Tracking) states for 2005–2010. We obtained county-level HSI ED visit data for 14 Tracking states. We used the National Center for Health Statistics Urban-Rural Classification Scheme to categorize counties by urbanicity as 1) large central metropolitan (LCM), 2) large fringe metropolitan (LFM), 3) small–medium metropolitan (SMM), or 4) nonmetropolitan (NM). We also assigned counties to one of six US climate regions. Negative binomial regression was used to examine trends in HSI ED visits over time across all counties and by urbanicity for each climate region, adjusting for pertinent variables. During 2005–2010, there were 98,462 HSI ED visits in the 14 states. ED visits for HSI decreased 3.0 % (p < 0.01) per year. Age-adjusted incidence rates of HSI ED visits increased from most urban to most rural. Overall, ED visits were significantly higher for NM areas (IRR = 1.41, p < 0.01) than for LCM areas. The same pattern was observed in all six climate regions; compared with LCM, NM areas had from 14 % to 90 % more ED visits for HSI. These findings of significantly increased HSI ED visit rates in more rural settings suggest a need to consider HSI ED visit variability by county urbanicity and climate region when designing and implementing local HSI preventive measures and interventions. PMID:26205070

  10. The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform

    Science.gov (United States)

    Vedovetto, Alessio; Soriani, Nicola; Merlo, Emanuela; Gregori, Dario

    2014-01-01

    Objective To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. Study Design A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010–2011). ED visits were considered “inappropriate” by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal Findings In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. Conclusion The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health. PMID:24495258

  11. Identifying potentially preventable emergency department visits by nursing home residents in the United States

    Science.gov (United States)

    Burke, Robert E.; Rooks, Sean P.; Levy, Cari; Schwartz, Robert; Ginde, Adit A.

    2015-01-01

    Objectives To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. Design Retrospective analysis of the 2005-2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) to those that led to admission (less likely preventable). Setting Nationally representative sample of United States EDs; Federal hospitals and hospitals with less than six beds were excluded. Participants Older (age ≥65 years) nursing home residents with an ED visit during this time period. Measurements Patient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. Results Older NH residents accounted for 3,857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing prior to ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, p<0.001), while infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). CT scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications prior to ED discharge in 9.4% of visits

  12. Poor asthma education and medication compliance are associated with increased emergency department visits by asthmatic children

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    Saleh Al-Muhsen

    2015-01-01

    Full Text Available BACKGROUND: Acute exacerbations of bronchial asthma remain a major cause of frequent Emergency Department (ED visits by pediatric patients. However, other factors including psychosocial, behavioural and educational, are also reportedly associated with repetitive ED visits. Therefore, it is necessary to determine whether such visits are justifiable. OBJECTIVE: The objective of this cross-sectional study was to identify risk factors associated with visits to ED by asthmatic children. METHODS: Asthmatic children (n = 297 between 1-17 years old were recruited and information collected at the time of visiting an ED facility at two major hospitals. RESULTS: Asthmatic patients visited the ED 3.9 ΁ 3.2 times-per-year, on average. Inadequately controlled asthma was perceived in 60.3% of patients. The majority of patients (56.4% reported not receiving education about asthma. Patients reflected misconceptions about the ED department, including the belief that more effective treatments are available (40.9%, or that the ED staff is better qualified (27.8%. About half of patients (48.2% visited the ED because of the convenience of being open 24 hours, or because they are received immediately (38.4%. Uncontrolled asthma was associated with poor education about asthma and/or medication use. Patients educated about asthma, were less likely to stop corticosteroid therapy when their symptoms get better (OR:0.55; 95% CI:0.3-0.9; P = 0.04. CONCLUSION: This study reports that most patients had poor knowledge about asthma and were using medications improperly, thus suggesting inefficient application of management action plan. Unnecessary and frequent visits to the ED for asthma care was associated with poor education about asthma and medication use. Potential deficiencies of the health system at directing patients to the proper medical facility were uncovered and underline the necessity to improve education about the disease and medication compliance of patients and

  13. Continuity in a VA patient-centered medical home reduces emergency department visits.

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    Krisda H Chaiyachati

    Full Text Available One major goal of the Patient-Centered Medical Home (PCMH is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED.To characterize continuity under the Veterans Health Administration's PCMH model--the Patient Aligned Care Team (PACT, at one large Veterans Affair's (VA's primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits.Retrospective, observational cohort study of patients at the West Haven VA (WHVA Primary Care Clinic from March 2011 to February 2012.The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011.Our exposure variable was continuity of care--a patient seeing their assigned primary care provider (PCP at each clinic visit. The outcome of interest was having an ED visit.The patients encompassed 42,969 total clinic visits, and 3185 (24% of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care--at least one visit with their assigned PCP--had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71, controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001. Compared to patients with low continuity (50% continuity were less likely to utilize the ED.Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non-primary care services.

  14. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  15. Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid.

    Science.gov (United States)

    Pajewski, Nicholas M; Okunseri, Christopher

    2014-01-01

    To examine patterns of dental service utilization for adult Medicaid enrollees in Wisconsin following nontraumatic dental condition (NTDC) visits to the emergency department (ED). This is a retrospective, observational study of claims for NTDC visits to the ED and dental service encounters from the Wisconsin Medicaid Evaluation and Decision Support database (2001-2009). We used competing risk models to predict probabilities of returning to the ED versus obtaining follow-up care from a dentist. We observed a 43 percent increase in the rate of NTDC visits to the ED, with most of this increase occurring from 2001 to 2005. Within 30 days of an NTDC visit to the ED, ∼29.6 percent of enrollees will first visit a dentist office, while ∼9.9 percent will return to the ED. Young to middle-aged adults (18 to dental providers were more likely to return to the ED following a NTDC visit. Among the enrollees that first visited a dental office following an ED visit, 37.6 percent had an extraction performed at this visit. Almost one in five adult Medicaid enrollees will subsequently return to the ED following a previous NTDC visit. The provision of definitive care for these individuals appears to primarily consist of extractions. © 2012 American Association of Public Health Dentistry.

  16. Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana.

    Science.gov (United States)

    DeYoung, Kathryn; Chen, Yushiuan; Beum, Robert; Askenazi, Michele; Zimmerman, Cali; Davidson, Arthur J

    Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

  17. Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals

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    Zynal Karaca

    2013-09-01

    Full Text Available Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP State Emergency Department Databases (SEDD were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times.Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals.Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups. [West J Emerg Med. 2013;14(5:529–541.

  18. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED

    OpenAIRE

    Schoenenberger, Andreas; Exadaktylos, Aristomenis

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the ...

  19. Time-series Analysis of Heat Waves and Emergency Department Visits in Atlanta, 1993 to 2012.

    Science.gov (United States)

    2017-05-31

    Heat waves are extreme weather events that have been associated with adverse health outcomes. However, there is limited knowledge of heat waves' impact on population morbidity, such as emergency department (ED) visits. We investigated associations between heat waves and ED visits for 17 outcomes in Atlanta over a 20-year period, 1993-2012. Associations were estimated using Poisson log-linear models controlling for continuous air temperature, dew-point temperature, day of week, holidays, and time trends. We defined heat waves as periods of consecutive days with temperatures beyond the 98th percentile of the temperature distribution over the period from 1945-2012. We considered six heat wave definitions using maximum, minimum, and average air temperatures and apparent temperatures. Associations by heat wave characteristics were examined. Among all outcome-heat wave combinations, associations were strongest between ED visits for acute renal failure and heat waves defined by maximum apparent temperature at lag 0 [relative risk (RR) = 1.15; 95% confidence interval (CI): 1.03-1.29], ED visits for ischemic stroke and heat waves defined by minimum temperature at lag 0 (RR = 1.09; 95% CI: 1.02-1.17), and ED visits for intestinal infection and heat waves defined by average temperature at lag 1 (RR = 1.10; 95% CI: 1.00-1.21). ED visits for all internal causes were associated with heat waves defined by maximum temperature at lag 1 (RR = 1.02; 95% CI: 1.00, 1.04). Heat waves can confer additional risks of ED visits beyond those of daily air temperature, even in a region with high air-conditioning prevalence. https://doi.org/10.1289/EHP44.

  20. Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus.

    Science.gov (United States)

    Yan, Justin W; Gushulak, Katherine M; Columbus, Melanie P; van Aarsen, Kristine; Hamelin, Alexandra L; Wells, George A; Stiell, Ian G

    2017-12-01

    Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. We conducted a 1-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days. There were 833 ED visits for hyperglycemia in the 1-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age 20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit. This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients

  1. Determining the rate of follow-up after hospital emergency department visits for dental conditions

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    Meyer B

    2016-03-01

    Full Text Available Beau Meyer,1,2 Eric Adkins,3,4 Nathan M Finnerty,4 Fonda G Robinson5 1Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, 2Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 3The Ohio State University Wexner Medical Center Emergency Department, 4Department of Emergency Medicine, College of Medicine, 5Clinic Administration and Patient Care, College of Dentistry, The Ohio State University, Columbus, OH, USA Background: Emergency department (ED visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC after hospital ED visits for nontraumatic dental conditions. Methods: This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results: Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC's regular dental clinic. Conclusion: Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. Keywords: emergencies, dental health services, health services accessibility, access to care, dental emergency treatment

  2. Influence of climate on emergency department visits for syncope: role of air temperature variability.

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    Andrea Galli

    Full Text Available BACKGROUND: Syncope is a clinical event characterized by a transient loss of consciousness, estimated to affect 6.2/1000 person-years, resulting in remarkable health care and social costs. Human pathophysiology suggests that heat may promote syncope during standing. We tested the hypothesis that the increase of air temperatures from January to July would be accompanied by an increased rate of syncope resulting in a higher frequency of Emergency Department (ED visits. We also evaluated the role of maximal temperature variability in affecting ED visits for syncope. METHODOLOGY/PRINCIPAL FINDINGS: We included 770 of 2775 consecutive subjects who were seen for syncope at four EDs between January and July 2004. This period was subdivided into three epochs of similar length: 23 January-31 March, 1 April-31 May and 1 June-31 July. Spectral techniques were used to analyze oscillatory components of day by day maximal temperature and syncope variability and assess their linear relationship. There was no correlation between daily maximum temperatures and number of syncope. ED visits for syncope were lower in June and July when maximal temperature variability declined although the maximal temperatures themselves were higher. Frequency analysis of day by day maximal temperature variability showed a major non-random fluctuation characterized by a ∼23-day period and two minor oscillations with ∼3- and ∼7-day periods. This latter oscillation was correlated with a similar ∼7-day fluctuation in ED visits for syncope. CONCLUSIONS/SIGNIFICANCE: We conclude that ED visits for syncope were not predicted by daily maximal temperature but were associated with increased temperature variability. A ∼7-day rhythm characterized both maximal temperatures and ED visits for syncope variability suggesting that climate changes may have a significant effect on the mode of syncope occurrence.

  3. Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007-2011).

    Science.gov (United States)

    Fuhrmann, Christopher M; Sugg, Margaret M; Konrad, Charles E; Waller, Anna

    2016-02-01

    Extreme heat is the leading cause of weather-related mortality in the U.S. Extreme heat also affects human health through heat stress and can exacerbate underlying medical conditions that lead to increased morbidity and mortality. In this study, data on emergency department (ED) visits for heat-related illness (HRI) and other selected diseases were analyzed during three heat events across North Carolina from 2007 to 2011. These heat events were identified based on the issuance and verification of heat products from local National Weather Service forecast offices (i.e. Heat Advisory, Heat Watch, and Excessive Heat Warning). The observed number of ED visits during these events were compared to the expected number of ED visits during several control periods to determine excess morbidity resulting from extreme heat. All recorded diagnoses were analyzed for each ED visit, thereby providing insight into the specific pathophysiological mechanisms and underlying health conditions associated with exposure to extreme heat. The most common form of HRI was heat exhaustion, while the percentage of visits with heat stroke was relatively low (65 years of age) were at greatest risk for HRI during the early summer heat event (8.9 visits per 100,000), while young and middle age adults (18-44 years of age) were at greatest risk during the mid-summer event (6.3 visits per 100,000). Many of these visits were likely due to work-related exposure. The most vulnerable demographic during the late summer heat event was adolescents (15-17 years of age), which may relate to the timing of organized sports. This demographic also exhibited the highest visit rate for HRI among all three heat events (10.5 visits per 100,000). Significant increases (p events (3-8%). The greatest increases were found in visits with hypotension during the late summer event (23%) and sequelae during the early summer event (30%), while decreases were noted for visits with hemorrhagic stroke during the middle and late

  4. Factors associated with patient visits to the emergency department for asthma therapy

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    AL-Jahdali Hamdan

    2012-12-01

    Full Text Available Abstract Background Acute asthma attacks remain a frequent cause of emergency department (ED visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED. Methods A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients’ reasons for visiting the ED. Result Four hundred fifty (N = 450 patients were recruited, 39.1% of whom were males with a mean age of 42.3 ± 16.7. The mean duration of asthma was 155.90 ± 127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7% of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7% and to obtain oxygen (75.1%. Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year, p-value = 0.0145 and p-value = 0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0

  5. Depression Is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain

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    Andrew Charles Meltzer

    2014-05-01

    Full Text Available Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/ severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. Results: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10 had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5, (p=0.013. Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression.

  6. Alcohol Use as Risk Factors for Older Adults’ Emergency Department Visits: A Latent Class Analysis

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    Namkee G. Choi, PhD

    2015-12-01

    Full Text Available Introduction: Late middle-aged and older adults’ share of emergency department (ED visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. Methods: Data came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713. Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/ moderate drinkers, and current heavy drinkers, chronic health and mental health status, and past-year ED visits as indicators. Results: LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/ mental health problems; Class 2 (21%; low-risk group consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. Conclusion: Alcohol nonuse/use (and quantity of use and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex

  7. The air quality health index and emergency department visits for urticaria in Windsor, Canada.

    Science.gov (United States)

    Kousha, Termeh; Valacchi, Giuseppe

    2015-01-01

    Ambient air pollution exposure has been associated with several health conditions, limited not only to respiratory and cardiovascular systems but also to cutaneous tissues. However, few epidemiological studies examined pollution exposure on skin problems. Basically, the common mechanism by which pollution may affect skin physiology is by induction of oxidative stress and inflammation. Urticaria is among the skin pathologies that have been associated with pollution. Based on the combined effects of three ambient air pollutants, ozone (O₃), nitrogen dioxide (NO₂), and fine particulate matter (PM) with a median aerodynamic diameter of less than 2.5 μm (PM(2.5)), on mortality, the Air Quality Health Index (AQHI) in Canada was developed. The aim of this study was to examine the associations of short-term changes in AQHI with emergency department (ED) visits for urticaria in Windsor-area hospitals in Canada. Diagnosed ED visits were retrieved from the National Ambulatory Care Reporting System (NACRS). A time-stratified case-crossover design was applied to 2905 ED visits (males = 1215; females = 1690) for urticaria from April 2004 through December 2010. Odds ratios (OR) and their corresponding 95% confidence intervals (95%CI) for ED visits associated with increase by one unit of risk index were calculated employing conditional logistic regression. Positive and significant results were observed between AQHI levels and OR for ED visits for urticaria in Windsor for lags 2 and 3 days. A distributed lag nonlinear model technique was applied to daily counts of ED visits for lags 0 to 10 and significant results were obtained from lag 2 to lag 5 and for lag 9. These findings demonstrated associations between ambient air pollution and urticarial confirming that air pollution affects skin conditions.

  8. Impact of Ramadan on emergency department visits and on medical emergencies.

    Science.gov (United States)

    Al Assaad, Reem G; Bachir, Rana; El Sayed, Mazen J

    2017-07-12

    Fasting during Ramadan is important to Muslims. This study describes changes in emergency department (ED) visits and in frequencies of emergency conditions and impact on clinical outcomes during Ramadan in a tertiary care center in Beirut, Lebanon. Patients presenting to ED during Ramadan 1 month before and 1 month after Ramadan over a 3-year period with specific conditions (acute coronary syndrome, stroke, seizure, diabetes, renal colic, headache or hypertension) were included. Clinical and sociodemographic characteristics, ED volume, diagnoses, and outcomes were examined during two periods (Ramadan vs. non-Ramadan). Multiple logistic regressions were performed to identify the impact of Ramadan on ED bounce-back and mortality at ED discharge. A total of 3536 patients were included. The daily average ED volume was higher during non-Ramadan months (145.65±22.14) compared with Ramadan (128.85±14.52). The average ED length of stay was higher during Ramadan (5.42±14.86 vs. 3.96±4.29 h; P=0.006). Frequencies and admission rates for the selected diseases were comparable during the two periods, except for patients with acute coronary syndrome or stroke who had lower admission rates during Ramadan.ED bounce-back rates and mortality at ED discharge were higher during Ramadan (odds=1.34, 95% confidence interval: 1.03-1.74 and odds ratio=2.88, 95% confidence interval: 1.01-8.27, respectively). EDs might experience a decreased in volumes, higher length of stay, and potentially worse outcomes during Ramadan. Changes in the frequencies of ED visits related to common conditions are not expected. Prospective studies documenting fasting status would clarify further the impact of Ramadan.

  9. Impact of a countywide smoke-free workplace law on emergency department visits for respiratory diseases: a retrospective cohort study.

    Science.gov (United States)

    Croghan, Ivana T; Ebbert, Jon O; Hays, J Taylor; Schroeder, Darrell R; Chamberlain, Alanna M; Roger, Véronique L; Hurt, Richard D

    2015-01-22

    With the goal of reducing exposure to secondhand smoke, the state of Minnesota (MN), enacted a smoke-free law (i.e., Freedom to Breathe Act) in all workplaces, restaurants, and bars in 2007. This retrospective cohort study analyzes emergency department (ED) visits in Olmsted County, MN, for chronic obstructive pulmonary disease (COPD) and asthma over a five-year period to assess changes after enactment of the smoke-free law. We calculated the rates of ED visits in Olmsted County, MN, with a primary diagnosis of COPD and asthma in the five-year period from January 1, 2005 to December 31, 2009. Analyses were performed using segmented Poisson regression to assess whether ED visit rates declined following enactment of the smoke free law after adjusting for potential underlying temporal trends in ED visit rates during this time period. Using segmented Poisson regression analyses, a significant reduction was detected in asthma-related ED visits (RR 0.814, p law. The reduction in asthma related ED visits was observed in both adults (RR 0.840, p = 0.015) and children (RR 0.751, p = 0.015). In Olmsted County, MN, asthma-related ED visits declined significantly after enactment of a smoke-free law. These results add to the body of literature supporting community health benefits of smoke-free policies in public environments and their potential to reduce health care costs.

  10. Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios Non-Urgent and Non-Referred Patients Presenting to the Emergency Department (ED: Understanding the Reasons of the Non Urgent Patients to Visit the ED

    Directory of Open Access Journals (Sweden)

    Manuel Espinel Vallejo

    2011-09-01

    ó acudir a urgencias porque no mejoró con el tratamiento que le prescribió el MC (71% y porque no estaba satisfecho con el tratamiento y quería una segunda opinión (39%. El 70% consideró que su problema de salud no era grave pero pensaba que sí era merecedor de atención urgente o rápida. El 63% expresó alta preocupación por su problema. El 63% consideró que el actual problema de salud no podía ser resuelto por su MC en caso de ser atendido en ese momento. Finalmente el 50% consideró que el SUH tenía más capacidad para resolver los problemas de salud que el CS. Conclusión: La mejor eficacia y efectividad, en términos de uso y gestión de recursos técnicos y del tiempo para resolver el problema de salud, y la comodidad, en términos de horarios, disponibilidad y accesibilidad, parecen ser las principales razones por las cuales las personas con problemas de salud de baja complejidad utilizan por cuenta propia los SUH. La preocupación, más que la gravedad, parece movilizar activamente la búsqueda de solución al problema de salud de manera rápida y urgente. Estas razones parecen estar condicionadas en la experiencia institucional previa con el CS.

    Objectives: The objectives of this study are: 1 To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED, 2 To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3 To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours,

  11. Impact of the ABCDE triage on the number of patient visits to the emergency department

    Directory of Open Access Journals (Sweden)

    Menezes Ricardo

    2010-06-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for those patients who need it the most. Methods A face-to-face triage system based on the letters A (patient directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse. If the patient was not considered to be in need of immediate care (i.e. A-D he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo. To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public

  12. Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids

    Directory of Open Access Journals (Sweden)

    Hyeon-Ju Ryoo

    2016-05-01

    Full Text Available Introduction: Visits to the emergency department (ED for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide. Methods: We performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN. All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral. Results: Of the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]. Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02-1.22], for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15-1.40], and for prescription opioids (OR 1.30, 95% CI [1.17-1.43]. This significant association prevailed after controlling for “seeking detox.” Conclusion: Women are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes.

  13. Relationship between summertime ambient ozone levels and emergency department visits for asthma in central New Jersey

    Energy Technology Data Exchange (ETDEWEB)

    Weisel, C.P.; Cody, R.P.; Lioy, P.J. [Rutgers Univ., Piscataway, NJ (United States)

    1995-03-01

    The 5-year retrospective study of the association between temperature and emergency department (ED) visits for asthma with mean ambient ozone levels between 10:00 and 15:00 was conducted in central New Jersey during the summer months. An association was identified in each of the years (1986-1990). Between 8 and 34% of the total variance in ED visits for asthma was explained by the two environmental variables in the step-wise multiple regression analysis. ED visits occurred 28% more frequently when the mean ozone levels were >0.06 ppm than when they were < 0.06 ppm. This result was statistically significant in a covariance analysis. An evaluation of the effects of ozone on asthmatics reported in the literature was completed to determine if, as proposed by Bates, the results from different types of studies were coherent among the health metrics. A consistency in the magnitude of reported effects and the time lag between exposure and response for four different health indices (symptom reports, decrements in expiratory flow, ED visits, and hospital admissions) was identified and indicates a coherence between ozone and respiratory response to ozone exposure. This supports a proposition that ozone adversely affects asthmatics at levels below the current U.S. standard. 34 refs., 1 fig., 4 tabs.

  14. Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA

    Directory of Open Access Journals (Sweden)

    Leila Heidari

    2016-10-01

    Full Text Available Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED visits were collected in Atlanta, Georgia, USA during 1993–2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research.

  15. Prevalence of Drug-Related Emergency Department Visits at a Teaching Hospital in Malaysia.

    Science.gov (United States)

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Rahman, Ab Fatah Ab

    Data on the prevalence of adverse drug event (ADE)-related emergency department (ED) visits in developing countries are limited. Malaysia is located in South-East Asia, and, to our knowledge, no information exists on ADE-related ED visits. The objective of this study was to determine the prevalence, preventability, severity, and outcome of drug-related ED visits. A cross-sectional study was conducted in consenting patients who visited the ED of Hospital Universiti Sains Malaysia over a 6-week period. The ED physician on duty determined whether or not the visit was drug related according to set criteria. Other relevant information was extracted from the patient's medical folder by a clinical pharmacist. Of the 434 consenting patients, 133 (30.6 %; 95 % confidence interval [CI] 26-35 %) visits were determined to be ADE related; 55.5 % were considered preventable, 11.3 % possibly preventable, and 33.1 % not preventable. Severity was classed as mild in 1.5 %, moderate in 67.7 %, and severe in 30.8 %. The most common ADEs reported were drug therapeutic failure (55.6 %) and adverse drug reactions (32.3 %). The most frequently implicated drugs were antidiabetics (n = 31; 23.3 %), antihypertensives (n = 28; 21.1 %), antibiotics (n = 13; 9.8 %), and anti-asthmatics (n = 11; 8.3 %). A total of 93 patients (69.9 %) were admitted to the ED for observation, 25 (18.8 %) were discharged immediately after consultation, and 15 (11.3 %) were admitted to the ward through the ED. The prevalence of ADE-related ED visits was high; more than one-half of the events were considered preventable and one-third was classed as severe. As such, preventive measures will minimize future occurrences and increase patient safety.

  16. Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.

    Science.gov (United States)

    Vanbrabant, P; Knockaert, D

    2009-01-01

    Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors. A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed. The study was performed over a one year period at a tertiary hospital ED. Data are reported as relative risk (RR) and 95% confidence interval (CI). There were a total of 51.210 ED visits during the study period. The total number of ED return visits within 72 hours was 1.124 (2,19%; 95% CI 2,07 to 2,32). The total number of ED patients managed by the GIM service was 9.511. The percentage of patients treated by the GIM service who returned to the ED within 72 hours was 1,48% (95% CI 1,25 to 1,74) when calculated for the whole group and 2,9 % (95% CI 2,46-3,41) for those discharged home from the ED (n = 4.860). The majority (82,98%) of ED return visits by patients discharged from the GIM service were unscheduled and related to their index presenting complaint. Abdominal pain was the commonest initial presenting symptom in the patients who returned to the ED after discharge. Patients with diarrhoea as the initial initial presenting symptom had the highest relative risk of an ED return visit (RR = 4.07). The percentage ED return visits by patients discharged from the ED by the GIM service is 1,48%. Patients presenting with diarrhoea as the initial presenting symptom have the highest relative risk of an early ED return visit. Our main practical conclusion is that patients with abdominal pain need to be re-examined carefully and instructed about potential evolution before discharge.

  17. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

  18. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit.

    Science.gov (United States)

    McGovern, M; Kernan, R; O'Neill, M B

    2017-02-10

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child's illness but on educating and empowering the parent.

  19. Predicting Factors and Risk Stratification for Return Visits to the Emergency Department Within 72 Hours in Pediatric Patients.

    Science.gov (United States)

    Sung, Sheng-Feng; Liu, Kang Ernest; Chen, Solomon Chih-Cheng; Lo, Chia-Lun; Lin, Kuei-Chih; Hu, Ya-Han

    2015-12-01

    A return visit (RV) to the emergency department (ED) is usually used as a quality indicator for EDs. A thorough comprehension of factors affecting RVs is beneficial to enhancing the quality of emergency care. We performed this study to identify pediatric patients at high risk of RVs using readily available characteristics during an ED visit. We retrospectively collected data of pediatric patients visiting 6 branches of an urban hospital during 2007. Potential variables were analyzed using a multivariable logistic regression analysis to determine factors associated with RVs and a classification and regression tree technique to identify high-risk groups. Of the 35,435 visits from which patients were discharged home, 2291 (6.47%) visits incurred an RV within 72 hours. On multivariable analysis, younger age, weekday visits, diagnoses belonging to the category of symptoms, signs, and ill-defined conditions, and being seen by a female physician were associated with a higher probability of RVs. Children younger than 6.5 years who visited on weekdays or between midnight and 8:00 AM on weekends or holidays had the highest probability of returning to the ED within 72 hours. Our study reexamined several important factors that could affect RVs of pediatric patients to the ED and identified high-risk groups of RVs. Further intervention studies or qualitative research could be targeted on these at-risk groups.

  20. Emergency department visits during an Olympic gold medal television broadcast

    OpenAIRE

    Donald A Redelmeier; Vermeulen, Marian J

    2011-01-01

    Background Practice pattern variations are often attributed to physician decision-making with no accounting for patient preferences. Objective To test whether a mass media television broadcast unrelated to health was associated with changes in the rate and characteristics of visits for acute emergency care. Design Time-series analysis of emergency department visits for any reason. Subjects Population-based sample of all patients seeking emergency care in Ontario, Canada. Measures The broadcas...

  1. Physician’s changes in management of return visits to the Emergency Department

    Directory of Open Access Journals (Sweden)

    Adrianna Long

    2016-06-01

    Full Text Available Return visits to the Emergency Department (ED are estimated between 2-3.1%, which impacts ED care costs and wait times. Adverse events for unscheduled return visits (URVs have been reported to be as high as 30%. The objective of this study was to characterize the attitudes and management of Emergency Medicine (EM physicians regarding patients presenting with the same chief complaint to the ED for an URV. An online survey questionnaire was developed and sent to 160 accredited EM Graduate Medical Education programs in the United States. The questionnaire consisted of case vignettes wherein providers were asked to submit what orders they would place for each scenario. The mean numbers of tests and treatments were compared from initial visit to repeat visit with same chief complaint. Physicians also provided feedback regarding their management of URVs. There were estimated 6988 eligible participants with 397 responses (response rate 5.7%. There was a statistical significance (P<0.001 in provider management of URVs with pediatric fever, but there was no statistical significance for management of the other chief complaints. There were 77% of physicians that felt an increased work up is warranted for URVs. The results of this study indicate that majority of EM residents and staff working in training programs feel that they should approach the management of URV patients with a more extensive workup despite no clinical change. These findings suggest that further analysis should be performed regarding provider management of URVs and the associated healthcare costs.

  2. US-Based Emergency Department Visits for Fluoroquinolone-Associated Hypersensitivity Reactions

    Science.gov (United States)

    Jones, S. Christopher; Budnitz, Dan; Sorbello, Alfred; Mehta, Hina

    2015-01-01

    Purpose To estimate the rate of hypersensitivity reactions per 100,000 prescription dispensings of fluoroquinolones based on care rendered in a nationally-representative sample of US hospital emergency departments (ED). Methods We analyzed the frequency of fluoroquinolone-associated hypersensitivity reactions using the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance system (2004–2010) in conjunction with US retail outpatient prescription data from IMS Health (2004–2010). We further categorized reaction severity into three subgroups (mild, moderate, severe). Results Based on 1,422 cases of fluoroquinolone-associated hypersensitivity reactions and national drug utilization projections, we estimated risk of hypersensitivity reactions for moxifloxacin, ciprofloxacin, and levofloxacin. The absolute risk of a fluoroquinolone-related hypersensitivity reaction of any severity was low (44.0 (95% CI 34.8–53.3) ED visits/100,000 prescriptions; however, we identified a statistically significant difference in the relative risk (rate ratios) of seeking care in an ED attributed to moxifloxacin hypersensitivity compared to either levofloxacin or ciprofloxacin. For all reaction severities, the estimated ED visits/100,000 prescriptions were 141.3 (95% CI 99.9–182.7) for moxifloxacin, 40.8 (95% CI 31.5–50.0) for levofloxacin, and 26.3 (95% CI 20.8–31.9) for ciprofloxacin. When the rates were stratified by reaction severity category (mild or moderate-severe), moxifloxacin continued to be implicated in more ED visits per 100,000 prescriptions dispensed than either levofloxacin or ciprofloxacin. Conclusion Fluoroquinolones may cause hypersensitivity reactions requiring care in an ED, and relative to use, the rate of moxifloxacin-related hypersensitivity reactions is higher than comparator fluoroquinolones. PMID:23963962

  3. A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010.

    Science.gov (United States)

    Macpherson, Alison; Fridman, Liraz; Scolnik, Michal; Corallo, Ashley; Guttmann, Astrid

    2014-12-01

    There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.

  4. Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

    Directory of Open Access Journals (Sweden)

    Amanda S. Newton

    2014-01-01

    Full Text Available Objective. This study explores the association of patient and emergency department (ED mental health visit characteristics with wait time and length of stay (LOS. Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR with 95% confidence intervals (CIs. Results. Sex (male: HR=1.48, 95% CI=1.20–1.84, ED type (pediatric ED: HR=5.91, 95% CI=4.16–8.39, and triage level (Canadian Triage and Acuity Scale (CTAS 2: HR=3.62, 95% CI=2.24–5.85 were statistically significant predictors of wait time. ED type (pediatric ED: HR=1.71, 95% CI=1.18–2.46, triage level (CTAS 5: HR=2.00, 95% CI=1.15–3.48, number of consultations (HR=0.46, 95% CI=0.31–0.69, and number of laboratory investigations (HR=0.75, 95% CI=0.66–0.85 predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

  5. Socioeconomic factors are associated with frequency of repeat emergency department visits for closed pediatric fractures

    Science.gov (United States)

    Dy, Christopher J.; Lyman, Stephen; Do, Huong T.; Fabricant, Peter D.; Marx, Robert G.; Green, Daniel W.

    2014-01-01

    Background Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared to those without a return visit using standard univariate statistical tests and logistic regression analyses. Results Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of non-white or unidentified race were significantly more likely to have a revisit than white patients (OR 1.27; p=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR 1.55; p<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR 0.72; p=0.001). Conclusions Our analysis revealed that non-white patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, while patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when

  6. Suicide Prevention in an Emergency Department Population: The ED-SAFE Study.

    Science.gov (United States)

    Miller, Ivan W; Camargo, Carlos A; Arias, Sarah A; Sullivan, Ashley F; Allen, Michael H; Goldstein, Amy B; Manton, Anne P; Espinola, Janice A; Jones, Richard; Hasegawa, Kohei; Boudreaux, Edwin D

    2017-06-01

    Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed. A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts

  7. Coarse particles and respiratory emergency department visits in California.

    Science.gov (United States)

    Malig, Brian J; Green, Shelley; Basu, Rupa; Broadwin, Rachel

    2013-07-01

    Although respiratory disease has been strongly connected to fine particulate air pollution (particulate matter effects of coarse particles (particulate matter from 2.5 to 10 μm in diameter), possibly because of the greater spatial heterogeneity of coarse particles. In this study, we evaluated the relationship between coarse particles and respiratory emergency department visits, including common subdiagnoses, from 2005 to 2008 in 35 California counties. A time-stratified case-crossover design was used to help control for time-invariant confounders and seasonal influences, and the study population was limited to those residing within 20 km of pollution monitors to mitigate the influence of spatial heterogeneity. Significant associations between respiratory emergency department visits and coarse particle levels were observed. Asthma visits showed associations (for 2-day lag, excess risk per 10 μg/m³ = 3.3%, 95% confidence interval: 2.0, 4.6) that were robust to adjustment by other common air pollutants (particles acute respiratory infection visits were not associated, although some suggestion of a relationship with chronic obstructive pulmonary disease visits was present. Our results indicate that coarse particle exposure may trigger asthma exacerbations requiring emergency care, and reducing exposures among asthmatic persons may provide benefits.

  8. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits.

    Science.gov (United States)

    Takahashi, Paul Y; Pecina, Jennifer L; Upatising, Benjavan; Chaudhry, Rajeev; Shah, Nilay D; Van Houten, Holly; Cha, Steve; Croghan, Ivana; Naessens, James M; Hanson, Gregory J

    2012-05-28

    Efficiently caring for frail older adults will become an increasingly important part of health care reform;telemonitoring within homes may be an answer to improve outcomes. This study sought to assess differences in hospitalizations and emergency department (ED) visits among older adults using telemonitoring vs usual care. A randomized controlled trial was performed among adults older than 60 years at high risk for rehospitalization. Participants were randomized to telemonitoring (with daily input) or to patient-driven usual care. Telemonitoring was accomplished by daily biometrics,symptom reporting, and videoconference. The primary outcome was a composite end point of hospitalizations and ED visits in the 12 months following enrollment. Secondary end points included hospitalizations,ED visits, and total hospital days. Intent-to-treat analysis was performed. Two hundred five participants were enrolled,with a mean age of 80.3 years. The primary outcome of hospitalizations and ED visits did not differ between the telemonitoring group (63.7%) and the usual care group(57.3%) (P=.35). No differences were observed in secondary end points, including hospitalizations, ED visits,and total hospital days. No significant group differences in hospitalizations and ED visits were found between the pre-enrollment period vs the post-enrollment period. Mortality was higher in the telemonitoring group (14.7%)than in the usual care group (3.9%) (P=.008). Among older patients, telemonitoring did not result in fewer hospitalizations or ED visits. Secondary outcomes demonstrated no significant differences between the telemonitoring group and the usual care group.The cause of greater mortality in the telemonitoring group is unknown.

  9. Proposed ICD-10-CM Surveillance Case Definitions for Injury Hospitalizations and Emergency Department Visits.

    Science.gov (United States)

    Hedegaard, Holly B; Johnson, Renee L; Ballesteros, Michael F

    2017-01-01

    This report describes a collaboration between the National Center for Health Statistics and the National Center for Injury Prevention and Control to develop proposed surveillance case definitions for injury hospitalizations and emergency department (ED) visits for use with administrative data sets coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The proposed ICD-10-CM surveillance case definitions were developed by applying General Equivalence Mappings to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) definitions. As with the ICD-9-CM definitions, there are slight differences between the proposed ICD-10-CM surveillance case definition for injury hospitalizations and the one for ED visits. The inclusion criteria for an injury hospitalization requires a case to have a principal diagnosis of one of the included nature-of-injury (injury diagnosis) codes. The inclusion criteria for an injury ED visit requires the case to have either a principal diagnosis of one of the included nature-of-injury codes or the presence of selected external-cause codes. The ICD-10-CM nature-of-injury and external-cause codes included in the proposed definitions are presented and caveats for use of the proposed definitions are described.

  10. Risk factors for early return visits to the emergency department in patients with urinary tract infection.

    Science.gov (United States)

    Jorgensen, Sarah; Zurayk, Mira; Yeung, Samantha; Terry, Jill; Dunn, Maureen; Nieberg, Paul; Wong-Beringer, Annie

    2017-06-21

    Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI. A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30days (ERVs). We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible). Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P=0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P=0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; Prisk patients for post-discharge follow-up. Copyright © 2017. Published by Elsevier Inc.

  11. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study.

    Directory of Open Access Journals (Sweden)

    Thomas E Cowling

    Full Text Available BACKGROUND: The number of visits to hospital emergency departments (EDs in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS. Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. METHODS: A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001. Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

  12. Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study

    Science.gov (United States)

    Cowling, Thomas E.; Cecil, Elizabeth V.; Soljak, Michael A.; Lee, John Tayu; Millett, Christopher; Majeed, Azeem; Wachter, Robert M.; Harris, Matthew J.

    2013-01-01

    Background The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. Methods A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. Main Result and Conclusion General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation. PMID:23776694

  13. Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

    Science.gov (United States)

    Sun, Yan; Heng, Bee Hoon; Tay, Seow Yian; Tan, Kelvin Brian

    2015-12-01

    Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate. This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals' information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM). The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was

  14. Can geriatric approaches support the care of old patients in emergency departments? A review from a Swiss ED.

    Science.gov (United States)

    Schoenenberger, Andreas W; Exadaktylos, Aristomenis K

    2014-01-01

    In the coming decades, old patients will account for an increasing proportion of emergency department (ED) visits. During or after their stay in the ED, they more frequently suffer adverse outcomes than younger patients. There is evidence that specific age-centred approaches improve the outcomes. We therefore reviewed specific conditions needing particular attention in older ED patients, such as cognitive disorders and delirium, impaired mobility and falls, as well as problems related to the activities of daily living, disability, poly-pharmacy, adverse drug effects, co-morbidity and atypical presentation. We also propose steps to further improve the quality of care in older ED patients by using appropriate age-centred management.

  15. Review of the US Department of Energy Classified Visits Program

    Energy Technology Data Exchange (ETDEWEB)

    Martin, S W; Killinger, M H; Segura, M A

    1992-07-01

    This review examines the US Department of Energy (DOE) Classified Visits Program, which is administered by the Office of Safeguards and Security. The overall purpose of this analysis is to (1) ensure that DOE policy and implementing procedures are appropriate to maintain US national security intentions; (2) evaluate the effectiveness of the process used across the DOE complex; and (3) recommend changes which will enhance the overall efficiency of the process while maintaining the program's integrity.

  16. Risk Factors Associated With Emergency Department Return Visits Following Trauma System Discharge.

    Science.gov (United States)

    Ruttan, Timothy; Lawson, Karla A; Piper, Karen; Wilkinson, Matthew

    2017-06-06

    Little evidence exists in the pediatric trauma literature regarding what factors are associated with re-presentation to the hospital for patients discharged from the emergency department (ED). This was a retrospective cohort study of trauma system activations at a pediatric trauma center from June 30, 2007, through June 30, 2013, who were subsequently discharged from the ED or after a brief inpatient stay. Returns within 30 days were reviewed. χ, Student t test, and univariate logistical regression were used to compare predictive factors for those returning and not. One thousand eight hundred sixty-three patient encounters were included in the cohort. Seventy-two patients (3.9%) had at least 1 return visit that was related to the original trauma activation. Age, sex, language, race/ethnicity, ED length of stay, arrival mode, level of trauma activation, and transfer from an outside hospital did not vary significantly between the groups. Patients with public insurance were almost 2 times more likely to return compared with those with private insurance (odds ratio, 1.92; 95% confidence interval, 1.11-3.35). Income by zip code was associated with the risk of a return visit, with patients in neighborhoods at less than the 50th percentile income twice as likely to return to the ED (odds ratio, 2.15; 95% confidence interval, 1.30-3.54). Patients with public insurance and those from low-income neighborhoods were significantly more likely to return to the ED after trauma system activation. These data can be used to target interventions to decrease returns in high-risk trauma patients.

  17. Hospital-based inter-professional strategy to reduce in-patient admissions and emergency department visits for pediatric asthma.

    Science.gov (United States)

    Fleming, Karen; Kuzik, Brian; Chen, Chee

    2011-01-01

    Pediatric asthma is a common reason for emergency department (ED) visits and in-patient hospital admissions. Evidence demonstrates that asthma management initiated in the ED has limited benefit unless followed by ongoing coordinated inter-professional care (IPC). The Royal Victoria Hospital (RVH) of Barrie, Ontario, has developed a best practice model of care for pediatric asthma. Primary care providers and ED physicians are actively encouraged to refer children with any recurrent respiratory problems consistent with asthma to the Paediatric Asthma Clinic (PAC). Quarterly PAC visits with a certified asthma educator and a pediatrician include lung function measurement, written action plans and primary care provider communication. Ongoing outcome monitoring of patients receiving IPC has revealed that, compared with 12 months prior to enrolment in the PAC, patients show a two-thirds decrease in asthma-related ED visits and an 85% decrease in admissions. The PAC has contributed to an ongoing decline in the rates of pediatric asthma-related ED visits and admissions at RVH, which are currently less than half the rates seen at our peer hospitals. IPC for chronic diseases is best practice, and our model of care for pediatric asthma continues to provide critical data demonstrating and supporting the advantages of IPC in chronic disease management. RVH modifies practice and policy to meet best practices, optimizing the care provided to children with pediatric asthma.

  18. Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

    Directory of Open Access Journals (Sweden)

    Brian Y. Choi, MD, MPH

    2016-03-01

    Full Text Available Introduction: A disproportionate number of individuals with human immunodeficiency virus (HIV have mental health and substance-use disorders (MHSUDs, and MHSUDs are significantly associated with their emergency department (ED visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21-34, 35-49, 50-64, and 65+ years. Methods: We used the 2012 Nationwide Emergency Department Sample (NEDS dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV. Multinomial and binary logistic regression analyses, with “treat-and-release” as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group. Results: Mood and “other” mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects (RRR=3.56, CI [2.69-4.70]; RRR=4.44, CI [3.72-5.30]; and RRR=5.64, CI [4.38- 7.26] in the 21-34, 35-49, and 50-64 age groups, respectively. Cognitive disorders had mediumto-large effects on hospital admissions in all age groups and large effects on death in the 35-49 (RRR=7.29, CI [3.90-13.62] and 50-64 (RRR=5.38, CI [3.39-8.55] age groups. Alcohol use disorders (AUDs had small effects on hospital admission in all age groups (RRR=2.35, 95% CI [1.92-2.87]; RRR=2.15, 95% CI [1.95-2.37]; RRR=1.92, 95% CI [1.73-2.12]; and OR=1.93, 95% CI [1.20-3.10] in the 21-34, 35-49, 50-64, and 65+ age groups, respectively. Drug use disorders (DUDs had small-to-medium effects on hospital admission (RRR=4.40, 95% CI [3.87-5.0]; RRR=4.07, 95% CI [3.77-4.40]; RRR=4.17, 95% CI [3.83-4.55]; and OR=2.53, 95% CI [2.70- 3.78] in the 21-34, 35-49, 50-64, and 65+ age groups, respectively. AUDs and DUDs were also significantly related to

  19. Characteristics of Cannabis-Only and Other Drug Users Who Visit the Emergency Department

    Science.gov (United States)

    Woodruff, Susan I.; McCabe, Cameron T.; Hohman, Melinda; Clapp, John D.; Shillington, Audrey M.; Eisenberg, Kimberly; Sise, C. Beth; Castillo, Edward M.; Chan, Theodore C.; Sise, Michael J.

    2016-01-01

    Abstract Emergency department (ED) settings have gained interest as venues for illegal drug misuse prevention and intervention, with researchers and practitioners attempting to capitalize on the intersection of need and opportunity within these settings. This study of 686 adult patients visiting two EDs for various reasons who admitted drug use compared daily cannabis-only users, nondaily cannabis-only users, and other drug users on sociodemographic and drug-related severity outcomes. The three drug use groups did not differ on most sociodemographic factors or medical problem severity scores. Forty-five percent of the sample was identified as having a drug use problem. ED patients who used drugs other than cannabis were at particular risk for high drug use severity indicators and concomitant problems such as psychiatric problems and alcohol use severity. However, 19–29% of cannabis-only users were identified as having problematic drug use. Furthermore, daily cannabis-only users fared less well than nondaily cannabis users with regard to drug use severity indicators and self-efficacy for avoiding drug use. Results may assist emergency medicine providers and medical social workers in matching patients to appropriate intervention. For example, users of drugs other than cannabis (and perhaps heavy, daily cannabis-only users) may need referral to specialty services for further assessment. Enhancement of motivation and self-efficacy beliefs could be an important target of prevention and treatment for cannabis-only users screened in the ED. PMID:27689138

  20. Effect of Bariatric Surgery on Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Camargo, Carlos A; Brown, David F M; Hasegawa, Kohei

    2017-09-15

    Atrial fibrillation (AF) and obesity are major health problems in the United States. However, little is known about whether bariatric surgery affects AF-related morbidities. This study investigated whether bariatric surgery is associated with short-term and long-term changes in the risk of emergency department (ED) visits or hospitalizations for AF. We performed a self-controlled case series study of obese adults with AF who underwent bariatric surgery by using population-based ED and inpatient databases in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or hospitalization for AF. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using presurgery months 13 to 24 as a reference period. Our sample consisted of 523 obese adults with AF who underwent bariatric surgery. The median age was 57 years (interquartile range 48 to 64 years), 59% were female, and 84% were non-Hispanic white. During the reference period, 15.9% (95% confidence interval [CI] 12.7% to 19.0%) of patients had an ED visit or hospitalization for AF. The risk remained similar in the subsequent 12-month presurgery period (adjusted OR [aOR] 1.29 [95% CI, 0.94 to 1.76] p = 0.11). In contrast, the risk significantly increased within 12 months after bariatric surgery (aOR 1.53 [95% CI 1.13 to 2.07] p = 0.006). The risk remained elevated during 13-24 months after bariatric surgery (aOR 1.41 [95% CI, 1.03 to 1.91] p = 0.03). In conclusion, this population-based study demonstrated that bariatric surgery was associated with an increased risk of AF episodes requiring an ED visit or hospitalization for at least 2 years after surgery among obese patients with AF. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy.

    Science.gov (United States)

    Doran, Kelly M; McCormack, Ryan P; Johns, Eileen L; Carr, Brendan G; Smith, Silas W; Goldfrank, Lewis R; Lee, David C

    2016-04-01

    Hurricane Sandy struck New York City on October 29, 2012, causing not only a large amount of physical damage, but also straining people's health and disrupting health care services throughout the city. In prior research, we determined that emergency department (ED) visits from the most vulnerable hurricane evacuation flood zones in New York City increased after Hurricane Sandy for several medical diagnoses, but also for the diagnosis of homelessness. In the current study, we aimed to further explore this increase in ED visits for homelessness after Hurricane Sandy's landfall. We performed an observational before-and-after study using an all-payer claims database of ED visits in New York City to compare the demographic characteristics, insurance status, geographic distribution, and health conditions of ED patients with a primary or secondary ICD-9 diagnosis of homelessness or inadequate housing in the first week after Hurricane Sandy's landfall versus the baseline weekly average in 2012 prior to Hurricane Sandy. We found statistically significant increases in ED visits for diagnosis codes of homelessness or inadequate housing in the week after Hurricane Sandy's landfall. Those accessing the ED for homelessness or inadequate housing were more often elderly and insured by Medicare after versus before the hurricane. Secondary diagnoses among those with a primary ED diagnosis of homelessness or inadequate housing also differed after versus before Hurricane Sandy. These observed differences in the demographic, insurance, and co-existing diagnosis profiles of those with an ED diagnosis of homelessness or inadequate housing before and after Hurricane Sandy suggest that a new population cohort-potentially including those who had lost their homes as a result of storm damage-was accessing the ED for homelessness or other housing issues after the hurricane. Emergency departments may serve important public health and disaster response roles after a hurricane, particularly for

  2. Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.

    Science.gov (United States)

    Hankin, Abigail; Wei, Stanley; Foreman, Juron; Houry, Debra

    2014-08-01

    Homicide is the second leading cause of death among youth aged 15-24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18-24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3-5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses. Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly

  3. Screening for Violence Risk Factors Identifies Young Adults at Risk for Return Emergency Department Visit for Injury

    Directory of Open Access Journals (Sweden)

    Abigail Hankin

    2014-08-01

    Full Text Available Introduction: Homicide is the second leading cause of death among youth aged 15–24. Prior crosssectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. Methods: This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a aggression, b perceived likelihood of violence, c recent violent behavior, d peer behavior, e community exposure to violence, and f positive future outlook. At 12 months following the initial ED visit, the participants’ medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chisquare and logistic regression analyses. Results: Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants’ average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first

  4. Urban air pollution and meteorological factors affect emergency department visits of elderly patients with chronic obstructive pulmonary disease in Taiwan.

    Science.gov (United States)

    Ding, Pei-Hsiou; Wang, Gen-Shuh; Guo, Yue-Leon; Chang, Shuenn-Chin; Wan, Gwo-Hwa

    2017-05-01

    Both air pollution and meteorological factors in metropolitan areas increased emergency department (ED) visits from people with chronic obstructive pulmonary disease (COPD). Few studies investigated the associations between air pollution, meteorological factors, and COPD-related health disorders in Asian countries. This study aimed to investigate the relationship between the environmental factors and COPD-associated ED visits of susceptible elderly population in the largest Taiwanese metropolitan area (Taipei area, including Taipei city and New Taipei city) between 2000 and 2013. Data of air pollutant concentrations (PM10, PM2.5, O3, SO2, NO2 and CO), meteorological factors (daily temperature, relative humidity and air pressure), and daily COPD-associated ED visits were collected from Taiwan Environmental Protection Administration air monitoring stations, Central Weather Bureau stations, and the Taiwan National Health Insurance database in Taipei area. We used a case-crossover study design and conditional logistic regression models with odds ratios (ORs), and 95% confidence intervals (CIs) for evaluating the associations between the environmental factors and COPD-associated ED visits. Analyses showed that PM2.5, O3, and SO2 had significantly greater lag effects (the lag was 4 days for PM2.5, and 5 days for O3 and SO2) on COPD-associated ED visits of the elderly population (65-79 years old). In warmer days, a significantly greater effect on elderly COPD-associated ED visits was estimated for PM2.5 with coexistence of O3. Additionally, either O3 or SO2 combined with other air pollutants increased the risk of elderly COPD-associated ED visits in the days of high relative humidity and air pressure difference, respectively. This study showed that joint effect of urban air pollution and meteorological factors contributed to the COPD-associated ED visits of the susceptible elderly population in the largest metropolitan area in Taiwan. Government authorities should review

  5. Epidemiology of Injury-Related Emergency Department Visits in the US Among Youth with Autism Spectrum Disorder.

    Science.gov (United States)

    Kalb, Luther G; Vasa, Roma A; Ballard, Elizabeth D; Woods, Steven; Goldstein, Mitchell; Wilcox, Holly C

    2016-08-01

    Several reports suggest children with autism spectrum disorder (ASD) are more likely to be seen for injury-related ED visits; however, no nationally representative study has examined this question. Using data from the 2008 Nationwide Emergency Department Sample, over a quarter of all visits among those with ASD were related to injury. In the multivariate analyses, the odds of an injury-related visit was 54 % greater among those with ASD compared to youth with intellectual disability (ID), but 48 % less compared to youth without ID or ASD. Compared to all other pediatric injury-visits in the US, visits among children with ASD were more likely to be due to self-inflicted injury and poisoning and were more likely to result in hospitalization (all p < 0.001).

  6. Predictors of regional variations in hospitalizations following emergency department visits for atrial fibrillation.

    Science.gov (United States)

    Barrett, Tyler W; Self, Wesley H; Jenkins, Cathy A; Storrow, Alan B; Heavrin, Benjamin S; McNaughton, Candace D; Collins, Sean P; Goldberger, Jeffrey J

    2013-11-01

    The emergency department (ED) is often where atrial fibrillation (AF) is first detected and acutely treated and affected patients dispositioned. We used the Nationwide Emergency Department Sample to estimate the percentage of visits resulting in hospitalization and investigate associations between patient and hospital characteristics with hospitalization at the national and regional levels. We conducted a cross-sectional study of adults with AF listed as the primary ED diagnosis in the 2007 to 2009 Nationwide Emergency Department Sample. We performed multivariate logistic regression analyses investigating the associations between prespecified patient and hospital characteristics with hospitalization. From 2007 to 2009, there were 1,320,123 weighted ED visits for AF, with 69% hospitalized nationally. Mean regional hospitalization proportions were: Northeast (74%), Midwest (68%), South (74%), and West (57%). The highest odds ratios for predicting hospitalization were heart failure (3.85, 95% confidence interval [CI] 3.66 to 4.02), chronic obstructive pulmonary disease (2.47, 95% CI 2.34 to 2.61), and coronary artery disease (1.65, 95% CI 1.58 to 1.73). After adjusting for age, privately insured (0.77, 95% CI 0.73 to 0.81) and self-pay (0.77 95% CI 0.66 to 0.90) patients had lower odds compared with Medicare recipients, whereas Medicaid (1.21, 95% CI 1.11 to 1.32) patients tended to have higher odds. Patients living in low-income zip codes (1.18, 95% CI 1.12 to 1.25) and patients treated at large metropolitan hospitals (1.75, 95% CI 1.59 to 1.93) had higher odds. In conclusion, our analysis showed considerable regional variation in the management of patients with AF in the ED and in associations between patient socioeconomic and hospital characteristics with ED disposition; adapting best practices from among these variations in management could reduce hospitalizations and health-care expenses. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?

    Science.gov (United States)

    Salvi, Fabio; Rossi, Lorena; Lattanzio, Fabrizia; Cherubini, Antonio

    2017-03-01

    This study aimed at verifying the role of polypharmacy as an independent risk factor for adverse health outcomes in older emergency department (ED) patients. This was a large (n = 2057) sample of older ED patients (≥65 years) participating in an observational cohort study. Polypharmacy and excessive polypharmacy were defined as having 6-9 drug prescriptions and 10 or more drug prescriptions in the last 3 months, respectively. The total number of medication prescriptions was also available. Outcome measures were in-hospital mortality; 30-day ED return; ED revisit, hospital admission, and mortality at 6 months. Logistic and Cox regression models as well as receiver operating characteristic curves using the Youden index and the area under the curve were calculated. Polypharmacy and excessive polypharmacy were present in 624 (30.3 %) and 367 (17.8 %) subjects, respectively. The mean number of prescriptions in the last 3 months was 5.7 (range 0-25) drugs. Polypharmacy and, particularly, excessive polypharmacy were constantly and independently associated with worse outcomes. A cut-off of 6 had the highest value of the Youden Index in predicting the majority of the adverse outcomes considered. Polypharmacy and excessive polypharmacy are independent risk factors for adverse health outcomes after an ED visit. Further studies are needed to clarify whether drug related issues (such as non-compliance, inappropriate or suboptimal prescribing, adverse drug reactions, and drug-drug or drug-disease interactions) or underlying multimorbidity and disease severity, as well as clinical complexity and frailty, are responsible for the negative outcomes associated with polypharmacy.

  8. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

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    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  9. Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation.

    Science.gov (United States)

    Hawkins, Summer Sherburne; Hristakeva, Sylvia; Gottlieb, Mark; Baum, Christopher F

    2016-08-01

    Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N=128,807), ear infections (N=288,697), and respiratory infections (N=410,686) using outpatient ED visit data in Massachusetts (2001-2010), New Hampshire (2001-2009), and Vermont (2002-2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10-17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6-9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections.

  10. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study

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    Gestro, Massimo; Condemi, Vincenzo; Bardi, Luisella; Fantino, Claudio; Solimene, Umberto

    2017-05-01

    Abstract Otitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P urban environments.

  11. Do emergency physicians attribute drug-related emergency department visits to medication-related problems?

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    Hohl, Corinne M; Zed, Peter J; Brubacher, Jeffrey R; Abu-Laban, Riyad B; Loewen, Peter S; Purssell, Roy A

    2010-06-01

    Adverse drug events represent the most common cause of preventable nonsurgical adverse events in medicine but may remain undetected. Our objective is to determine the proportion of drug-related visits emergency physicians attribute to medication-related problems. This prospective observational study enrolled adults presenting to a tertiary care emergency department (ED) during 12 weeks. Drug-related visits were defined as ED visits caused by adverse drug events. The definition of adverse drug event was varied to examine both narrow and broad adverse drug event classification systems. Clinical pharmacists evaluated all patients for drug-related visits, using standardized assessment algorithms, and then followed patients until hospital discharge. Interrater agreement for the clinical pharmacist diagnosis of drug-related visit was assessed. Emergency physicians, blinded to the clinical pharmacist opinion, were interviewed at the end of each shift to determine whether they attributed the visit to a medication-related problem. An independent committee reviewed and adjudicated all cases in which the emergency physicians' and clinical pharmacists' assessments were discordant, or either the emergency physician or clinical pharmacist was uncertain. The primary outcome was the proportion of drug-related visits attributed to a medication-related problem by emergency physicians. Nine hundred forty-four patients were enrolled, of whom 44 patients received a diagnosis of the narrowest definition of an adverse drug event, an adverse drug reaction (4.7%; 95% confidence interval [CI] 3.5% to 6.2%). Twenty-seven of these were categorized as medication-related by emergency physicians (61.4%; 95% CI 46.5% to 74.3%), 10 were categorized as uncertain (22.7%; 95% CI 12.9% to 37.1%), and 7 categorized as a non-medication-related problem (15.9%; 95% CI 8.0% to 29.5%). Seventy-eight patients (8.3%; 95% CI 6.7% to 10.2%) received a diagnosis of an adverse drug event caused by an adverse drug

  12. Male Patient Visits to the Emergency Department Decline During the Play of Major Sporting Events

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    Jerrard, David A

    2009-05-01

    Full Text Available OBJECTIVES: To study whether emergency department (ED visits by male patients wane simultaneously with the play of scheduled professional and college sports events.METHODS: Retrospective cohort analysis looked at ED male patient registration rates during a time block lasting from two hours before, during, and two hours after the play of professional football games (Monday night, Sundays, post-season play, major league baseball, and a Division I college football and basketball team, respectively. These registration rates were compared to rates at similar times on similar days of the week during the year devoid of a major sporting contest. Games were assumed to have a play time of three hours. Data was collected from April 2000 through March 2003 at an urban academic ED seeing 33,000 male patients above the age of 18 years annually.RESULTS: A total of 782 games were identified and used for purposes of the study. Professional football game dates had a mean of 17.9 males (95% confidence interval [CI] 17.4-18.4 registering vs. 26.8 males (95% CI 25.9-27.6 on non-game days. A registration rate for major league baseball was 18.4 patients (95% CI 17.6-18.4. The mean for registration on comparable non-game days was 23.9 patients (95% CI 22.8-24.3. For the regional Division I college football team, the mean number of patients registering on game days and non-game days was 21.7 (95% CI 20.9-22.4 and 23.4 (95% CI 22.9-23.7, respectively. Division I college basketball play for game and non-game days had mean rates of registration of 14.5 (95% CI 13.9-15.1 and 15.5 (95% CI 15.1-15.9 patients, respectively. For all sports dates collectively, a comparison of two means yielded a mean of 18.2 patients (95% CI 17.4-18.8 registering during the study hours on game days vs. 23.3 patients (95% CI 22.0-23.7 on non-game days. The mean difference was 5.1 patients (95% CI 3.7 to 7.0 with p < .000074.CONCLUSION: Male patient visits to the ED decline during major sporting

  13. [Public hospital emergency department visits due to burns in Brazil, 2009].

    Science.gov (United States)

    Gawryszewski, Vilma Pinheiro; Bernal, Regina Tomie Ivata; Silva, Nilza Nunes da; Morais Neto, Otaliba Libânio de; Silva, Marta Maria Alves da; Mascarenhas, Márcio Dênis Medeiros; Sá, Naíza Nayla Bandeira de; Monteiro, Rosane Aparecida; Malta, Deborah Carvalho

    2012-04-01

    The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers.

  14. Emergency Department Visits Related to Schizophrenia Among Adults Aged 18-64: United States, 2009-2011.

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    Albert, Michael; McCaig, Linda F

    2015-09-01

    ED care is important for the treatment of acute presentations of schizophrenia and may serve as a safety net for schizophrenic patients not otherwise receiving care (4,5). This analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data indicates that during 2009-2011, an average of 382,000 ED visits related to schizophrenia occurred each year among adults aged 18-64, corresponding to an overall visit rate of 20.1 per 10,000 adults. A visit having a first-, second-, or third-listed diagnosis of schizophrenia (i.e., whether the visit was directly or indirectly related to schizophrenia) was included in the analysis to provide a broader description of ED use by these patients. The distribution of the primary diagnosis of visits related to schizophrenia was: schizophrenia (58.8%), another mental disorder (15.4%), and a nonmental health disorder (25.7%) (data not shown). Among adults aged 18-64, the rate for ED visits related to schizophrenia was about twice as high for men as for women. Public insurance (Medicaid, Medicare, or dual Medicare and Medicaid) was more frequently the primary expected source of payment for ED visits related to schizophrenia compared with ED visits not related to schizophrenia. ED visits related to schizophrenia were more frequently made by patients who were homeless compared with ED visits not related to schizophrenia. About one-third of ED visits related to schizophrenia resulted in a hospital admission, and another 16.7% resulted in a transfer to a psychiatric hospital--both higher than the percentages for ED visits not related to schizophrenia. One of the goals of Healthy People 2020 is to improve mental health through prevention and by ensuring access to appropriate, quality mental health services (6). National data on the rates and characteristics of ED visits related to schizophrenia will help policymakers and practitioners address disparities and meet this goal.

  15. Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005–2013

    Science.gov (United States)

    Lee, Sangil; Herrin, Jeph; Bobo, William V.; Johnson, Ryan; Sangaralingham, Lindsey R.; Campbell, Ronna L.

    2017-01-01

    Introduction Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States. Methods We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationally representative database containing administrative claims data on privately insured and Medicare Advantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSA between 2005 and 2013 who were discharged home. Study inclusion required continuous insurance enrollment for the 12 months preceding and the 31 days following the index ED visit. During the study period we included only the first ED visit for each patient. Results A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 days following discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increased age (age 65+ vs. age return visits within 30 days following discharge. Conclusion In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED or hospital within 30 days. This study identified a number of factors associated with return visits for acute care. PMID:28874941

  16. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

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    Schaffer Andrea

    2012-01-01

    Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

  17. Lunar Phases and Emergency Department Visits for Renal Colic Due to Ureteral Calculus.

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    Andy W Yang

    Full Text Available Urolithiasis affects an estimated 5% of the population and the lifetime risk of passing a stone in the urinary tract is estimated to be 8-10%. Urinary calculus formation is highly variable and while certain risk factors such as age, gender, seasonality, anatomic abnormality, and metabolic diseases have been identified, not much is known regarding the association of environmental factors such as lunar phases on renal colic. We conducted a retrospective study to test the hypothesis that full moon phase is an environmental factor associated for increased emergency department (ED visits for renal colic due to ureteral calculus.We analyzed 559 renal colic diagnoses by the ED at the University of Nebraska Medical Center in a 24-month period and compared them with corresponding lunar phases as well as supermoon events. The lunar phases were defined as full moon ± two days, new moon ± two days, and the days in-between as normal days according to the lunar calendar. Supermoon event dates were obtained from NASA.90 cases (16.1% were diagnosed during full moon phase, 89 cases (15.9% were diagnosed during new moon phase, and 380 cases (68.0% were diagnosed during normal days. The incidence of renal colic showed no statistically significant association with lunar phases or supermoon events.In this retrospective longitudinal study with adequate power, neither full moon phase nor supermoon event exhibited an association with increased renal colic diagnoses due to ureteral calculus by the ED at the University of Nebraska Medical Center.

  18. Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis

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    Rowe Brian H

    2009-06-01

    Full Text Available Abstract Background Relatively few studies have been conducted of the association between air pollution and emergency department (ED visits, and most of these have been based on a small number of visits, for a limited number of health conditions and pollutants, and only daily measures of exposure and response. Methods A time-series analysis was conducted on nearly 400,000 ED visits to 14 hospitals in seven Canadian cities during the 1990s and early 2000s. Associations were examined between carbon monoxide (CO, nitrogen dioxide (NO2, ozone (O3, sulfur dioxide (SO2, and particulate matter (PM10 and PM2.5, and visits for angina/myocardial infarction, heart failure, dysrhythmia/conduction disturbance, asthma, chronic obstructive pulmonary disease (COPD, and respiratory infections. Daily and 3-hourly visit counts were modeled as quasi-Poisson and analyses controlled for effects of temporal cycles, weather, day of week and holidays. Results 24-hour average concentrations of CO and NO2 lag 0 days exhibited the most consistent associations with cardiac conditions (2.1% (95% CI, 0.0–4.2% and 2.6% (95% CI, 0.2–5.0% increase in visits for myocardial infarction/angina per 0.7 ppm CO and 18.4 ppb NO2 respectively; 3.8% (95% CI, 0.7–6.9% and 4.7% (95% CI, 1.2–8.4% increase in visits for heart failure. Ozone (lag 2 days was most consistently associated with respiratory visits (3.2% (95% CI, 0.3–6.2%, and 3.7% (95% CI, -0.5–7.9% increases in asthma and COPD visits respectively per 18.4 ppb. Associations tended to be of greater magnitude during the warm season (April – September. In particular, the associations of PM10 and PM2.5with asthma visits were respectively nearly three- and over fourfold larger vs. all year analyses (14.4% increase in visits, 95% CI, 0.2–30.7, per 20.6 μg/m3 PM10 and 7.6% increase in visits, 95% CI, 5.1–10.1, per 8.2 μg/m3 PM2.5. No consistent associations were observed between three hour average pollutant

  19. Predicting return visits to the emergency department for pediatric patients: Applying supervised learning techniques to the Taiwan National Health Insurance Research Database.

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    Hu, Ya-Han; Tai, Chun-Tien; Chen, Solomon Chih-Cheng; Lee, Hai-Wei; Sung, Sheng-Feng

    2017-06-01

    Return visits (RVs) to the emergency department (ED) consume medical resources and may represent a patient safety issue. The occurrence of unexpected RVs is considered a performance indicator for ED care quality. Because children are susceptible to medical errors and utilize considerable ED resources, knowing the factors that affect RVs in pediatric patients helps improve the quality of pediatric emergency care. We collected data on visits made by patients aged ≤18years to EDs from the National Health Insurance Research Database. The outcome of interest was a RV within 3days of the initial visit. Potential factors were categorized into demographics, medical history, features of ED visits, physician characteristics, hospital characteristics, and treatment-seeking behavior. A multivariate logistic regression was used to identify independent predictors of RVs. We compared the performance of various data mining techniques, including Naïve Bayes, classification and regression tree (CART), random forest, and logistic regression, in predicting RVs. Finally, we developed a decision tree to stratify the risk of RVs. Of 125,940 visits, 6,282 (5.0%) were followed by a RV within 3 days. Predictors of RVs included younger age, higher acuity, intravenous fluid, more examination types, complete blood count, consultation, lower hospital level, hospitalization within one week before the initial visit, frequent ED visits in the past one year, and visits made in Spring or on Saturdays. Patients with allergic diseases and those underwent ultrasound examination were less likely to return. Decision tree models performed better in predicting RVs in terms of area under curve. The decision tree constructed using the CART technique showed that the number of ED visits in the past one year, diagnosis category, testing of complete blood count, and age were important discriminators of risk of RVs. We identified several factors which are associated with RVs to the ED in pediatric patients

  20. Feasibility of Non-Mydriatic Ocular Fundus Photography in the Emergency Department: Phase I of the FOTO-ED Study

    Science.gov (United States)

    Bruce, Beau B.; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L.; Newman, Nancy J.; Wright, David W.

    2011-01-01

    Objectives Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by non-ophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of non-mydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Methods Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mmHg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a non-mydriatic fundus camera. Photographs were reviewed by a neuro-ophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of non-mydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. Results Three hundred fifty patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient’s total ED visit. Conclusions Non-mydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by non-physician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. PMID:21906202

  1. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study.

    Science.gov (United States)

    Bruce, Beau B; Lamirel, Cédric; Biousse, Valérie; Ward, Antionette; Heilpern, Katherine L; Newman, Nancy J; Wright, David W

    2011-09-01

    Examination of the ocular fundus is imperative in many acute medical and neurologic conditions, but direct ophthalmoscopy by nonophthalmologists is underutilized, poorly performed, and difficult without pharmacologic pupillary dilation. The objective was to examine the feasibility of nonmydriatic fundus photography as a clinical alternative to direct ophthalmoscopy by emergency physicians (EPs). Adult patients presenting to the emergency department (ED) with headache, acute focal neurologic deficit, diastolic blood pressure ≥ 120 mm Hg, or acute visual change had ocular fundus photographs taken by nurse practitioners using a nonmydriatic fundus camera. Photographs were reviewed by a neuroophthalmologist within 24 hours for findings relevant to acute ED patient care. Nurse practitioners and patients rated ease, comfort, and speed of nonmydriatic fundus photography on a 10-point Likert scale (10 best). Timing of visit and photography were recorded by automated electronic systems. A total of 350 patients were enrolled. There were 1,734 photographs taken during 230 nurse practitioner shifts. Eighty-three percent of the 350 patients had at least one eye with a high-quality photograph, while only 3% of patients had no photographs of diagnostic value. Mean ratings were ≥ 8.7 (standard deviation [SD] ≤ 1.9) for all measures. The median photography session lasted 1.9 minutes (interquartile range [IQR] = 1.3 to 2.9 minutes), typically accounting for less that 0.5% of the patient's total ED visit. Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well-received by staff and patients, and requires a trivial amount of time to perform. © 2011 by the Society for Academic Emergency Medicine.

  2. An Analysis of US Emergency Department Visits From Falls From Skiing, Snowboarding, Skateboarding, Roller-Skating, and Using Nonmotorized Scooters.

    Science.gov (United States)

    Nathanson, Brian H; Ribeiro, Kara; Henneman, Philip L

    2016-07-01

    We analyzed the US incidence of emergency department (ED) visits and hospitalizations for falls from skiing, snowboarding, skateboarding, roller-skating, and nonmotorized scooters in 2011. The outcome was hospital admission from the ED. The primary analysis compared pediatric patients aged 1 to 17 years to adults aged 18 to 44 years. The analysis used ICD-9 E-codes E885.0 to E885.4 using discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Approximately 214 000 ED visits met study criteria. Skiing injuries had the highest percentage of hospitalizations (3.30% in pediatric patients and 6.65% in adults 18-44 years old). Skateboard and snowboard injuries were more likely to require hospitalization than roller skating injuries in pediatric patients (odds ratio = 2.42; 95% CI = 2.14-2.75 and odds ratio = 1.83; 95% CI =1.55-2.15, respectively). In contrast, skateboard and snowboard injuries were less severe than roller-skating injuries in adults.

  3. The Impact on Emergency Department Visits for Respiratory Illness During the Southern California Wildfires

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    Paul B. Dohrenwend

    2013-03-01

    Full Text Available Introduction: In 2007 wildfires ravaged Southern California resulting in the largest evacuationdue to a wildfire in American history. We report how these wildfires affected emergencydepartment (ED visits for respiratory illness.Methods: We extracted data from a Kaiser Permanente database for a single metropolitancommunity ED. We compared the number of visits due to respiratory illness at t ime intervalsof 2 weeks before and during the time when the fires were burnin g. We counted the totalnumber of patients with chief complaint of dyspnea, cough, and asthma and final internationalclassification of disease 9 coding diagnosis of asthma, bronchitis, chronic obstructivepulmonary disease and respiratory syndrome, and analyzed data for both total number andproportion of ED visits. We evaluated the data using Early Aberration Reporting Systemsoftware to determine significant single-visit increases compared to expected counts. We alsoanalyzed the average length of ED stay. Data on air quality were extracted from the http://www.airnow.gov site.Results: There were significant differences between pre-fire and fire period average visit countsfor the chief complaints of dyspnea and asthma. Dypnea complaints increased by 3.2 visits perday. During the fire the diagnoses of asthma increased significantly by 2.6 patients per day. Airquality reached air quality index values of 300, indicating very unhealthy conditions. Average EDlength of stay times remained unchanged during the fire period compared to the pre-fire period.Conclusion: The 2007 Southern California wildfires caused significant surges in the volume ofED patients seeking treatment for respiratory illness. Disaster plans should prepare for thesesurges when future wildfires occur.

  4. Emergency Department Visits and Injury Hospitalizations for Female and Male Victims and Perpetrators of Intimate Partner Violence

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    Catherine L. Kothari

    2015-01-01

    Full Text Available Introduction. The potential for hospital-based interventions for male victims of intimate partner violence (IPV as well as adult perpetrators of both genders has been largely unexplored despite early evidence of acute-care utilization that may be as high as female victims. The current investigation compared the emergency department (ED and injury-related-hospitalization rates of IPV-involved individuals against standardized national norms, assessing differences by gender and victim/perpetrator-status. Methods. This cross-sectional study collected one-year ED and in-patient visit data from hospital records for individuals listed as victim or perpetrator in an IPV criminal charging request in a Midwestern county (N=2,937. Expected rates were calculated based upon age-adjusted national norms. Results. The IPV-involved population generated ED rates 4.1 times higher than expected and injury-related-hospitalization rates that were 4.0 times higher than expected. Bi-directionally-violent individuals (both victim and perpetrator in IPV charges consistently had the highest utilization rates (ED 8.4 RR, injury-hospitalization 22.5 RR. Victims, primarily female, had higher ED-visits than perpetrators, primarily male (victims = 4.6 RR, perpetrator = 3.1 RR. Perpetrators, though, had higher injury hospitalizations (victims = 0.8RR, perpetrators = 5.5 RR. Conclusions. Substantial opportunities exist within acute-care medical settings to intervene with IPV-involved women, men, victims, and perpetrators, although the magnitude of the opportunity varied by setting, gender and victim/perpetrator-status.

  5. Drinking water turbidity and emergency department visits for gastrointestinal illness in New York City, 2002-2009.

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    Jennifer L Hsieh

    Full Text Available Studies have examined whether there is a relationship between drinking water turbidity and gastrointestinal (GI illness indicators, and results have varied possibly due to differences in methods and study settings.As part of a water security improvement project we conducted a retrospective analysis of the relationship between drinking water turbidity and GI illness in New York City (NYC based on emergency department chief complaint syndromic data that are available in near-real-time.We used a Poisson time-series model to estimate the relationship of turbidity measured at distribution system and source water sites to diarrhea emergency department (ED visits in NYC during 2002-2009. The analysis assessed age groups and was stratified by season and adjusted for sub-seasonal temporal trends, year-to-year variation, ambient temperature, day-of-week, and holidays.Seasonal variation unrelated to turbidity dominated (~90% deviance the variation of daily diarrhea ED visits, with an additional 0.4% deviance explained with turbidity. Small yet significant multi-day lagged associations were found between NYC turbidity and diarrhea ED visits in the spring only, with approximately 5% excess risk per inter-quartile-range of NYC turbidity peaking at a 6 day lag. This association was strongest among those aged 0-4 years and was explained by the variation in source water turbidity.Integrated analysis of turbidity and syndromic surveillance data, as part of overall drinking water surveillance, may be useful for enhanced situational awareness of possible risk factors that can contribute to GI illness. Elucidating the causes of turbidity-GI illness associations including seasonal and regional variations would be necessary to further inform surveillance needs.

  6. Outdoor air pollution and emergency department visits for asthma among children and adults: A case-crossover study in northern Alberta, Canada

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    Rowe Brian H

    2007-12-01

    Full Text Available Abstract Background Recent studies have observed positive associations between outdoor air pollution and emergency department (ED visits for asthma. However, few have examined the possible confounding influence of aeroallergens, or reported findings among very young children. Methods A time stratified case-crossover design was used to examine 57,912 ED asthma visits among individuals two years of age and older in the census metropolitan area of Edmonton, Canada between April 1, 1992 and March 31, 2002. Daily air pollution levels for the entire region were estimated from three fixed-site monitoring stations. Similarly, daily levels of aeroallergens were estimated using rotational impaction sampling methods for the period between 1996 and 2002. Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression with adjustment for temperature, relative humidity and seasonal epidemics of viral related respiratory disease. Results Positive associations for asthma visits with outdoor air pollution levels were observed between April and September, but were absent during the remainder of the year. Effects were strongest among young children. Namely, an increase in the interquartile range of the 5-day average for NO2 and CO levels between April and September was associated with a 50% and 48% increase, respectively, in the number of ED visits among children 2 – 4 years of age (p Conclusion Our findings, taken together, suggest that exposure to ambient levels of air pollution is an important determinant of ED visits for asthma, particularly among young children and the elderly.

  7. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

    Science.gov (United States)

    Wang, Henry E; Jones, Allison R; Donnelly, John P

    2017-09-01

    The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. Analysis of data from the National Hospital Ambulatory Medical Care Survey. U.S. emergency department visits, 2009-2011. Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. None. We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated

  8. Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure.

    Science.gov (United States)

    Yam, Felix K; Lew, Tiffany; Eraly, Satish A; Lin, Hsiang-Wen; Hirsch, Jan D; Devor, Michelle

    2016-01-01

    Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit. To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC. This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits. A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911-1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001). Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do

  9. The effects of cocaine and heroin price on drug-related emergency department visits.

    Science.gov (United States)

    Dave, Dhaval

    2006-03-01

    This paper estimates the empirical relationship between cocaine and heroin prices and drug-related hospital ED admissions for 21 U.S. cities. These outcomes bypass some of the problems with self-reports and directly measure a component of healthcare costs associated with heavy drug usage. The price elasticity of the probability of a cocaine and heroin episode is estimated at -0.27 and -0.10, respectively. A 10% increase in prices can prevent 10,723 cocaine and heroin-related ED visits, with cost savings between 21 million dollars and 47 million dollars. These low magnitudes of the drug outcome-price response have implications for the cost-effectiveness of enforcement-driven price increases.

  10. Hospital emergency department visits for carbon monoxide poisoning following an October 2006 snowstorm in western New York.

    Science.gov (United States)

    Muscatiello, Neil A; Babcock, Gwen; Jones, Rena; Horn, Edward; Hwang, Syni-An

    2010-01-01

    Following an October 2006 snowstorm that caused widespread power outages in western New York State, hospital emergency department (ED) visits for carbon monoxide (CO) poisoning increased. Overall, 264 people representing 155 households were diagnosed with CO poisoning during the power outages. Telephone interviews were conducted with a subset of these individuals. Respondents provided information about exposure sources, CO alarms, and awareness of CO warnings. In many households, portable generators were operated in an enclosed area. Awareness of CO warnings may have contributed to knowledge about locating portable generators outside. When operated outside, however, portable generators were generally located too close to the home. Gas kitchen ranges were used for heat by numerous households. In the short term, CO education and improved clarity of CO warning information is important for increasing awareness about power outage-related CO risks. Improvements in the combustion efficiency of portable generators should be a long-term goal.

  11. A Rural-Urban Comparison in Emergency Department Visits for U.S. Children with Autism Spectrum Disorder

    Science.gov (United States)

    Zhang, Wanqing; Mason, Ashley E.; Boyd, Brian; Sikich, Linmarie; Baranek, Grace

    2017-01-01

    We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children…

  12. Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits

    Directory of Open Access Journals (Sweden)

    Chang CH

    2015-04-01

    Full Text Available Chih-Hao Chang,1 Kuo-Chien Tsao,2,3 Han-Chung Hu,1,4 Chung-Chi Huang,1,4 Kuo-Chin Kao,1,4 Ning-Hung Chen,1,4 Cheng-Ta Yang,1,4 Ying-Huang Tsai,4,5 Meng-Jer Hsieh4,51Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan; 2Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation; 3Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; 4Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan; 5Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, TaiwanBackground: Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED visits remains controversial.Methods: Viral culture and polymerase chain reaction (PCR were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC counts, serum C-reactive protein (CRP, procalcitonin (PCT, and clinical symptoms were compared among patients with different types of infections.Results: Viruses were isolated from 16 (22.2% of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7% patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9% had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria

  13. Hospitalization and emergency department visits among seniors receiving homecare: a pilot study

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    Abernathy Tom

    2005-07-01

    Full Text Available Abstract Background Despite the recent growth in home health services, data on clinical outcomes and acute health care utilization among older adults receiving homecare services are sparse. Obtaining such data is particularly relevant in Ontario where an increasing number of frail seniors receiving homecare are awaiting placement in long-term care facilities. In order to determine the feasibility of a large-scale study, we conducted a pilot study to assess utilization of acute health care services among seniors receiving homecare to determine associated clinical outcomes. Methods This prospective cohort study followed forty-seven seniors admitted to homecare by two homecare agencies in Hamilton, Ontario over a 12-month period. Demographic information and medical history were collected at baseline, and patients were followed until either termination of homecare services, death, or end of study. The primary outcome was hospitalization. Secondary outcomes included emergency department visits that did not result in hospitalization and death. Rates of hospitalization and emergency department visits without admission were calculated, and univariate analyses were performed to test for potential risk factors. Survival curves for accumulative rates of hospitalization and emergency department visits were created. Results 312 seniors were eligible for the study, of which 123 (39% agreed to participate initially. After communicating with the research nurse, of the 123 who agreed to participate initially, 47 (38% were enrolled in the study. Eleven seniors were hospitalized during 3,660 days of follow-up for a rate of 3.0 incident hospitalizations per 1,000 homecare-days. Eleven seniors had emergency department visits that did not result in hospitalization, for a rate of 3.3 incident emergency department visits per 1,000 homecare-days. There were no factors significantly associated with hospitalization or emergency department visits when adjustment was made

  14. National targets, process transformation and local consequences in an NHS emergency department (ED): a qualitative study.

    Science.gov (United States)

    Vezyridis, Paraskevas; Timmons, Stephen

    2014-06-13

    In the attempt to reduce waiting times in emergency departments, various national health services have used benchmarking and the optimisation of patient flows. The aim of this study was to examine staff attitudes and experience of providing emergency care following the introduction of a 4 hour wait target, focusing on clinical, organisational and spatial issues. A qualitative research design was used and semi-structured interviews were conducted with 28 clinical, managerial and administrative staff members working in an inner-city emergency department. A thematic analysis method was employed and NVivo 8 qualitative data analysis software was used to code and manage the emerging themes. The wait target came to regulate the individual and collective timescales of healthcare work. It has compartmentalised the previous unitary network of emergency department clinicians and their workspace. It has also speeded up clinical performance and patient throughput. It has disturbed professional hierarchies and facilitated the development of new professional roles. A new clinical information system complemented these reconfigurations by supporting advanced patient tracking, better awareness of time, and continuous, real-time management of emergency department staff. The interviewees had concerns that this target-oriented way of working forces them to have a less personal relationship with their patients. The imposition of a wait-target in response to a perceived "crisis" of patients' dissatisfaction led to the development of a new and sophisticated way of working in the emergency department, but with deep and unintended consequences. We show that there is a dynamic interrelation of the social and the technical in the complex environment of the ED. While the 4 hour wait target raised the profile of the emergency department in the hospital, the added pressure on clinicians has caused some concerns over the future of their relationships with their patients and colleagues. To

  15. Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths - United States, 2010.

    Science.gov (United States)

    Jones, Christopher M; Paulozzi, Leonard J; Mack, Karin A

    2014-10-10

    The abuse of prescription drugs has led to a significant increase in emergency department (ED) visits and drug-related deaths over the past decade. Opioid pain relievers (OPRs) and benzodiazepines are the prescription drugs most commonly involved in these events. Excessive alcohol consumption also accounts for a significant health burden and is common among groups that report high rates of prescription drug abuse. When taken with OPRs or benzodiazepines, alcohol increases central nervous system depression and the risk for overdose. Data describing alcohol involvement in OPR or benzodiazepine abuse are limited. To quantify alcohol involvement in OPR and benzodiazepine abuse and drug-related deaths and to inform prevention efforts, the Food and Drug Administration (FDA) and CDC analyzed 2010 data for drug abuse-related ED visits in the United States and drug-related deaths that involved OPRs and alcohol or benzodiazepines and alcohol in 13 states. The analyses showed alcohol was involved in 18.5% of OPR and 27.2% of benzodiazepine drug abuse-related ED visits and 22.1% of OPR and 21.4% of benzodiazepine drug-related deaths. These findings indicate that alcohol plays a significant role in OPR and benzodiazepine abuse. Interventions to reduce the abuse of alcohol and these drugs alone and in combination are needed.

  16. A randomized study of electronic mail versus telephone follow-up after emergency department visit.

    Science.gov (United States)

    Ezenkwele, Ugo A; Sites, Frank D; Shofer, Frances S; Pritchett, Ellen N; Hollander, Judd E

    2003-02-01

    This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. Secondary outcome was the median time of response. There were 1561 patients initially screened. Of these, 444 had e-mail and were included in the study. Half were contacted by telephone and the rest via e-mail. Our telephone contact rate was 58% (129/222) after two calls in a 48-h period and our e-mail contact was 41% (90/222). The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.

  17. Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: a case-crossover study

    OpenAIRE

    Xiao, Qingyang; Liu, Yang; Mulholland, James A.; Russell, Armistead G.; Darrow, Lyndsey A.; Tolbert, Paige E.; Strickland, Matthew J.

    2016-01-01

    Background Estimating the health effects of ambient air pollutant mixtures is necessary to understand the risk of real-life air pollution exposures. Methods Pediatric Emergency Department (ED) visit records for asthma or wheeze (n = 148,256), bronchitis (n = 84,597), pneumonia (n = 90,063), otitis media (n = 422,268) and upper respiratory tract infection (URI) (n = 744,942) were obtained from Georgia hospitals during 2002–2008. Spatially-contiguous daily concentrations of 11 ambient air pollu...

  18. A Comparison of Medical and Psychobehavioral Emergency Department Visits Made by Adults with Intellectual Disabilities

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    Yona Lunsky

    2012-01-01

    Full Text Available Study Objective. We describe and contrast medical to psychobehavioral emergency visits made by a cohort of adults with intellectual disabilities. Methods. This was a study of 221 patients with intellectual disabilities who visited the emergency department because of a psychobehavioral or medical emergency. Patient profiles are described and logistic regression was used to assess predictors of psychobehavioral emergencies in this group, including age, residence, psychiatric diagnosis, cognitive level, and life events. Results. Ninety-eight individuals had medical emergencies and 123 individuals presented with psychobehavioral emergencies. The most common medical issue was injury and the most common psychobehavioral issue was aggression. In the multivariate analysis, life events (odds ratio (OR 0.28; 95% confidence interval (CI 0.10 to 0.75, psychiatric diagnosis (OR 2.35; 95% CI 1.12 to 4.95, and age group (OR 4.97; 95% CI 1.28 to 19.38 were associated with psychobehavioral emergencies. Psychobehavioral emergencies were more likely to result in admission and caregivers reported lower rates of satisfaction with these visits. Conclusion. Emergency departments would benefit from greater understanding of the different types of presentations made by adults with intellectual disabilities, given the unique presentations and outcomes associated with them.

  19. Effect of Language Barriers on Follow-up Appointments After an Emergency Department Visit

    Science.gov (United States)

    Sarver, Joshua; Baker, David W

    2000-01-01

    OBJECTIVE To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment. DESIGN Cohort study. SETTING Public hospital emergency department. PARTICIPANTS English- and Spanish-speaking patients (N =714) presenting with nonemergent medical problems. MEASUREMENTS AND MAIN RESULTS Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P =.05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P =.78). CONCLUSIONS Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments. PMID:10760001

  20. 78 FR 71591 - Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and...

    Science.gov (United States)

    2013-11-29

    ... Privacy Act of 1974; Computer Matching Program between the U.S. Department of Education (ED) and the U.S.... SUPPLEMENTARY INFORMATION: Pursuant to the Privacy Act of 1974, as amended (Privacy Act) (5 U.S.C. 552a), the..., the Computer Matching and Privacy Protection Act of 1988, 54 FR 25818 (June 19, 1989), and...

  1. Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease.

    Science.gov (United States)

    Inoue, Susumu; Khan, Isra'a; Mushtaq, Rao; Sanikommu, Srinivasa Reddy; Mbeumo, Carline; LaChance, Jenny; Roebuck, Michael

    2016-01-01

    Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED's timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007-2008, (2) years 2011-2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study

  2. Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED?

    Science.gov (United States)

    Pines, Jesse M; Bernstein, Steven L

    2015-01-01

    ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.

  3. Patient Safety and Satisfaction Drivers in Emergency Departments Re-visited - An Empirical Analysis using Structural Equation Modeling

    DEFF Research Database (Denmark)

    Sørup, Christian Michel; Jacobsen, Peter

    2014-01-01

    How can emergency department (ED) decision makers contribute to increase patient satisfaction rates? This question has been thoroughly investigated in many hospital departments but not so much in the ED, which has led to a number of untested hypotheses. Maximising value-added activities seen from...... a patient’s perspective has become an essential outcome in health care, meaning that the untested hypotheses are in need of quantitative testing. This study proposes an integrated framework in which four latent constructs reflecting principal aspects of patient care are tested. The four constructs...... are entitled safety and satisfaction, waiting time, information delivery, and infrastructure accordingly. As an empirical foundation, a recently published comprehensive survey in 11 Danish EDs is analysed in depth using structural equation modeling (SEM). Consulting the proposed framework, ED decision makers...

  4. Acute effects of outdoor air pollution on emergency department visits due to five clinical subtypes of coronary heart diseases in shanghai, china.

    Science.gov (United States)

    Xie, Juan; He, Mingzhen; Zhu, Weiying

    2014-01-01

    Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD. We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter emergency department (ED) visits due to five different subtypes of CHD in Shanghai, China, from 2010 to 2012. We applied an over-dispersed Poisson generalized addictive model to analyze the associations after controlling for the seasonality, day of the week, and weather conditions. We identified a total of 47 523 ED visits for CHD. A 10-µg/m(3) increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%-1.87%), 0.90% (95% CI -0.14%-1.93%), and 1.44% (95% CI 0.63%-2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. The associations were stronger among people aged 65 years or more than in younger individuals and in the cool season versus the warm one. Outdoor air pollution may have different effects of air pollution on 5 subtypes of CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution.

  5. A Rural-Urban Comparison in Emergency Department Visits for U.S. Children with Autism Spectrum Disorder.

    Science.gov (United States)

    Zhang, Wanqing; Mason, Ashley E; Boyd, Brian; Sikich, Linmarie; Baranek, Grace

    2017-03-01

    We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children with ASD in rural areas were economically disadvantaged and concentrated in the South and Midwest regions. Rural children diagnosed with ASD and multiple comorbidities during emergency department visits were 1.6 times as that of urban children. Rural children with ASD, particularly those with multiple comorbidities, require more emergency department services when compared with urban children with ASD.

  6. Characteristics of patients and families who make early return visits to the pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Logue EP

    2013-06-01

    Full Text Available Erin Patricia Logue,1 Samina Ali,2,3 Judith Spiers,4 Amanda S Newton,2,3 Janice A Lander4 1 Alberta Health Services, 2Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3Women and Children’s Health Research Institute, 4Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Objectives: The primary objective of this study was to identify reasons why parents make early return visits, within 72 hours of discharge from a tertiary care pediatric emergency department (PED. A secondary objective was to investigate associated demographic and diagnostic variables. Methods: A survey was conducted with a convenience sample of parents of children returning to the PED within 72 hours of discharge. A chart review was also completed for consented survey participants. Recruitment occurred from September 2005 to August 2006 at the Stollery Children's Hospital, Edmonton, Alberta, Canada. Results: A total of 264 parents were approached to participate. Overall, 231 surveys were returned and 212 (92% charts were reviewed. The overall rate of early return during the study period was 5.4%. More than half of parents stated that they returned because their child's condition worsened and many parents (66.7% reported feeling stressed. Patients were typically under 6 years of age (67.4%, and most frequently diagnosed with infectious diseases (38.0%. Patients triaged with the Canadian Emergency Department Triage and Acuity Scale (CTAS as CTAS 2 (emergent for initial visits were more likely to be admitted on return, regardless of age (P < 0.001. Conclusion: Variables associated with early returns included young age, diagnosis, triage acuity, and parental stress. Future variable definition should include a deeper exploration of modifiable factors such as parental stress and patient education. These next steps may help direct interventions and resources to address needs in this group and possibly pre-empt the need to return

  7. U.S. trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001-2009.

    Science.gov (United States)

    Feng, Lisa B; Pines, Jesse M; Yusuf, Hussain R; Grosse, Scott D

    2013-10-01

    Using computed tomography (CT) to evaluate patients with chest symptoms is common in emergency departments (EDs). This article describes recent trends of CT use in U.S. EDs for patients presenting with symptoms common to acute pulmonary embolism (PE). The 2001-2009 National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of U.S. ED encounters, was used for data collection. Patients with at least one of three complaints (chest pain, dyspnea, or hemoptysis) were categorized into the chest symptom study (CSS) group. The yearly increases in CT use for the complaints were tabulated first, then linear regression analysis was used to calculate average rates of increases in CT use between 2001 and 2007, the years where CT use increased, for the overall population and among specific subgroups. The ratios of the number of visits when CT was ordered and there was a target diagnosis relative to the total number of visits with CT in the CSS group (diagnosis/CT ratio) were calculated for PE and pneumonia. Annual CT rates for the CSS group increased from 2.6% in 2001 to 13.2% in 2007, subsequently leveling off at approximately 12.5% in 2008 and 2009. The average growth rate of CT use for the CSS group was 28.1% (95% confidence interval [CI] = 20.9% to 35.7%) per year between 2001 and 2007. Testing rates for all subgroups increased. The lowest growth rate was among Hispanic patients, whose CT rates grew 14.2% (95% CI = 5.7% to 23.5%) per year. The highest growth rate was in nonurban hospitals, at 43.1% (95% CI = 15.2% to 77.8%) per year. Patients triaged as nonurgent received the fewest CTs, compared to those who should be seen in 2 hours or less. With regard to sources of payment, the self-pay subgroup experienced the highest rate of increase at 35.1% (95% CI = 18.6% to 53.9%). The PE diagnosis/CT ratio from 2002 to 2009 was 2.7% for the CSS group. The pneumonia diagnosis/CT ratio grew from 5.8% in 2002 to 2005 to 7.8% in 2006 to

  8. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seongnam (Korea, Republic of)

    2015-06-15

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  9. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Directory of Open Access Journals (Sweden)

    Brian R. Sharp

    2016-09-01

    Full Text Available Introduction: Nausea and vomiting in pregnancy (NVP is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods: We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results: There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6% had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06-1.61], high parity (OR 1.50 95% CI [1.12-2.00], and early gestational age (OR 0.74 95% CI [0.60-0.90] were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59-0.91] was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002. Conclusion: NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.

  10. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    Science.gov (United States)

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  11. 17 September 2013 - Polish Members of Parliament visiting the Tunnel at Point 2 with Senior Engineer, Technology Department A. Siemko and visiting the ALICE cavern with ALICE Collaboration, B. Erazmus

    CERN Multimedia

    Anna Pantelia

    2013-01-01

    17 September 2013 - Polish Members of Parliament visiting the Tunnel at Point 2 with Senior Engineer, Technology Department A. Siemko and visiting the ALICE cavern with ALICE Collaboration, B. Erazmus

  12. A rare cause of Emergency Department visit for melena: Gastric Mucormycoma mimicking Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Ivan Comelli

    2012-07-01

    Full Text Available “Mucormycosis” is an extremely rare infection typically occuring in individuals with impaired immunity. Gastrointestinal Mucormycosis is the rarest form, and shows the highest mortality rate (50-85%. The diagnosis mostly depends on histological examination. Although culture can identify the fungal species, it is positive in only 52% of autopsy cases and 30% of surgical specimens. No reliable serologic or skin tests are available as yet. We describe a rare case of gastric mucormycoma, presenting to the Emergency Department (ED for melena, and the potential pitfalls encountered during its evaluation and treatment. In our patient gastroscopy showed a large infiltrative and ulcerated mass located in gastric fundus and extended up to the gastro-esophageal junction. Hystology of bioptic specimens showed findings suggestive of gastric adenocarcinoma, leading the patient to surgery, consisting of total gastrectomy with esophagodigiunal and enteroenteric anastomosis. Our patient had no typical risk factor for Mucormycosis, and we suppose that the feeding by nasogastric tube, possibly through contamination by paranasal sinuses, could have caused the disseminated fungal strains, supported by a transient immunity derangement occurred during the ICU staying.

  13. Hospital Readmission Following Emergency Room Visit for Cholelithiasis

    Science.gov (United States)

    Williams, Taylor P.; Dimou, Francesca M.; Adhikari, Deepak; Kimbrough, Thomas D.; Riall, Taylor S.

    2015-01-01

    Background For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the Emergency Department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. Methods We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for two years from the date of initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from initial ED visit to ED readmission. Results Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. 12.6% of patients had an elective cholecystectomy in the two years after the initial visit. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 days and all elective cholecystectomies occurred within one month of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 days from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7 % of patients having two or more additional ED visits, and 12.9% required emergent/urgent cholecystectomy. 43.5% of additional ED visits occurred within one month and 60.9% within three months of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal Ultrasound (US) or Computed Tomography (CT) scan during the course of multiple visits. Conclusion

  14. Hospital readmission after emergency room visit for cholelithiasis.

    Science.gov (United States)

    Williams, Taylor P; Dimou, Francesca M; Adhikari, Deepak; Kimbrough, Thomas D; Riall, Taylor S

    2015-08-01

    For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for 2 y from the date of the initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from the initial ED visit to ED readmission. Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 d from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7% of patients having two or more additional ED visits, and 12.9% required emergent and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits. Failure to achieve a timely surgical follow-up leads to multiple

  15. Predictors of Emergency Department Utilization Among Children in Vulnerable Families.

    Science.gov (United States)

    Flood, Colin; Sheehan, Karen; Crandall, Marie

    2016-03-08

    Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits.

  16. The effect of ozone associated with summertime photochemical smog on the frequency of asthma visits to hospital emergency departments

    Energy Technology Data Exchange (ETDEWEB)

    Cody, R.P. (Robert Wood Johnson Medical School, Piscataway, NJ (United States)); Weisel, C.P.; Lioy, P.J. (Robert Wood Johnson Medical School, Piscataway, NJ (United States) Environmental and Occupational Health Sciences Institute, Piscataway, NJ (United States)); Birnbaum, G. (Morristown Memorial Hospital, NJ (United States))

    1992-08-01

    A retrospective study using ambient ozone, temperature, and other environmental variables and their effect on the frequency of hospital visits for asthma was conducted in New Jersey, an area that often exceeds the allowable national standard for ozone. Data on emergency department visits for asthma, bronchitis, and finger wounds (a nonrespiratory control) were analyzed for the period May through August for 1988 and 1989. Asthma visits were correlated with temperature while the correlation between asthma visits and ozone concentration was nonsignificant. However, when temperature was controlled for in a multiple regression analysis, a highly significant relationship between asthma visits and ozone concentration was identified. Between 13 and 15% of the variability of the asthma visits and ozone concentration was identified. Between 13 and 15% of the variability of the asthma visits was explained in the regression model by temperature and ambient ozone levels. This association, when compared to similar studies in Canada, shows the contribution of ozone to asthma admissions to be stronger in areas with higher ozone concentrations. Thus, among regions with periodic accumulations of ozone in the ambient atmosphere, an exposure-response relationship may be discernible. This supports the need to attain air quality standards for ozone to protect individuals in the general population from the adverse health effects caused by ambient ozone exposure. 21 refs., 1 fig., 6 tabs.

  17. Factors affecting communication in emergency departments: doctors and nurses' perceptions of communication in a trilingual ED in Hong Kong.

    Science.gov (United States)

    Pun, Jack K H; Matthiessen, Christian M I M; Murray, Kristen A; Slade, Diana

    2015-12-01

    This study investigates clinicians' views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians' engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in

  18. Reduction in hospitalisations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare programme.

    Science.gov (United States)

    Cerqueiro, J M; González-Franco, A; Montero-Pérez-Barquero, M; Llácer, P; Conde, A; Dávila, M F; Carrera, M; Serrado, A; Suárez, I; Pérez-Silvestre, J; Satué, J A; Arévalo-Lorido, J C; Rodríguez, A; Herrero, A; Jordana, R; Manzano, L

    2016-01-01

    Heart failure (HF) is a disease with high morbidity and mortality. We evaluated the usefulness of the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral para Pacientes con IC [UMIPIC]) programme. We analysed the patient data from the UMIPIC programme, which was recorded in the HF registry (RICA) of the Spanish Society of Internal Medicine. We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the programme against those that occurred during the subsequent follow-up year, using the chi-squared test. A total of 258 patients (mean age, 80years; 51.9% women) were included in the study. During the previous year, there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up (75% reduction, P<.001). There were 613 hospitalisations for HF during the previous year and 92 during the follow-up (85% reduction, P<.001); 655 vs. 302 in terms of emergency department visits for any cause (53.9% reduction, P<.001); and 440 vs. 120 for emergency department visits for HF (72% reduction, P<.001). There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF. The UMIPIC programme based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Rate, characteristics, and factors associated with high emergency department utilization

    NARCIS (Netherlands)

    M.C. van der Linden (M. Christien); C.L. van den Brand (Crispijn); N. van der Linden (Naomi); A.H. Rambach (Anna H.J.H.); C. Brumsen (Caro)

    2014-01-01

    textabstractBackground: Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent

  20. Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints

    Energy Technology Data Exchange (ETDEWEB)

    Atkinson, R.W.; Anderson, H.R.; Strachan, D.P.; Bland, J.M.; Bremner, S.A. [St. George`s Hospital Medical School, Dept. of Public Health Sciences, London (United Kingdom); Ponce de Leon, A. [IME/UERJ Rua Sao Francisco Xavier, Dept. de Estatistica, Maracana Rio de Janeiro (Brazil)

    1999-02-01

    Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A and E) departments in London for respiratory complaints. A and E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A and E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A poison regression allowing for seasonal patterns meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 {mu}m (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO{sub 2}: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 {mu}g{sup .}m{sup -3} increase (10th-90th percentile range) and a 3.0% (95% Cl 0.8-5.2) increase for a 31 {mu}g{sup .}m{sup -3} increase in PM10. There were also significant associations between visits for asthma and SO{sub 2}, NO{sub 2} and PM10. No significant associations between O{sub 3} and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints

  1. Short-term associations between outdoor air pollution and visits to accident and emergency departments in London for respiratory complaints

    Energy Technology Data Exchange (ETDEWEB)

    Atkinson, R.W.; Anderson, H.R.; Strachan, D.P.; Bland, J.M.; Bremner, S.A. [St. George' s Hospital Medical School, Dept. of Public Health Sciences, London (United Kingdom); Ponce de Loen, A. [IME/UERJ Rua Sao Francisco Xavier, Dept. de Estatistica, Maracana Rio de Janeiro , RJ (Brazil)

    1999-07-01

    Many epidemiological studies have shown positive short-term associations between health and current levels of outdoor air pollution. The aim of this study was to investigate the association between air pollution and the number of visits to accident and emergency (A and E) departments in London for respiratory complaints. A and E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A and E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 {mu}m (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO{sub 2}: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 {mu}g{sup .}m{sup -3} increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 {mu}g{sup .}m{sup -3} increase in PM10. There were also significant associations between visits for asthma and SO{sub 2}, NO{sub 2} and PM10. No significant associations between O{sub 3} and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of air pollution currently experineced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory

  2. Geographic information system analysis on the distribution of patients visiting the periodontology department at a dental college hospital.

    Science.gov (United States)

    Jeong, Byungjoon; Joo, Hyun-Tae; Shin, Hyun-Seung; Lim, Mi-Hwa; Park, Jung-Chul

    2016-06-01

    The aim of this study is to analyze and visualize the distribution of patients visiting the periodontology department at a dental college hospital, using a geographic information system (GIS) to utilize these data in patient care and treatment planning, which may help to assess the risk and prevent periodontal diseases. Basic patient information data were obtained from Dankook University Dental Hospital, including the unit number, gender, date of birth, and address, down to the dong (neighborhood) administrative district unit, of 306,656 patients who visited the hospital between 2007 and 2014. The data of only 26,457 patients who visited the periodontology department were included in this analysis. The patient distribution was visualized using GIS. Statistical analyses including multiple regression, logistic regression, and geographically weighted regression were performed using SAS 9.3 and ArcGIS 10.1. Five factors, namely proximity, accessibility, age, gender, and socioeconomic status, were investigated as the explanatory variables of the patient distribution. The visualized patient data showed a nationwide scale of the patient distribution. The mean distance from each patient's regional center to the hospital was 30.94±29.62 km and was inversely proportional to the number of patients from the respective regions. The distance from a regional center to the adjacent toll gate had various effects depending on the local distance from the hospital. The average age of the patients was 52.41±12.97 years. Further, a majority of regions showed a male dominance. Personal income had inconsistent results between analyses. The distribution of patients is significantly affected by the proximity, accessibility, age, gender and socioeconomic status of patients, and the patients visiting the periodontology department travelled farther distances than those visiting the other departments. The underlying reason for this needs to be analyzed further.

  3. Team Visitation Guidelines. Wisconsin Department of Public Instruction Secondary Vocational Program Evaluation Project.

    Science.gov (United States)

    Klitzke, Elizabeth; And Others

    The guidelines contained in this manual were written to outline the role of the visiting team members and the team leader and to familiarize the team with the details necessary to conduct a comprehensive external evaluation of Wisconsin secondary vocational programs. The responsibilities of school personnel are also spelled out so that team…

  4. Emergency Department Use among Adults with Autism Spectrum Disorders (ASD)

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha

    2016-01-01

    A cross-sectional analyses using Nationwide Emergency Department Sample (2006-2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22-64 years with and without ASD (matched 1:3). Around 0.4% ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to…

  5. Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis

    Science.gov (United States)

    Whittaker, William; Anselmi, Laura; Lau, Yiu-Shing; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Stokes, Jonathan

    2016-01-01

    Background Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators. Methods and Findings Throughout 2014, 56 primary care practices (346,024 patients) in Greater Manchester, England, offered 7-day extended access, compared with 469 primary care practices (2,596,330 patients) providing routine access. Extended access included evening and weekend opening and served both urgent and routine appointments. To assess the effects of extended primary care access on hospital services, we apply a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Propensity score matching techniques were used to match practices without extended access to practices with extended access. Differences in the change in “minor” patient-initiated emergency department visits per 1,000 population were compared between practices with and without extended access. Populations registered to primary care practices with extended access demonstrated a 26.4% relative reduction (compared to practices without extended access) in patient-initiated emergency department visits for “minor” problems (95% CI -38.6% to -14.2%, absolute difference: -10,933 per year, 95% CI -15,995 to -5,866), and a 26.6% (95% CI -39.2% to -14.1%) relative reduction in costs of patient-initiated visits to emergency departments for minor problems (absolute difference: -£767,976, -£1,130,767 to -£405,184). There was an insignificant

  6. "What do people do if they don't have insurance?": ED to ED Referrals.

    Science.gov (United States)

    Medford-Davis, Laura N; Prasad, Siddharth; Rhodes, Karin V

    2017-08-28

    Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits. This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached. 143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain. The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or

  7. The use of alternative pollutant metrics in time-series studies of ambient air pollution and respiratory emergency department visits.

    Science.gov (United States)

    Darrow, Lyndsey A; Klein, Mitchel; Sarnat, Jeremy A; Mulholland, James A; Strickland, Matthew J; Sarnat, Stefanie E; Russell, Armistead G; Tolbert, Paige E

    2011-01-01

    Various temporal metrics of daily pollution levels have been used to examine the relationships between air pollutants and acute health outcomes. However, daily metrics of the same pollutant have rarely been systematically compared within a study. In this analysis, we describe the variability of effect estimates attributable to the use of different temporal metrics of daily pollution levels. We obtained hourly measurements of ambient particulate matter (PM₂.₅), carbon monoxide (CO), nitrogen dioxide (NO₂), and ozone (O₃) from air monitoring networks in 20-county Atlanta for the time period 1993-2004. For each pollutant, we created (1) a daily 1-h maximum; (2) a 24-h average; (3) a commute average; (4) a daytime average; (5) a nighttime average; and (6) a daily 8-h maximum (only for O₃). Using Poisson generalized linear models, we examined associations between daily counts of respiratory emergency department visits and the previous day's pollutant metrics. Variability was greatest across O₃ metrics, with the 8-h maximum, 1-h maximum, and daytime metrics yielding strong positive associations and the nighttime O₃ metric yielding a negative association (likely reflecting confounding by air pollutants oxidized by O₃). With the exception of daytime metric, all of the CO and NO₂ metrics were positively associated with respiratory emergency department visits. Differences in observed associations with respiratory emergency room visits among temporal metrics of the same pollutant were influenced by the diurnal patterns of the pollutant, spatial representativeness of the metrics, and correlation between each metric and copollutant concentrations. Overall, the use of metrics based on the US National Ambient Air Quality Standards (for example, the use of a daily 8-h maximum O₃ as opposed to a 24-h average metric) was supported by this analysis. Comparative analysis of temporal metrics also provided insight into underlying relationships between specific air

  8. An Observational Study to Evaluate the Prevalence of Erectile Dysfunction (ED) and Prescribing Pattern of Drugs in Patients with ED Visiting an Andrology Specialty Clinic, Mumbai: 2012-14

    Science.gov (United States)

    Kulkarni, Vijay R.; Bhagat, Sagar B.; Beldar, Amit S.; Patel, Sadiq B.

    2015-01-01

    Introduction: Erectile dysfunction (ED) is a common occurrence and its incidence is expected to increase significantly along with the increase in various lifestyle diseases. The drug utilization for ED is very low. Also, studies describing the prescription pattern in ED are lacking. Materials and Methods: We conducted a retrospective cross-sectional observational study, including a drug utilization analysis, of 606 prescriptions as per the standard guidelines (WHO and STROBE). Results: Out of 606, 249 (41%) were from the age group of 30-39 years. Addictions were present in 388 (64%). Out of 606, 186 had urological, 154 had cardiovascular and 102 had psychological co-morbid disorders. Out of 348, 201 were prescribed Tadalafil (low dose) on a once daily basis. Out of 172, 121 were prescribed Sildenafil (high dose) on an ‘as and when required’ basis. Nutritional/ herbal supplements were prescribed in 126/606. The ratio of ‘Prescribed Daily Dose’ to ‘Defined Daily Dose’ of Tadalafil, Sildenafil, and Dapoxetine were 1.1, 1.3 and 1.5 respectively. Conclusion: Measures for de-addiction play an important role in the overall management of ED. The most common co-morbid disorders were urological, like BPH, LUTS, etc, followed by cardiovascular, psychological and diabetes. Overall, rational pharmacotherapy was observed. Tadalafil was the most commonly prescribed drug for ED. The main factor in the selection of a particular PDE5 inhibitor was its pharmacokinetics and cost. Udenafil, being the costliest, was the least prescribed. Dapoxetine was used in a significant number of individuals primarily for PE with ED. The combination of Papaverine, Chlorpromazine ± Alprostadil was used as intracavernosal injection in patients not responding to oral drugs. PMID:26393163

  9. Self Inflicted Injuries among Children in United States - estimates from a nationwide emergency department sample.

    Directory of Open Access Journals (Sweden)

    Naseem Sulyman

    Full Text Available OBJECTIVE: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. METHODS: The Nationwide Emergency Department Sample (year 2007 was used. All ED visits occurring among children (aged ≤18 years with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. RESULTS: 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females. The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females and 93 died in hospitals following in-patient admission (75 males and 18 females. A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%. A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%. 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. CONCLUSIONS: Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.

  10. 28 May 2010 - Japanese Ambassador H. Ueda visiting the LHC superconducting magnet test hall with CERN Technology Deputy Department Head L. Rossi.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    CERN-HI-1005088 02 Japanese Ambassador H. Ueda (right) visiting the LHC superconducting magnet test hall with Technology Deputy Department Head L. Rossi(left). H. Ueda is accompanied by KEK and ATLAS Collaboration T. Kondo (centre).

  11. 23rd June 2010 - University of Bristol Head of the Aerospace Engineering Department and Professor of Aerospace Dynamics N. Lieven visiting CERN control centre with Beams Department Head P. Collier, visiting the LHC superconducting magnet test hall with R. Veness and CMS control centre with Collaboration Spokesperson G. Tonelli and CMS User J. Goldstein.

    CERN Multimedia

    Jean-Claude Gadmer

    2010-01-01

    23rd June 2010 - University of Bristol Head of the Aerospace Engineering Department and Professor of Aerospace Dynamics N. Lieven visiting CERN control centre with Beams Department Head P. Collier, visiting the LHC superconducting magnet test hall with R. Veness and CMS control centre with Collaboration Spokesperson G. Tonelli and CMS User J. Goldstein.

  12. 13 September 2013 - Chairman of the Board of Directors of the von Karman Institute Kingdom of Belgium J.-P. Contzen visiting the ATLAS experimental cavern with ATLAS Former Spokesperson P. Jenni; visiting the LHC tunnel at Point 1 with Technology Department N. Delruelle and signing the guest book with Technology Department Head F. Bordry. International Relations Adviser T. Kurtyka present.

    CERN Multimedia

    Laurent Egli (visit)

    2013-01-01

    13 September 2013 - Chairman of the Board of Directors of the von Karman Institute Kingdom of Belgium J.-P. Contzen visiting the ATLAS experimental cavern with ATLAS Former Spokesperson P. Jenni; visiting the LHC tunnel at Point 1 with Technology Department N. Delruelle and signing the guest book with Technology Department Head F. Bordry. International Relations Adviser T. Kurtyka present.

  13. The full moon and ED patient volumes: unearthing a myth.

    Science.gov (United States)

    Thompson, D A; Adams, S L

    1996-03-01

    To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

  14. Return to the emergency department after ventricular shunt evaluation.

    Science.gov (United States)

    Sarda, Samir; Simon, Harold K; Hirsh, Daniel A; Wang, Andrew; Shane Tubbs, R; Chern, Joshua J

    2016-04-01

    OBJECT Patients with CSF shunts are medically complex and frequently present to the emergency department (ED) with suspected shunt malfunction. After adequate evaluation in the ED and proper disposition, some patients return to the ED within a short period of time. In this study, the authors examined the reasons for ED revisits within 7 days of the index ED visit to discern possible preventable returns. METHODS There were 3080 index ED visits made by patients with shunted hydrocephalus between 2010 and 2013. Index ED visits preceded by another ED visit or neurosurgical procedure within 60 days were excluded. Index ED visits for reasons unrelated to shunt function and those that led directly to admissions and shunt revision surgeries were also excluded. The remaining 1509 ED visits were eligible for analysis in this study. Final dispositions from the index ED visit included home (1176 cases), admission to the neurosurgery service for observation (134 cases), and admission to other services (199 cases). Subsequent events within 7 days, including ED revisits, hospital admissions, and shunt-related surgery were recorded, and reasons for the ED revisits were categorized based on whether the visit was related to shunt function concerns. Clinical and socioeconomic factors were analyzed for their association with ED revisits by using statistical methods. RESULTS Of the 1176 patients discharged home from the ED after shunt function evaluation, 101 (8.6%) returned to the ED within 7 days. Of the 134 patients admitted to the neurosurgery service for observation only, 8 (6.0%) returned to the ED within 7 days of discharge. Of the 199 patients admitted to hospital services other than neurosurgery, 13 (6.5%) returned to the ED within 7 days of discharge. The reasons for ED revisits vary (total of 122 visits combining the 3 groups), but at least 60% of the revisits were clearly unrelated to shunt function. A younger age, daytime arrival to the ED, and living within the

  15. Refined assessment of associations between drinking water residence time and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia.

    Science.gov (United States)

    Levy, Karen; Klein, Mitchel; Sarnat, Stefanie Ebelt; Panwhar, Samina; Huttinger, Alexandra; Tolbert, Paige; Moe, Christine

    2016-08-01

    Recent outbreak investigations suggest that a substantial proportion of waterborne disease outbreaks are attributable to water distribution system issues. In this analysis, we examine the relationship between modeled water residence time (WRT), a proxy for probability of microorganism intrusion into the distribution system, and emergency department visits for gastrointestinal (GI) illness for two water utilities in Metro Atlanta, USA during 1993-2004. We also examine the association between proximity to the nearest distribution system node, based on patients' residential address, and GI illness using logistic regression models. Comparing long (≥90th percentile) with intermediate WRTs (11th to 89th percentile), we observed a modestly increased risk for GI illness for Utility 1 (OR = 1.07, 95% CI: 1.02-1.13), which had substantially higher average WRT than Utility 2, for which we found no increased risk (OR = 0.98, 95% CI: 0.94-1.02). Examining finer, 12-hour increments of WRT, we found that exposures >48 h were associated with increased risk of GI illness, and exposures of >96 h had the strongest associations, although none of these associations was statistically significant. Our results suggest that utilities might consider reducing WRTs to water consumption.

  16. Contribution of ED admissions to inpatient hospital revenue.

    Science.gov (United States)

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  17. Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act.

    Science.gov (United States)

    Dresden, Scott M; Powell, Emilie S; Kang, Raymond; McHugh, Megan; Cooper, Andrew J; Feinglass, Joe

    2017-02-01

    We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation. Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI -27,037 to -21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI -11.1 to -6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged. ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be

  18. Ed Deutschman Interview [video

    OpenAIRE

    Deutschman, Ed

    2011-01-01

    Background: Ed Deutschman was a Navy cadet at the Del Monte Pre-Flight School, located at the now (2013) Naval Postgraduate School. Mr Deutschman visited the Dudley Knox Library on May 2, 2011, and spoke about his service in World War II as a Corsair fighter pilot in the Pacific.

  19. Study of patients of road traffic accidents a rriving in emergency department [ED] of V.S hospital at Ahmedabad city, single centre pilot study.

    Directory of Open Access Journals (Sweden)

    Aharnish Shah

    2014-07-01

    Full Text Available Objectives of the study According to the latest world status report on road safety released by WHO, we are now the world leaders in road traffic accident rate & related mortality. Our study intends to find out the epidemiological factors, risk factors, use of safety measures, compliance with traffic laws, presenting injuries & ED intervention required, in patients with road traffic accidents. Materials & methods Our study is a cross sectional observational study in which data was obtained from 150 patients of road traffic accidents arriving at any time to emergency department. Collected data included information about basic details, basic crash characteristics, risk factors, use of safety measures, injuries sustained, ED intervention required & disposition. Results Approximately 77% of the patients belong to 11-50 yr age group. The most common time of RTA is between 6 am to 12 noon [36.67%]. However accidents requiring admission were more during night time [62.74%]. Innocent passengers & pedestrians contributed to 41% of the accident cases. Non compliance with traffic laws & safety measures like driving without license [20%], using mobile phones while driving [10%], not using headlights at night [26%], not using seatbelts [80%], not using helmets [91%], etc were found in a substantial number of cases. Intracranial bleed & skull fractures were significantly (31.2% v/s 0% more in drivers without helmets than those with helmets. ED intervention required in decreasing order were dressing ( 38%, laceration repair (27.33%, splinting (24%, crash intubation (10%, ICD (2.66%. Conclusion: Well equipped secondary & tertiary level trauma centres, specially dedicated to management of trauma patients, with a proper triage plan, are necessary for proper management of trauma patients & better utilisation of resources. Our study shows that an ER physician should be trained in l aceration repair, dressing, splint/slab application, fracture/dislocation reduction

  20. Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

    Science.gov (United States)

    Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

    2015-06-01

    To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

  1. Therapy Dogs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nickolas Nahm

    2012-09-01

    Full Text Available Introduction: This study examined acceptance by staff and patients of a therapy dog (TD in the emergency department (ED.Methods: Immediately after TD visits to a University Hospital ED, all available ED staff, patients, and their visitors were invited to complete a survey.Results: Of 125 ‘‘patient’’ and 105 staff responses, most were favorable. Ninety-three percent of patients and 95% of staff agreed that TDs should visit EDs; 87.8% of patients and 92% of staff approved of TDs for both adult and pediatric patients. Fewer than 5% of either patients or staff were afraid of the TDs. Fewer than 10% of patients and staff thought the TDs posed a sanitary risk or interfered with staff work.Conclusion: Both patients and staff approve of TDs in an ED. The benefits of animal-assisted therapy should be further explored in the ED setting.

  2. International perspectives on emergency department crowding.

    Science.gov (United States)

    Pines, Jesse M; Hilton, Joshua A; Weber, Ellen J; Alkemade, Annechien J; Al Shabanah, Hasan; Anderson, Philip D; Bernhard, Michael; Bertini, Alessio; Gries, André; Ferrandiz, Santiago; Kumar, Vijaya Arun; Harjola, Veli-Pekka; Hogan, Barbara; Madsen, Bo; Mason, Suzanne; Ohlén, Gunnar; Rainer, Timothy; Rathlev, Niels; Revue, Eric; Richardson, Drew; Sattarian, Mehdi; Schull, Michael J

    2011-12-01

    The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States

  3. Emergency Department Use Among Older Adults With Dementia.

    Science.gov (United States)

    LaMantia, Michael A; Stump, Timothy E; Messina, Frank C; Miller, Douglas K; Callahan, Christopher M

    2016-01-01

    Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; Pdementia status (Pdementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.

  4. Cosmic visits

    CERN Multimedia

    Stefania Pandolfi

    2015-01-01

    On Saturday, 19 September, ESA astronaut Luca Parmitano and Amalia Ercoli Finzi, Principal Investigator of the SD2 experiment on board the ESA Rosetta spacecraft, visited the AMS Control Centre and other CERN installations.   From left to right: Sergio Bertolucci (CERN Director of Research and Computing), Amalia Ercoli Finzi (Emeritus Professor in the Aerospace department of the Polytechnic University of Milan and Principal Investigator of the SD2 experiment on board the ESA Rosetta spacecraft), Maurice Bourquin (AMS-02 Senior Scientist and Honorary Professor in the Nuclear and Corpuscular Physics department of the University of Geneva) and Luca Parmitano (Major in the Italian Air Force and European Space Agency astronaut) in the AMS Payload and Operation Control Centre. They were welcomed in the early morning by Sergio Bertolucci and then headed to the Prévessin site to visit the CERN Control Centre and the Payload and Operation Control Centre (POCC) of the Alpha Magnetic Sp...

  5. Visit at CERN of representatives of the Department of Piacenza (Italy), received by Lucio Rossi and Ugo Amaldi and hosted by the DG. The department of Piacenza is the native land of Edoardo Amaldi, one of the founding fathers of CERN, and the Department is preparing the celebration of the centennial of his birth.

    CERN Document Server

    Maximilien Brice

    2008-01-01

    Visit at CERN of representatives of the Department of Piacenza (Italy), received by Lucio Rossi and Ugo Amaldi and hosted by the DG. The department of Piacenza is the native land of Edoardo Amaldi, one of the founding fathers of CERN, and the Department is preparing the celebration of the centennial of his birth.

  6. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths by Sex — United States, 2001–2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — Overall rates of TBI climbed slowly from 2001 through 2007, then spiked sharply in 2008 and continued to climb through 2010. The increase in TBI rates in 2008 was...

  7. 物理疗法科923名进修人员情况调查与分析%Visiting Technicians in Physiotherapy Department:923 Subjects Investigation

    Institute of Scientific and Technical Information of China (English)

    魏北星; 张倩; 胡春英

    2015-01-01

    Objective To investigate the structure of the visiting technicians in Physiotherapy Department of Beijing Bo'ai Hospital, Chi-na Rehabilitation Center in the past 8 years. Methods 923 technicians visiting Physiotherapy Department from 2007 to 2014 were classified in the terms of provinces from, genders, ages, academic degrees, registers of practices and levels of hospital. Results Technicians visiting Physiotherapy Department came from 28 provinces (municipalities or municipality cities), (115.38 ± 5.30) persons per year, mainly aged 25-34 years (60.78%). The majority of the technicians (51.14%) accepted junior college education, and 46.37%did not registered for rehabil-itation related practices. The visiting technicians were more and more year by year, especially rehabilitation technicians. Genders, ages and academic degrees influenced on the proportion of rehabilitation technicians. Conclusion Institutes sending the visiting technician need to balance the genders, ages and registers of practice, to meet the good practice.%目的:了解目前物理疗法科进修人员变化趋势。方法对中国康复研究中心北京博爱医院物理疗法科2007年~2014年间923名进修人员的来源地、性别、年龄、学历、执业范围、医院级别等资料进行分析。结果进修人员来源涵盖28个省、市、自治区。年均进修人员(115.38±5.30)名。年龄以25~34岁为主(60.78%),学历以专科为主(51.14%),执业范围中非康复技师类占46.37%,康复技师类进修人员有逐渐增加趋势。进修人员总数逐年增加,性别、年龄和学历对于进修人员中康复技师的比例有影响。结论医院应对选派人员的性别、年龄、执业范围等统筹考虑,并注意人才梯队建设。

  8. [New routines in orthopedics department yielded more efficient care and more satisfied patients. Physiotherapist and team make the first assessment in new visits to the spine surgeon].

    Science.gov (United States)

    Knutsson, Björn; Torstensson, Thomas

    2015-09-11

    There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.

  9. The English Department in the Arab World Re-Visited: Language, Literature, or Translation? A Student's View

    Science.gov (United States)

    Al-Kharabsheh, Aladdin; Al-Azzam, Bakri; Obeidat, Marwan M.

    2009-01-01

    The remarkably prolonged controversial issue of which academic component among language, linguistics, literature and translation must be given the priority and take precedence over the other in the English departments in the Arab World during the college years has not only preoccupied a number of specialists and scholars in the field for a…

  10. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  11. Department

    African Journals Online (AJOL)

    USER

    2016-09-20

    Sep 20, 2016 ... Department of Mathematics, Faculty of Science, Kibabii University. 2. Department .... be seen that average rainfall exhibited a cyclic pattern with a reducing trend under both scenarios .... Department of Meteorology, University.

  12. Frequent users of the pediatric emergency department.

    Science.gov (United States)

    Seguin, Jade; Osmanlliu, Esli; Zhang, Xun; Clavel, Virginie; Eisman, Harley; Rodrigues, Robert; Oskoui, Maryam

    2017-04-06

    Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database. We analysed the relation between patient's characteristics and the number of PED visits over a 1-year period following the index visit. Patients totalling 52,088 accounted for 94,155 visits. Of those, 2,474 (4.7%) patients had five and more recurrent visits and accounted for 16.6% (15,612 visits) of the total PED visits. Lower level of acuity at index visit (odds ratio [OR] 0.85) was associated with a lower number of recurrent visits. Lower socioeconomic status (social deprivation index OR 1.09, material deprivation index OR 1.08) was associated with a higher number of recurrent visits. Asthma (OR 1.57); infectious ear, nose, and sinus disorders (OR 1.33); and other respiratory disorders (OR 1.56) were independently associated with a higher incidence of a recurrent visit within the year following the first visit. Our study is the first Canadian study to assess risk factors of frequent pediatric emergency use. The identified risk factors and diagnoses highlight the need for future evidence-based, targeted innovative research evaluating strategies to minimize ED crowding, to improve health outcomes and to improve patient satisfaction.

  13. National study of emergency department observation services.

    Science.gov (United States)

    Wiler, Jennifer L; Ross, Michael A; Ginde, Adit A

    2011-09-01

    The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs. © 2011 by the Society for Academic Emergency Medicine.

  14. Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department.

    Science.gov (United States)

    Hastings, S Nicole; Whitson, Heather E; Sloane, Richard; Landerman, Lawrence R; Horney, Carolyn; Johnson, Kimberly S

    2014-04-01

    To classify older adults in the emergency department (ED) according to healthcare use and to examine associations between group membership and future ED visits and hospital admissions. Secondary analysis. Medicare Current Beneficiary Survey. Adults aged 65 and older with at least one treat-and-release ED visit between January 1, 2000, and September 30, 2007 (N = 4,964). Measures of health service use included primary care visits, treat-and-release ED visits, and hospital days in the 12 months preceding the index ED visit. Five groups of individuals in the ED with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care visits. "Wellderly" (34%) had fewer visits of all types than other groups. "Chronically Illderly" (14%) had the highest mean number of primary care visits and hospital days. "Acute Carederly" (9.8%) had lowest mean number of primary care visits but higher ED visits and hospital days than all other groups except the "Sickest Elderly." Sickest Elderly (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. Primary Carederly and Wellderly had a lower risk of hospital admission within 30 days of the index ED visit than the other groups. In older adults released from an ED, group membership was associated with future health services use. Classification of individuals using readily available previous visit data may improve targeting of interventions to improve outcomes. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

  15. Using the Past to Predict the Future: Latent Class Analysis of Patterns of Health Service Use Among Older Emergency Department Patients

    Science.gov (United States)

    Hastings, S. Nicole; Whitson, Heather E.; Sloane, Richard; Landerman, Lawrence R.; Horney, Carolyn; Johnson, Kimberly S.

    2014-01-01

    Objectives To classify older emergency department (ED) patients by health care use and to examine associations between group membership and future ED visits and hospital admissions. Design Secondary analysis Setting Medicare Current Beneficiary Survey Participants Adults aged > = 65 years with at least one treat-and-release ED visit between 1/1/00 and 9/30/07 (N = 4,964). Measurements Measures of health service use included (1) primary care visits, (2) treat-and-release ED visits, and (3) hospital days in the 12 months preceding the index ED visit. Results Five groups of ED patients with distinct patterns of health service use were identified. "Primary Carederly" (39%) had low rates of ED and hospital use and a high mean number of primary care (PC) visits. “Wellderly" (34%) had fewer visits of all types compared to other groups. “Chronically Illderly” (14%) patients had the highest mean number of PC visits and hospital days. “Acute Carederly” (9.8%) had lowest mean number of PC visits but higher ED visits and hospital days than all other groups except the Sickest Elderly. Patients in the “Sickest Elderly” group (3.2%) had the highest number of ED visits; mean number of hospital days was more than four times that of any other group. “Primary Carederly” and “Wellderly” had a lower risk of hospital admission within 30 days of the index ED visit, while all other groups had a higher risk. Conclusion Among older patients released from an ED, group membership was associated with future health services use. Classification of patients using readily available previous visit data may improve targeting of interventions to improve patient outcomes. PMID:24635112

  16. Developing Calibration Weights and Standard-Error Estimates for a Survey of Drug-Related Emergency-Department Visits

    Directory of Open Access Journals (Sweden)

    Kott Phillip S.

    2014-09-01

    Full Text Available This article describes a two-step calibration-weighting scheme for a stratified simple random sample of hospital emergency departments. The first step adjusts for unit nonresponse. The second increases the statistical efficiency of most estimators of interest. Both use a measure of emergency-department size and other useful auxiliary variables contained in the sampling frame. Although many survey variables are roughly a linear function of the measure of size, response is better modeled as a function of the log of that measure. Consequently the log of size is a calibration variable in the nonresponse-adjustment step, while the measure of size itself is a calibration variable in the second calibration step. Nonlinear calibration procedures are employed in both steps. We show with 2010 DAWN data that estimating variances as if a one-step calibration weighting routine had been used when there were in fact two steps can, after appropriately adjusting the finite-population correct in some sense, produce standard-error estimates that tend to be slightly conservative.

  17. Self-referrals in the emergency department: reasons why patients attend the emergency department without consulting a general practitioner first-a questionnaire study

    NARCIS (Netherlands)

    Kraaijvanger, N.; Rijpsma, D.; Leeuwen, H. van; Edwards, M.J.R.

    2015-01-01

    BACKGROUND: To influence self-referral, it is crucial to know a patient's motives to directly visit the emergency department (ED). The goal of this study is to examine motives for self-referral to the ED and compare these motives in relation to appropriateness. METHODS: All self-referred patients vi

  18. 17 October 2013 - C. Ashton High Representative of the European Union for Foreign Affairs and Security Policy, Vice-President of the European Commission visiting the ATLAS cavern with ATLAS Collaboration Spokesperson D. Charlton; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest book with CERN Director-General R. Heuer.

    CERN Document Server

    Maximilien Brice

    2013-01-01

    17 October 2013 - C. Ashton High Representative of the European Union for Foreign Affairs and Security Policy, Vice-President of the European Commission visiting the ATLAS cavern with ATLAS Collaboration Spokesperson D. Charlton; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest book with CERN Director-General R. Heuer.

  19. 16 December 2013 - P. Lavie President of the Technion Institute of Technology in Israel visiting the ATLAS cavern with ATLAS Deputy Spokesperson T. Wengler; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest Book with CERN Director-General R. Heuer. G. Mikenberg, E. Rabinovici, Y. Rozen and S. Tarem present throughout.

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    16 December 2013 - P. Lavie President of the Technion Institute of Technology in Israel visiting the ATLAS cavern with ATLAS Deputy Spokesperson T. Wengler; visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and signing the Guest Book with CERN Director-General R. Heuer. G. Mikenberg, E. Rabinovici, Y. Rozen and S. Tarem present throughout.

  20. Evaluating the Impact of the Healthy Beginnings System of Care Model on Pediatric Emergency Department Utilization.

    Science.gov (United States)

    Tan, Cheryl H; Gazmararian, Julie

    2017-03-01

    The aim of this study was to evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) model is associated with a decrease in emergency department (ED) visits among children aged 6 months to 5.5 years. A retrospective, longitudinal study of ED utilization was conducted among children enrolled in the Healthy Beginnings SOC model between February 2011 and May 2013. Using medical records obtained from a children's hospital in Atlanta, the rate of ED visits per quarter was examined as the main outcome. A multilevel, multivariate Poisson model, with family- and child-level random effects, compared ED utilization rates before and after enrollment. Adjusted rate ratios and 95% confidence intervals were calculated after controlling for sociodemographic confounders. The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. The rate of ED visits after enrollment was not significantly different than the rate of ED visits before enrollment for children whose primary parent had an annual income of less than $5000 (P = 0.298), $20,000 to $29,999 (P = 0.199), or $30,000 or more (P = 0.117). However, for the children whose primary parent's annual income was $5000 to $19,999, the rate of ED visits after enrollment was significantly higher than the rate of ED visits before enrollment (adjusted rate ratio, 1.48; 95% confidence interval, 1.17-1.87). Enrollment in the SOC model does not appear to decrease the rate of ED visits among enrolled children. Additional strategies, such as education sessions on ED utilization, are needed to reduce the rate of ED utilization among SOC-enrolled children.

  1. March 2008 - ITER Organization Director-General K.Ikeda and Deputy Director-General N. Holtkamp, visiting the ATLAS cavern with Spokesperson P. Jenni, Accelerators Technology Department Head P. Lebrun and LHC Mangnets Group Leader L. Rossi.

    CERN Multimedia

    Claudia Marcelloni

    2008-01-01

    March 2008 - ITER Organization Director-General K.Ikeda and Deputy Director-General N. Holtkamp, visiting the ATLAS cavern with Spokesperson P. Jenni, Accelerators Technology Department Head P. Lebrun and LHC Mangnets Group Leader L. Rossi.

  2. Dr Phil Mjwara Director General, Department of Science and Technology (DST) Ministry of Science and Technology Republic of South Africa visit the Alice experiment introduce by Prof. Jurgen Schukraft, spokeperson for Alice.

    CERN Document Server

    Maximilien Brice

    2007-01-01

    Dr Phil Mjwara Director General, Department of Science and Technology (DST) Ministry of Science and Technology Republic of South Africa visit the Alice experiment introduce by Prof. Jurgen Schukraft, spokeperson for Alice.

  3. 20 January 2014 - Members of the Regional Assemblies and Parliaments United Kingdom of Great Britain and Northern Ireland visiting the LHC tunnel at Point 8 with Technology Department, Vacuum, Surfaces and Coatings Group P. Cruikshank.

    CERN Multimedia

    Pantelia, Anna

    2014-01-01

    20 January 2014 - Members of the Regional Assemblies and Parliaments United Kingdom of Great Britain and Northern Ireland visiting the LHC tunnel at Point 8 with Technology Department, Vacuum, Surfaces and Coatings Group P. Cruikshank.

  4. 9 July 2012 - Academy of Sciences Malaysia (ASM), Chairman, Mathematical and Physical Sciences Discipline Group M. Yahaya FASc and his delegation visiting the LHC superconducting magnet test hall with Technology Department G. De Rijk.

    CERN Document Server

    Maximilien Brice

    2012-01-01

    9 July 2012 - Academy of Sciences Malaysia (ASM), Chairman, Mathematical and Physical Sciences Discipline Group M. Yahaya FASc and his delegation visiting the LHC superconducting magnet test hall with Technology Department G. De Rijk.

  5. 23rd August 2011 - Turkish Representatives of the Union of Chambers and Commodity Exchanges, E. Uluatam and S. Kologlu, visiting the LHC superconducting magnet test hall with Engineering Department Head R. Saban.

    CERN Multimedia

    Benoit Jeannet

    2011-01-01

    23rd August 2011 - Turkish Representatives of the Union of Chambers and Commodity Exchanges, E. Uluatam and S. Kologlu, visiting the LHC superconducting magnet test hall with Engineering Department Head R. Saban.

  6. 28 June 2012 - Members of the European Brain Council led by President Mary Baker visiting the LHC tunnel at Point 5 with Technology Department Group Leader L. Bottura and CMS experimental area with Run Coordinator M. Chamizo-Llatas.

    CERN Multimedia

    Jean-Claude Gadmer

    2012-01-01

    28 June 2012 - Members of the European Brain Council led by President Mary Baker visiting the LHC tunnel at Point 5 with Technology Department Group Leader L. Bottura and CMS experimental area with Run Coordinator M. Chamizo-Llatas.

  7. 24th May 2011 - ITER Organization Director-General O.Motojima visiting SM18 with Technology Department Head F. Bordry and Deputy L. Rossi, accompanied by Adviser for Relations with ITER J.-P. Koutchouk.

    CERN Multimedia

    Maximilien Brice

    2011-01-01

    24th May 2011 - ITER Organization Director-General O.Motojima visiting SM18 with Technology Department Head F. Bordry and Deputy L. Rossi, accompanied by Adviser for Relations with ITER J.-P. Koutchouk.

  8. 10th December 2010 - German Delegation from the Novartis Foundation for Sustainable Development visiting the LHC superconducting magnet test hall with Technology Department S. Russenschuck and accompanied by Adviser for Life Sciences M. Dosanjh.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    10th December 2010 - German Delegation from the Novartis Foundation for Sustainable Development visiting the LHC superconducting magnet test hall with Technology Department S. Russenschuck and accompanied by Adviser for Life Sciences M. Dosanjh.

  9. Trends in the supply of California’s emergency departments and inpatient services, 2005–2014: a retrospective analysis

    Science.gov (United States)

    Chow, Jessica L; Niedzwiecki, Matthew J; Hsia, Renee Y

    2017-01-01

    Objectives Given increasing demand for emergency care, there is growing concern over the availability of emergency department (ED) and inpatient resources. Existing studies of ED bed supply are dated and often overlook hospital capacity beyond ED settings. We described recent statewide trends in the capacity of ED and inpatient hospital services from 2005 to 2014. Design Retrospective analysis. Setting Using California hospital data, we examined the absolute and per admission changes in ED beds and inpatient beds in all hospitals from 2005 to 2014. Participants Our sample consisted of all patients inpatient and outpatient) from 501 hospital facilities over 10-year period. Outcome measures We analysed linear trends in the total annual ED visits, ED beds, licensed and staffed inpatient hospital beds and bed types, ED beds per ED visit, and inpatient beds per admission (ED and non-ED). Results Between 2005 and 2014, ED visits increased from 9.8 million to 13.2 million (an increase of 35.0%, pbeds also increased (by 29.8%, pbeds. Despite this growth, ED beds per visit decreased by 3.9%, from 6.0 ED beds per 10 000 ED visits in 2005 to 5.8 beds in 2014 (p=0.01). While overall admission numbers declined by 4.9% (p=0.06), inpatient medical/surgical beds per visit grew by 11.3%, from 11.6 medical/surgical beds per 1000 admissions in 2005 to 12.9 beds in 2014 (pbeds per admission, by −15.3% (pbeds cannot keep pace with growing patient demand for acute care. Analysis of ED and inpatient supply should capture dynamic variations in patient demand. Our novel ‘beds pervisit’ metric offers improvements over traditional supply measures. PMID:28495813

  10. Geriatric Homelessness: Association with Emergency Department Utilization

    Science.gov (United States)

    Hategan, Ana; Tisi, Daniel; Abdurrahman, Mariam; Bourgeois, James A.

    2016-01-01

    Background Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. Methods ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period. Results Of all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED. Conclusions Despite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services. PMID:28050223

  11. 28 August 2013 - Director of Technical Quality Management Head of ESTEC Establishment European Space Agency F. Ongaro visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and Technology Department J.-P. Tock; visiting the ATLAS experimental area with ATLAS Deputy Spokesperson T. Wengler and signing the guest book with CERN Director-General R. Heuer. Accompanied throughout by F. Bordry and V. Parma.

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    28 August 2013 - Director of Technical Quality Management Head of ESTEC Establishment European Space Agency F. Ongaro visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry and Technology Department J.-P. Tock; visiting the ATLAS experimental area with ATLAS Deputy Spokesperson T. Wengler and signing the guest book with CERN Director-General R. Heuer. Accompanied throughout by F. Bordry and V. Parma.

  12. 10 September 2013 - Italian Minister for Economic Development F. Zanonato visiting the ATLAS cavern with Collaboration Spokesperson D. Charlton and Italian scientists F. Gianotti and A. Di Ciaccio; signing the guest book with CERN Director-General R. Heuer and Director for Research and Scientific Computing S. Bertolucci; in the LHC tunnel with S. Bertolucci, Technology Deputy Department Head L. Rossi and Engineering Department Head R. Saban; visiting CMS cavern with Scientists G. Rolandi and P. Checchia.

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    10 September 2013 - Italian Minister for Economic Development F. Zanonato visiting the ATLAS cavern with Collaboration Spokesperson D. Charlton and Italian scientists F. Gianotti and A. Di Ciaccio; signing the guest book with CERN Director-General R. Heuer and Director for Research and Scientific Computing S. Bertolucci; in the LHC tunnel with S. Bertolucci, Technology Deputy Department Head L. Rossi and Engineering Department Head R. Saban; visiting CMS cavern with Scientists G. Rolandi and P. Checchia.

  13. Emergency Department Utilization in the Texas Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  14. Emergency Department Utilization in the Texas Medicaid...

    Data.gov (United States)

    U.S. Department of Health & Human Services — There were 44,246 individuals enrolled in TexKat in 2005. Roughly 13 percent of these enrollees had at least one ED visit during the sample period, with one quarter...

  15. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  16. Characteristics of patients returning to emergency departments in Naples, Italy

    Directory of Open Access Journals (Sweden)

    Marinelli Paolo

    2008-05-01

    Full Text Available Abstract Background Crowding in hospital Emergency Departments (EDs is a problem in several countries. We evaluated the number and characteristics of patients who make repeated visits to the EDs in Naples, Italy. Methods All patients (≥ 16 years who presented to the EDs of three randomly selected non-academic acute care public hospitals, within randomly selected week periods, were studied. The two outcomes of interest were the re-utilization, within 72 hours, of the ED and the number of visits in the previous year. Results Of the 1430 sampled patients, 51.9% self-reported multiple visits in the previous year and 10.9% and 1.6% used the ED for 3 and ≥4 times, respectively. The number of visits in the previous year was significantly higher in those who live closer to hospital, with a more severe burden of overall comorbidity, and who were on pharmacological treatment. Overall, 72-hours return visits were found in 215 patients (15.8%. Patients were more likely to re-use within 72 hours the ED if younger, were not on pharmacological treatment, attended the ED more times in the previous year, were referred by a physician, arrived at the ED by car driven by other person, had problems of longer duration prior to arrival at the ED, had a surgical ED discharge diagnosis, and were admitted to the hospital. Conclusion The data may assist policymakers in the development and implementation of protocols to track changes in the re-utilization of the ED for the high financial impact and for the benefit of the patients.

  17. Exploring patterns of health service use in older emergency department patients.

    Science.gov (United States)

    Hastings, S Nicole; Horney, Carolyn; Landerman, Lawrence R; Sanders, Linda L; Hocker, Michael B; Schmader, Kenneth E

    2010-10-01

    Study objectives were to identify groups of older patients with similar patterns of health care use in the 12 months preceding an index outpatient emergency department (ED) visit and to identify patient-level predictors of group membership.   Subjects were adults ≥ 65 years of age treated and released from an academic medical center ED. Latent cluster analysis (LCA) models were estimated to identify groups with similar numbers of primary care (PC), specialist, and outpatient ED visits and hospital days within 12 months preceding the index ED visit.   In this sample (n = 308), five groups with distinct patterns of health service use emerged. Low Users (35%) had fewer visits of all types and fewer hospital days compared to sample means. Low Users were more likely to be female and had fewer chronic health conditions relative to the overall sample (p < 0.05). The ED to Supplement Primary Care Provider (PCP) (23%) group had more PCP visits, but also significantly more ED visits. Specialist Heavy (22%) group members had twice as many specialist visits, but no difference in PCP visits. Members of this class were more likely to be white and male (p < 0.05). High Users (15%) received more care in all categories and had more chronic baseline health conditions (p < 0.05) but no differences in demographic characteristics relative to the whole sample. The ED and Hospital as Substitution Care (6%) group had fewer PC and specialist visits, but more ED visits and hospital days.   In this sample of older ED patients, five groups with distinct patterns of health service use were identified. Further study is needed to determine whether identification of these patient groups can add important information to existing risk-assessment methods. © 2010 by the Society for Academic Emergency Medicine.

  18. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India

    Directory of Open Access Journals (Sweden)

    Nagarajan Sripriya

    2008-01-01

    Full Text Available Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth, which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

  19. Depart

    African Journals Online (AJOL)

    USER

    2017-01-26

    Jan 26, 2017 ... Department of Urban and Regional Planning, Ladoke Akintola University of Technology, ... informal automobile workshops in virtually every open space in Nigerian cities that ..... plantation to encourage a green society and.

  20. Emergency department crowding and risk of preventable medical errors.

    Science.gov (United States)

    Epstein, Stephen K; Huckins, David S; Liu, Shan W; Pallin, Daniel J; Sullivan, Ashley F; Lipton, Robert I; Camargo, Carlos A

    2012-04-01

    The objective of the study is to determine the association between emergency department (ED) crowding and preventable medical errors (PME). This was a retrospective cohort study of 533 ED patients enrolled in the National ED Safety Study (NEDSS) in four Massachusetts EDs. Individual patients' average exposure to ED crowding during their ED visit was compared with the occurrence of a PME (yes/no) for the three diagnostic categories in NEDSS: acute myocardial infarction, asthma exacerbation, and dislocation requiring procedural sedation. To accommodate site-to-site differences in available administrative data, ED crowding was measured using one of three previously validated crowding metrics (ED Work Index, ED Workscore, and ED Occupancy). At each site, the continuous measure was placed into site-specific quartiles, and these quartiles then were combined across sites. We found that 46 (8.6%; 95% confidence interval, 6.4-11.3%) of the 533 patients experienced a PME. For those seen during higher levels of ED crowding (quartile 4 vs. quartile 1), the occurrence of PMEs was more than twofold higher, both on unadjusted analysis and adjusting for two potential confounders (diagnosis, site). The association appeared non-linear, with most PMEs occurring at the highest crowding level. We identified a direct association between high levels of ED crowding and risk of preventable medical errors. Further study is needed to determine the generalizability of these results. Should such research confirm our findings, we would suggest that mitigating ED crowding may reduce the occurrence of preventable medical errors.

  1. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

    Directory of Open Access Journals (Sweden)

    Jung Hoon Woo

    Full Text Available The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1% were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each. Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

  2. Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.

    Science.gov (United States)

    Tran, Quincy Khoi; Bayram, Jamil D; Boonyasai, Romsai T; Case, Meredith A; Connor, Christine; Doggett, David; Fawole, Oluwakemi A; Ijagbemi, O Mayowa; Levin, Scott; Wu, Albert W; Pham, Julius Cuong

    2016-08-01

    Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population. Structured literature review of PubMed and clinicaltrials.gov was conducted to identify relevant studies. Inclusion criteria were studies evaluating ED returns by identifying risk factors and interventions in the pediatric population. Emergency department return was defined as returning to the ED within 1 year after initial visit. Abstract and full text articles were reviewed, and data were abstracted by 2 independent authors. A total of 963 articles were screened and yielded 42 potential relevant articles involving pediatric population. After full text review, a total of 12 articles were included in the final analysis (6 on risk factors and 6 on interventions). Risk factors for pediatric ED return included behavioral/psychiatric problems, younger age, acuity of illness, medical history of asthma, and social factors. Interventions included computer-generated instructions, postdischarge telephone coaching, ED-made appointments, case management, and home environment intervention. Emergency department-made appointments and postdischarge telephone coaching plus monetary incentive improved outpatient follow-up rate but not ED return. Home environment assessment coupled with case management reduced ED returns specifically among asthma patients. Several patient and visit characteristics can help predict children at risk for ED return. Although some interventions are successful at improving postdischarge follow-up, most did not reduce ED returns.

  3. The Impact of Infant Well-Child Care Compliance and Social Risks on Emergency Department Utilization.

    Science.gov (United States)

    Lawson, Nikki R; Klein, Melissa D; Ollberding, Nicholas J; Wurster Ovalle, Victoria; Beck, Andrew F

    2017-09-01

    Deployment of medical and social services at well-child visits promotes child health. A retrospective review of the electronic health record was conducted for infants presenting for their "newborn" visit over a 2-year period at an urban, academic primary care center. Primary outcomes were time to first emergency department (ED) visit, number of ED visits (emergent or nonemergent), and number of nonemergent ED visits by 2 years of life. Records from 212 consecutive newborns were evaluated-59.9% were black/African American and 84.4% publicly insured. A total of 72.6% visited the ED by 2 years of life. Sixty percent received ≥5 well-child visits by 14 months; 25.9% reported ≥1 social risk. There were no statistically significant associations between number of completed well-child visits, or reported social risks, and ED utilization. Renewed focus on preventive care delivery and content and its effect on ED utilization, and other patient outcomes, is warranted.

  4. The usage of complementary and alternative medicine in gastrointestinal patients visiting the outpatients’ department of a large tertiary care centre-views from Pakistan

    Science.gov (United States)

    Lail, Ghulamullah; Luck, Nasir; Tasneem, Abbas Ali; Rai, AyeshaAslam; Laeeq, Syed Mudasir; Majid, Zain

    2016-01-01

    Introduction The use of complementary and alternative medicine (CAM) has increased over the last few years, and an emergent data suggests that some CAM modalities may be helpful in addressing gastrointestinal (GI) conditions. Our aim was to find out the prevalence of such practices for GI condition amongst patients visiting an OPD of a large tertiary care centre of Karachi, Pakistan. Methods Patients visiting outpatient department of Hepatogastroenterology department at SIUT, Pakistan from March 2014 to March 2015, were included in this cross sectional study. A pre designed questionnaire was used that included the demographic data, primary disease of the patient, CAM modality used, reason for the use of CAM therapy and reasons for stopping it. Frequencies of different variables were computed using SPSS version 18. Results 906 patients were interviewed, out of which 52% (471) were males. The mean age at presentation was 39.81±12.4 years. 234 (25.8%) of the participants used one of the CAM modalities; Herbal medicine being most common one, seen in 122 (52.13%) followed by spiritual 61 (26%), and homeopathy 33 (14%). The duration of therapy was limited to six months in 161(68%), whereas 7 patients (2.9%) had prolonged duration of use of more than five years. Reasons for using CAM therapy included advice by family and friends in 66 patients (28%), personal will in 42 (17.94%), no benefit from allopathic treatment in 34 (14.5%), while high cost was the reason of use in 3(5%) of the patients. The most common reason for discontinuation of CAM was no benefit, seen in 113 patients (48.30%), followed by physician's advice in 32 (17%) patients, and side effects in 19 (8%). On the other hand 44 patients (18.80%) reported benefit from the therapy while 14 (5.9%) were still continuing with CAM modality. Among the CAM users 140 (60.09%) were un-educated or had primary education while CAM nonusers had 328 (47%) were either uneducated or had primary education only correlation

  5. The emergency department occupancy rate: a simple measure of emergency department crowding?

    Science.gov (United States)

    McCarthy, Melissa L; Aronsky, Dominik; Jones, Ian D; Miner, James R; Band, Roger A; Baren, Jill M; Desmond, Jeffrey S; Baumlin, Kevin M; Ding, Ru; Shesser, Robert

    2008-01-01

    We examine the validity of the emergency department (ED) occupancy rate as a measure of crowding by comparing it to the Emergency Department Work Index Score (EDWIN), a previously validated scale. A multicenter validation study was conducted according to ED visit data from 6 academic EDs for a 3-month period in 2005. Hourly ED occupancy rate (ie, total number of patients in ED divided by total number of licensed beds) and EDWIN scores were calculated. The correlation between the scales was determined and their validity evaluated by their ability to discriminate between hours when 1 or more patients left without being seen and hours when the ED was on ambulance diversion, using area under the curve (AUC) statistics estimated from the bootstrap method. We calculated the ED occupancy rate and EDWIN for 2,208 consecutive hours at each of the 6 EDs. The overall correlation between the 2 scales was 0.58 (95% confidence interval [CI] 0.56 to 0.60). The ED occupancy rate (AUC=0.73; 95% CI 0.65 to 0.80) and the EDWIN (AUC=0.65; 95% CI 0.58 to 0.72) did not differ significantly in correctly identifying hours when patients left without being seen. The ED occupancy rate (AUC=0.78; 95% CI 0.75 to 0.80) and the EDWIN (AUC=0.70; 95% CI 0.59 to 0.81) performed similarly for ED diversion hours. The ED occupancy rate and the EDWIN classified leaving without being seen and ambulance diversion hours with moderate accuracy. Although the ED occupancy rate is not ideal, its simplicity makes real-time assessment of crowding feasible for more EDs nationwide.

  6. Insurance Expansion and Hospital Emergency Department Access: Evidence From the Affordable Care Act.

    Science.gov (United States)

    Garthwaite, Craig; Gross, Tal; Notowidigdo, Matthew; Graves, John A

    2017-02-07

    Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). To investigate the effect of the 2014 ACA Medicaid expansion on the location, insurance status, and type of ED visits. Quasi-experimental observational study from 2012 to 2014. 126 investor-owned, hospital-based EDs. Uninsured and Medicaid-insured adults aged 18 to 64 years. ACA expansion of Medicaid in January 2014. Number of ED visits overall, type of visit (for example, nondiscretionary or nonemergency), and average travel time to the ED. Interrupted time-series analyses comparing changes from the end of 2013 to end of 2014 for patients from Medicaid expansion versus nonexpansion states were done. There were 1.06 million ED visits among patients from 17 Medicaid expansion states, and 7.87 million ED visits among patients from 19 nonexpansion states. The EDs treating patients from Medicaid expansion states saw an overall 47.1% decrease in uninsured visits (95% CI, -65.0% to -29.3%) and a 125.7% (CI, 89.2% to 162.6%) increase in Medicaid visits after 12 months of ACA expansion. Average travel time for nondiscretionary conditions requiring immediate medical care decreased by 0.9 minutes (-6.2% [CI, -8.9% to -3.5%]) among all Medicaid patients from expansion states. We found little evidence of similar changes among patients from nonexpansion states. Results reflect shifts in ED care at investor-owned facilities, which limits generalizability to other hospital types. Meaningful changes in insurance status and location and type of ED visits in the first year of ACA Medicaid expansion were found, suggesting that expansion provides patients with a greater choice of hospital facilities. Robert Wood Johnson Foundation.

  7. A Significant Visit

    Institute of Scientific and Technical Information of China (English)

    SHI YONGMING

    2010-01-01

    @@ North Korean leader KimJong Ⅱ paid a visit to China from May 3-7. The trip was on the agenda as early as last January, when Wang Jiarui, head of the International Department of the Communist Party of China Central Committee visited North Korea and delivered Chinese President Hu Jintao's invitation to Kim.

  8. Department

    African Journals Online (AJOL)

    USER

    2017-05-25

    May 25, 2017 ... Department of Animal production Federal University of Technology Minna – Niger state,. Nigeria ... principles by poultry farmers in Kwara State, Nigeria. The ma .... usually incur by broiler and layer farmers ... A multi-stage sampling technique .... their birds under intensive care, which is ... husbandry system.

  9. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.

    NARCIS (Netherlands)

    Buurman, B.M.; Berg, W. van den; Korevaar, J.C.; Milisen, K.; Haan, R.J. de; Rooij, S.E. de

    2011-01-01

    Objectives: To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands. Methods: This i

  10. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments

    NARCIS (Netherlands)

    B.M. Buurman; W. van den Berg; J.C. Korevaar; K. Milisen; R.J. de Haan; S.E. de Rooij

    2011-01-01

    To compare the prognostic value of four screening instruments used to detect the risk for poor outcomes [in terms of likelihood of recurrent emergency department (ED) visits, hospitalizations, or mortality] for older patients discharged home from an ED in the Netherlands. This is a prospective cohor

  11. Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

    Science.gov (United States)

    Allen, Michael H.; Abar, Beau W.; McCormick, Mark; Barnes, Donna H.; Haukoos, Jason; Garmel, Gus M.; Boudreaux, Edwin D.

    2013-01-01

    Joint Commission National Patient Safety Goal 15 calls for organizations "to identify patients at risk for suicide." Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%-11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in…

  12. Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2.

    Science.gov (United States)

    Hossein Nejad, Hooman; Banaie, Mohsen; Seyedhosseini Davarani, Seyed Hossein; Khazaeipour, Zahra

    2016-06-01

    The Emergency Severity Index (ESI) is a five-level triage system that has shown promising reliability and validity. According to ESI algorithm, in the presence of danger zone respiratory rate (RR), heart rate (HR) or Oxygen (O2) saturation, patients should be up-triaged from ESI level 3 to 2 Hence, the current study aimed to investigate the value of the measurement of vital signs in predicting the up-triage of patients from ESI level 3 to 2. Patients who visited the emergency department at Imam Khomeini Hospital Complex, Tehran, Iran, and were categorized into ESI level 3 were investigated. RR, HR, and O2 saturation were recorded by the triage nurse, and the rates of abnormalities in these three variables were evaluated. Out of 551 cases who were up-triaged from ESI level 3 to 2,489 (88.7%) had an increased RR, and 539 (97.8%) had an increased RR or HR. Only 12 cases (2.2%) had normal RR and HR, who were up-triaged only due to abnormal O2 saturation. Out of these 12 cases, 10 had O2 saturations triaged into ESI level 2 in the first place and 1 could not be located for further investigations. In conclusion, compared to O2 saturation, the abnormal findings during the assessment of RR and HR seem to much more commonly result in the up-triage of patients from ESI level 3 to 2.

  13. Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States.

    Science.gov (United States)

    Schlichting, Lauren E; Rogers, Michelle L; Gjelsvik, Annie; Linakis, James G; Vivier, Patrick M

    2017-08-18

    For many children, the Emergency Department (ED) serves as the main destination for health care, whether it be for emergent or non-urgent reasons. Through examination of repeat utilization and ED reliance, in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care. Nationally representative data from the 2010-2014 Medical Expenditure Panel Survey (MEPS) were used to examine the annual ED utilization of children age 0-17 years by insurance coverage. Overall utilization, repeat utilization (≥2 ED visits), and ED reliance (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High ED reliance was defined as having >33% of outpatient visits in a year being ED visits. A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a one-year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.40-1.73) than children with private insurance, whereas uninsured children were less likely (aOR: 0.64; 95% CI: 0.51-0.81). Children age three and under were significantly more likely to visit the ED than children age 15-17, whereas female children and Hispanic and non-Hispanic other race children were significantly less likely to visit the ED than male children and non-Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a one-year period. Children with public insurance were more likely to have two or more visits to the ED (aOR: 1.53; 95% CI: 1.19-1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for

  14. Emergency Department Visits of Obstetrics and Gynecology Triage Classification%探析妇产科急诊就诊分级

    Institute of Scientific and Technical Information of China (English)

    翁廷松; 何美玲

    2012-01-01

      为妇产科急诊就诊者提供快捷、方便、及时、同质的医疗服务,提高危急重症救治效率,为急诊患者提供安全优质的服务,提高患者满意度。通过对妇产科急诊就诊者进行预检分诊,按照《妇产科急诊预检分诊内容》对就诊者病情进行分类分级,充分利用、合理配置急诊医疗资源,保证真正的急诊患者得到更好的诊治,达到提高妇产科急诊患者分诊分级的准确度,降低分诊不当影响的危急重症患者的救治及抢救效率,加强医疗安全,提高患者满意度的目的。%  Obstetrics and gynecology emergency room visits by providing fast,convenient,timely,and the homogeneity of the medical service, improve efficiency of emergency and severe treatment for emergency patients to provide safe and high quality services,improve patient satisfaction.For obstetric and gynecological emergency department visits,pre-screening triage classification and grading the attenders condition in accordance with the emergency pre-screening of obstetrics and gynecology triage content,take full advantage of the rational allocation of emergency medical resources,to ensure that the true emergency patients are better treatment,to improve the accuracy of the classification of obstetrics and gynecology emergency patient triage,treatment and rescue efficiency to reduce the undue influence of the critical triage of critically ill patients,and strengthen the healthcare safety and improve patient satisfaction and purpose.

  15. Automated electronic medical record sepsis detection in the emergency department

    OpenAIRE

    Su Q. Nguyen; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P; Wang, Henry E.

    2014-01-01

    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  16. Automated electronic medical record sepsis detection in the emergency department

    OpenAIRE

    Nguyen, Su Q.; Edwin Mwakalindile; Booth, James S.; Vicki Hogan; Jordan Morgan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.

    2014-01-01

    Background. While often first treated in the emergency department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods. We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and lab...

  17. Automated electronic medical record sepsis detection in the Emergency Department

    OpenAIRE

    Nguyen, Su; Mwakalindile, Edwin; Booth, James S.; Hogan, Vicki; Morgan, Jordan; Prickett, Charles T; Donnelly, John P.; Wang, Henry E.

    2014-01-01

    Background: While often first treated in the Emergency Department (ED), identification of sepsis is difficult. Electronic medical record (EMR) clinical decision tools offer a novel strategy for identifying patients with sepsis. The objective of this study was to test the accuracy of an EMR-based, automated sepsis identification system. Methods : We tested an EMR-based sepsis identification tool at a major academic, urban ED with 64,000 annual visits. The EMR system collected vital sign and la...

  18. Visit safety

    CERN Multimedia

    2012-01-01

    Experiment areas, offices, workshops: it is possible to have co-workers or friends visit these places.     You already know about the official visits service, the VIP office, and professional visits. But do you know about the safety instruction GSI-OHS1, “Visits on the CERN site”? This is a mandatory General Safety Instruction that was created to assist you in ensuring safety for all your visits, whatever their nature—especially those that are non-official. Questions? The HSE Unit will be happy to answer them. Write to safety-general@cern.ch.   The HSE Unit

  19. Patterns in emergency-department arrivals and length of stay: Input for visualizations of crowding

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2016-01-01

    Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns...... to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly...... factors important to the evolving balance between the demand for ED services and the available resources. Visualization of the patterns, thus, appears a promising tool in managing ED crowding. However, visualizations presuppose reliable data and are expected by the clinicians to be accurate and prognostic...

  20. Patterns in emergency-department arrivals and length of stay: Input for visualizations of crowding

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2016-01-01

    Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns...... to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly...... patterns in patient arrivals. With respect to the flow of patients through the ED, length of stay increases from low to medium triage levels and then decreases from medium to high triage levels. Also, length of stay increases with patient age. The bottlenecks in the work in the ED relate to patient input...

  1. Evaluation of the Significance of Vital Signs in the Up-Triage of Patients Visiting Emergency Department from Emergency Severity Index Level 3 to 2

    Directory of Open Access Journals (Sweden)

    Hooman Hossein Nejad

    2016-06-01

    Full Text Available The Emergency Severity Index (ESI is a five-level triage system that has shown promising reliability and validity. According to ESI algorithm, in the presence of danger zone respiratory rate (RR, heart rate (HR or Oxygen (O2 saturation, patients should be up-triaged from ESI level 3 to 2 Hence, the current study aimed to investigate the value of the measurement of vital signs in predicting the up-triage of patients from ESI level 3 to 2. Patients who visited the emergency department at Imam Khomeini Hospital Complex, Tehran, Iran, and were categorized into ESI level 3 were investigated. RR, HR, and O2 saturation were recorded by the triage nurse, and the rates of abnormalities in these three variables were evaluated. Out of 551 cases who were up-triaged from ESI level 3 to 2,489 (88.7% had an increased RR, and 539 (97.8% had an increased RR or HR. Only 12 cases (2.2% had normal RR and HR, who were up-triaged only due to abnormal O2 saturation. Out of these 12 cases, 10 had O2 saturations <92% at common health status, 1 had acutely altered mental status and should have been triaged into ESI level 2 in the first place and 1 could not be located for further investigations. In conclusion, compared to O2 saturation, the abnormal findings during the assessment of RR and HR seem to much more commonly result in the up-triage of patients from ESI level 3 to 2.

  2. Utilization of Emergency Department Services by the Bedouin Population in Southern Israel

    Directory of Open Access Journals (Sweden)

    Arnon Dov Cohen

    2007-01-01

    Full Text Available Excessive use of the emergency department (ED is associated with increased costs and workload in the ED, patients' inconvenience and disruption of the continuity of care. The study's goal was to describe trends in ED utilization among Bedouins living in southern Israel. A retrospective cross-sectional study was conducted in primary care clinics in southern Israel. Patients included Bedouin and Jewish patients insured by Clalit Health Services. Data was retrieved from a central database. The number of visits to the ED and age-adjusted rates of ED visits during 2000-2003 were determined in the Bedouin vs. Jewish population. All visits that ended in hospitalization were excluded. Data was stratified according to patients' residence (semi-nomadic vs. urban Bedouins and referral origin. Age-adjusted rates of ED visits decreased from 42.9/1000 patients/month in 2000 to 38.3/1000 patients/month in 2003. There were more ED visits in the Bedouin as compared to Jewish population (38.3/1000 vs. 21.8/1000 patients/month. The decrease in ED utilization was more prominent among adult semi-nomadic Bedouins (from 60.8/1000 to 40.3/1000 patients/month. The proportion of referrals by the family physician to ED significantly decreased (among urban Bedouins: from 54.3% to 43.2%, p<0.001; among semi-nomadic Bedouins: from 53.9% to 39.9%, p<0.001, while the proportion of selfreferrals and referrals from physicians other than the family physician increased. A decrease in ED utilization by the Bedouin population during the last years was demonstrated. Utilization of ED services is still increased as compared to the non-Bedouin population. Interventions to control excessive use of ED services in the Bedouin population are currently underway.

  3. 9 July 2008 - Microsoft Co-Founder P. Allen visiting ATLAS control room and underground experimental area with Adviser J. Ellis and IT Department Head W. von Rüden.

    CERN Multimedia

    Maximilien Brice

    2008-01-01

    9 July 2008 - Microsoft Co-Founder P. Allen visiting ATLAS control room and underground experimental area with Adviser J. Ellis and IT Department Head W. von Rüden and guided by ATLAS Collaboration Users S. Goldfarb, P. Nevski and L. Price.

  4. Applicability of the modified Emergency Department Work Index (mEDWIN) at a Dutch emergency department.

    Science.gov (United States)

    Brouns, Steffie H A; van der Schuit, Klara C H; Stassen, Patricia M; Lambooij, Suze L E; Dieleman, Jeanne; Vanderfeesten, Irene T P; Haak, Harm R

    2017-01-01

    Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN). Research on the EDWIN is often applied to limited settings and conducted over a short period of time. To explore whether the EDWIN as a measure can track occupancy at a Dutch ED over the course of one year and to identify fluctuations in ED occupancy per hour, day, and month. Secondary objective is to investigate the discriminatory value of the EDWIN in detecting crowding, as compared with the occupancy rate and prolonged ED-LOS. A retrospective cohort study of all ED visits during the period from September 2010 to August 2011 was performed in one hospital in the Netherlands. The EDWIN incorporates the number of patients per triage level, physicians, treatment beds and admitted patients to quantify ED crowding. The EDWIN was adjusted to emergency care in the Netherlands: modified EDWIN (mEDWIN). ED crowding was defined as the 75th percentile of mEDWIN per hour, which was ≥0.28. In total, 28,220 ED visits were included in the analysis. The median mEDWIN per hour was 0.15 (Interquartile range (IQR) 0.05-0.28); median mEDWIN per patient was 0.25 (IQR 0.15-0.39). The EDWIN was higher on Wednesday (0.16) than on other days (0.14-0.16, poccupancy rate revealed an area under the curve (AUC) of 0.86 (95%CI 0.85-0.87). The AUC of mEDWIN compared with a prolonged ED-LOS (≥4 hours) was 0.50 (95%CI 0.40-0.60). The mEDWIN was applicable at a Dutch ED. The mEDWIN was able to identify fluctuations in ED occupancy. In addition, the mEDWIN had high discriminatory power for identification of a busy ED, when compared with the occupancy rate.

  5. Visit ISOLDE!

    CERN Multimedia

    CERN Bulletin

    2013-01-01

    CERN Internal Communication is organising a visit to ISOLDE – an opportunity for you to see the CERN set-up that can produce over 1000 different isotopes!   If you wish to participate, you can sign up for a visit by sending us an e-mail. Note that the visits will take place between 18 and 22 February, and will be open only to CERN access-card holders.   The visit will include an introduction by experts and a tour of the ISOLDE set-up. NB: For security reason, pregnant women and kids under the age of 16 can not take the tour.  

  6. Atendimentos decorrentes de queimaduras em serviços públicos de emergência no Brasil, 2009 Public hospital emergency department visits due to burns in Brazil, 2009

    Directory of Open Access Journals (Sweden)

    Vilma Pinheiro Gawryszewski

    2012-04-01

    Full Text Available O objetivo foi analisar os atendimentos por queimaduras em serviços de emergência, e fatores associados. Estudo transversal de 761 atendimentos coletados pelo Sistema de Vigilância de Violências e Acidentes em 2009. A maioria foi do sexo masculino (58,6%; adultos de 30 a 49 anos (23,1% e crianças de 0 a 9 anos (23%. A residência foi o local de ocorrência mais frequente (62,1%, especialmente para crianças e mulheres; em seguida comércio, serviços, indústria e construção (19,1%, especialmente entre homens de 20 a 49 anos. Queimaduras no trabalho foram 29,1% do total. Uso de álcool chegou a 5,1%. Agentes causadores em todas as idades: substância quente (43,6% e fogo/chama (24,2%; na faixa produtiva: substâncias químicas. As queimaduras entre 0 e 14 anos foram associadas com residência, substância e objeto quente e internação hospitalar; entre os de 15 a 49 anos associaram-se com fogo/chama e choque elétrico, via pública e alta da emergência. Estratégias de prevenção para crianças e trabalhadores devem ser implantadas.The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%, and the most prevalent age brackets were 30-49 years (23.1% and 0-4 years (23%. Most burns occurred at home (62.1%, especially among females and children, and in commerce/services/industry/construction (19.1%, mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6% and exposure to fire and flames (24.2%; among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with

  7. Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

    Science.gov (United States)

    Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

    2017-04-01

    We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians

  8. Urgent Care Transfers to an Academic Pediatric Emergency Department.

    Science.gov (United States)

    McCarthy, Jennifer L; Clingenpeel, Joel M; Perkins, Amy M; Eason, Margaret K

    2017-10-02

    The aim of this study was to investigate the hypothesis that a significant percentage of urgent care center to pediatric ED transfers can be discharged home without emergency department (ED) resource utilization. A retrospective chart review was completed for a 6-month period on all patients transferred from urgent care centers. A data collection tool focusing on demographics, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return was used. Each encounter was classified as "urgent" or "nonurgent" based on resource utilization criteria. Descriptive statistics were reported for demographics, encounter data, and 72-hour ED return stratified by nonurgent versus urgent classification. Two-sample t, χ, and Fisher exact tests were used to assess differences in characteristics between the nonurgent and urgent groups. One hundred nine patients met inclusion criteria. Of these, 93 (85%) were discharged from the ED. Twenty nine (27%) of the transferred patients were discharged without ED resource utilization. Seventy-two-hour return was noted for only 1 patient who was again discharged at the subsequent encounter. A large proportion of patients transferred from urgent care centers were directly discharged from the ED without any ED resource utilization. Eliminating or reducing such transfers has the potential to limit the amount of nonurgent ED visits, thus producing cost savings and better patient care.

  9. Prevalence of Chlamydia infection among women visiting a gynaecology outpatient department: evaluation of an in-house PCR assay for detection of Chlamydia trachomatis

    Directory of Open Access Journals (Sweden)

    Patel Achchhe L

    2010-09-01

    Full Text Available Abstract Background Screening women for Chlamydia trachomatis infection in developing countries is highly desirable because of asymptomatic infection. The existing diagnostic methods in developing countries are not effective and their sensitivity fall below 45.0% which leads to further spread of infection. There is an urgent need for improved and cost effective diagnostic tests that will reduce the burden of sexually transmitted infections in the developing world. Methods Prevalence of C. trachomatis infection among women visiting gynaecology department of Hindu Rao hospital in Delhi, India was determined using Roche Amplicor Multi Well Plate kit (MWP as well as using in-house PCR assay. We used 593 endocervical swabs for clinical evaluation of the in-house developed assay against Direct Fluorescence Assay (DFA; Group I n = 274 and Roche Amplicor MWP kit (Group II, n = 319 samples and determined the sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV of the in-house developed assay. Results We detected 23.0% positive cases and there was a higher representation of women aged 18-33 in this group. An in-house PCR assay was developed and evaluated by targeting unique sequence within the gyrA gene of C. trachomatis. Specificity of the reaction was confirmed by using genomic DNA of human and other STI related microorganisms as template. Assay is highly sensitive and can detect as low as 10 fg of C. trachomatis DNA. The resolved sensitivity of in-house PCR was 94.5% compared with 88.0% of DFA assay. The high specificity (98.4% and sensitivity (97.1% of the in-house assay against Roche kit and availability of test results within 3 hours allowed for immediate treatment and reduced the risk of potential onward transmission. Conclusions The in-house PCR method is cost effective (~ 20.0% of Roche assay and hence could be a better alternative for routine diagnosis of genital infection by C. trachomatis to facilitate

  10. Decreased health care quality associated with emergency department overcrowding.

    Science.gov (United States)

    Miró, O; Antonio, M T; Jiménez, S; De Dios, A; Sánchez, M; Borrás, A; Millá, J

    1999-06-01

    The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.

  11. Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization.

    Science.gov (United States)

    Gordon, Aliza S; Adamson, Wallace C; DeVries, Andrea R

    2017-02-17

    Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions. A cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy. A total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, Pvirtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, Pvirtual visit episodes, respectively, including medical and pharmacy costs. Virtual care appears to

  12. Use of the emergency department for dermatologic care in the United States by ethnic group.

    Science.gov (United States)

    Abokwidir, Manal; Davis, Scott A; Fleischer, Alan B; Pichardo-Geisinger, Rita O

    2015-01-01

    The emergency department (ED) is not the ideal setting for dermatologic care, but may be widely used, especially among disadvantaged ethnic minorities. This study was performed to characterize the role of the ED in providing dermatologic care for each racial and ethnic group in the United States. We analyzed visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2010. Settings (office-based, outpatient department or ED), diagnoses and race/ethnicity were assessed to compare usage of the ED across groups. Usage of the ED for dermatologic conditions increased over time (p dermatologic care of black (18.3%) and Hispanic (10.5%) patients than for white patients (5.9%) and were used most in rural or small metropolitan areas. Providing better insurance, more dermatologists in rural areas and better dermatologic training for family physicians may help improve care for underserved populations and reduce inappropriate use of the ED.

  13. Visit Itinerary

    CERN Multimedia

    2002-01-01

    The visit itinerary includes five area of halls 191 and 180:. End-Cap Toroid Integration Area . Barrel Toroid Integration Area . Cryogenic Test Facility for Toroid Magnets and Helium Pumps . Liquid Argon Cryostats Assembly Area . Central Solenoid Magnet Test Station

  14. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

    Science.gov (United States)

    Nelli, Jennifer; Tremblay, Steven; Caluyong, Myka B.; Freeman, Jeffrey; Stokes, Yehudis; Stiell, Ian G.; Nathan, Howard; Smyth, Catherine E.

    2016-01-01

    Background. Chronic pain (CP) accounts for 10–16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED. PMID:27829785

  15. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

    Directory of Open Access Journals (Sweden)

    Patricia A. Poulin

    2016-01-01

    Full Text Available Background. Chronic pain (CP accounts for 10–16% of emergency department (ED visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9 completed the study. The most frequently cited reason (60% for ED visits was inability to cope with pain. Mental health problems were common, including depression (61% and anxiety (45%. Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

  16. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.

    Science.gov (United States)

    Poulin, Patricia A; Nelli, Jennifer; Tremblay, Steven; Small, Rebecca; Caluyong, Myka B; Freeman, Jeffrey; Romanow, Heather; Stokes, Yehudis; Carpino, Tia; Carson, Amanda; Shergill, Yaadwinder; Stiell, Ian G; Taljaard, Monica; Nathan, Howard; Smyth, Catherine E

    2016-01-01

    Background. Chronic pain (CP) accounts for 10-16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

  17. Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France

    Directory of Open Access Journals (Sweden)

    Olivier Philippe

    2011-10-01

    Full Text Available Abstract Background For several decades, emergency departments (EDs utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43. The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61, gynaecological (kappa = 0.66 and toxicology complaints (kappa = 1.00. The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09 and hospitalization (kappa = 0.20. When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%. Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used

  18. Criminal correlates of injury-related emergency department recidivism.

    Science.gov (United States)

    Claassen, Cynthia A; Larkin, Gregory Luke; Hodges, Gayle; Field, Craig

    2007-02-01

    To investigate criminal and high-risk lifestyle factors that predict emergency department (ED) recidivism, a longitudinal (8-year) cohort study of ED trauma patients was conducted. Study patients provided risk and lifestyle behavior information via semi-structured interview. ED revisit and re-injury rates for 1995-2003 were acquired through hospital record review. Lifetime criminal arrest data were obtained for each study subject via record linkage from PublicData.com, an internet-based service. The 8-year ED re-visit rate was 47% (75/161), but revisits were more often medical than injury-related (30% vs. 17%, respectively). Over half (58%) of all injured ED patients had a documented arrest history, and arrests were significantly more common in those who came back to the ED for repeat trauma vs. those who did not revisit the ED (70.4% vs. 55.9%, respectively; p violence-related crimes, 23% (37/161) of 98 drug-related offenses, and 17.4% (28/161) of 89 other non-traffic-related crimes. ED recidivism for trauma care was associated with multiple substance abuse behaviors and drug-related arrests. Significant risk factors for ED recidivism seem to be high-risk substance-abuse-related behaviors and criminal activity, constituting important targets for effective ED-based intervention, referral, and follow-up.

  19. Cyclist Injuries Treated in Emergency Department (ED): Consequences and Costs in South-eastern Finland in an Area of 100 000 Inhabitants.

    Science.gov (United States)

    Airaksinen, Noora; Lüthje, Peter; Nurmi-Lüthje, Ilona

    2010-01-01

    In the present study, data of bicycle crashes leading to medical attendance in acute hospital or to death which occurred between June 1(st) 2004 and May 31(st) 2006 were analyzed. The final results consisted of injury data and patient records obtained from Kuusankoski Regional Hospital and from the road accident investigation teams. The total number of cases was 216. The severity of the injuries was classified according to the Abbreviated Injury Scale (2005). The majority of the bicycle crashes considered occurred when the injured was alone, without another party. Crashes were often alcohol-related (31%). Over one third of all cyclists' injuries were head injuries. Only 13% of the injured cyclists wore a helmet. 15% of those who wore a helmet sustained a head injury and, correspondingly, 43% of those who did not. Two bicyclists died. The number of bicycle crashes in the hospital data was at least fourfold compared to the number found in the official police statistics. Systematic collection of data on bicycle crashes in hospital emergency departments should be advanced in order to gain reliable information for prevention.

  20. Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia.

    Science.gov (United States)

    Franklin, Jeffery M; Grunwell, Jocelyn R; Bruce, Alice C; Smith, Robin C; Fitzpatrick, Anne M

    2017-08-01

    Racial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations. To compare asthma features in non-Hispanic black vs white children in Atlanta, Georgia, and determine what clinical features predict future ED use for asthma. Self-reported black and white children 6 to 17 years of age with persistent asthma treated with controller medications completed medical history questionnaires, lung function testing, aeroallergen sensitization testing, and venipuncture. Medical records were reviewed for asthma-related ED visits for 12 months after the initial study visit. A total of 276 children were enrolled. Black children, compared with white children, resided in more disadvantaged zip code areas and were more likely to have public insurance. Black children also had more features of asthma severity and more ED visits during the study period. Predictors of ED use, aside from a previous ED visit, differed by race. After adjustment for socioeconomic status, predictors of ED use in white children included an ED visit in the previous year and sensitization to pets and dust; in black children, predictors included ED use in the previous year, the number of asthma controller medications, forced expiratory volume in 1 second less than 80% predicted, blood eosinophil count greater than 4%, and mold sensitization. Asthma features and ED use differ between black and white children in metropolitan Atlanta. Strategies to eliminate allergen exposure in the home and improve asthma control in these children may require tailoring for different racial groups. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. Austrian visit

    CERN Multimedia

    2003-01-01

    Hans Hoffmann, Director for Technology Transfer and Scientific Computing, and Maria Rauch-Kallat, Minister of Health and Women's Issues, Austria, signing the visitors' book.Maria Rauch-Kallat, Minister of Health and Women's Issues, Austria, was welcomed by Hans Hoffmann, Director for Technology Transfer and Scientific Computing, on her visit to CERN on 19 May 2003. The theme of the visit was Technology Transfer and spin-offs from CERN for medical applications. Maria Rauch-Kallat toured also the installations of ATLAS.

  2. Polish visit

    CERN Multimedia

    2003-01-01

    On 6 October, Professor Michal Kleiber, Polish Minister of Science and Chairman of the State Committee for Scientific Research, visited CERN and met both the current and designated Director General, Luciano Maiani and Robert Aymar. Professor Kleiber visited the CMS and ATLAS detector assembly halls, the underground cavern for ATLAS, and the LHC superconducting magnet string test hall. Michal Kleiber (left), Polish minister of science and Jan Krolikowski, scientist at Warsaw University and working for CMS, who shows the prototypes of the Muon Trigger board of CMS.

  3. The influence of resident seniority on supervised practice in the emergency department

    Science.gov (United States)

    Chiu, I-Min; Syue, Yuan-Jhen; Kung, Chia-Te; Cheng, Fu-Jen; Lee, Chien-Hung; Lin, Yan-Ren; Li, Chao-Jui

    2017-01-01

    Abstract To investigate the influence of resident seniority on supervised clinical practice in the emergency department (ED). This was a retrospective, 1-year cohort study conducted in 5 EDs within Taiwan largest healthcare system. All adult nontrauma visits presenting to the EDs during the day shift between July 1, 2011 and June 30, 2012 were included in the analysis. Visits were divided into supervised (ie, treated by resident under attending physician's supervision) and attending-alone. Supervised visits were further categorized by resident seniority (junior, intermediate, and senior). The decision-making time (door-to-order and door-to-disposition time), patient dispositions (eg, ED observation and hospital admission), and diagnostic tool use (laboratory examination or computed tomography [CT]) were selected as clinical performance indicators. The differences in clinical performance were determined between supervised visits (ie, resident-seniority groups) and attending-alone visits. Junior residents were found to have longer median door-to-order and door-to-disposition time than were the other residents for urgent and nonurgent patients. Furthermore, compared with attending-alone visits, supervised visits with junior residents had a greater odds of ED observation (adjusted odds ratio [aOR], 1.1; 95% CI, 1.07–1.20), while supervised visits with all 3 resident-seniority groups had significantly greater odds of laboratory examinations (junior: aOR, 1.1; 95% CI, 1.03–1.16; intermediate: aOR, 1.1; 95% CI, 1.04–1.15; and senior: aOR, 1.1; 95% CI, 1.05–1.15). As resident seniority increases, less time is needed for decision making in supervised visits. However, compared to attending-alone visits, supervised visits still resulted in greater use of laboratory examinations and delayed patient disposition. PMID:28121953

  4. Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix.

    Science.gov (United States)

    Pines, Jesse M; Zocchi, Mark; Moghtaderi, Ali; Black, Bernard; Farmer, Steven A; Hufstetler, Greg; Klauer, Kevin; Pilgrim, Randy

    2016-08-01

    In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume.

  5. Ill, Itinerant, and Insured: The Top 20 Users of Emergency Departments in Baltimore City

    Directory of Open Access Journals (Sweden)

    Barbara Y. DiPietro

    2012-01-01

    Full Text Available The purpose of this study was to document the clinical and demographic characteristics of the 20 most frequent users of emergency departments (EDs in one urban area. We reviewed administrative records from three EDs and two agencies providing services to homeless people in Baltimore City. The top 20 users accounted for 2,079 visits at the three EDs. Their mean age was 48, and median age was 51. Nineteen patients visited at least 2 EDs, 18 were homeless, and 13 had some form of public insurance. The vast majority of visits (86% were triaged as moderate or high acuity. The five most frequent diagnoses were limb pain (n=9, lack of housing (n=6, alteration of consciousness (n=6, infection with human immunodeficiency virus (HIV (n=5, and nausea/vomiting (n=5. Hypertension, HIV infection, diabetes, substance abuse, and alcohol abuse were the most common chronic illnesses. The most frequent ED users were relatively young, accounted for a high number of visits, used multiple EDs, and often received high triage scores. Homelessness was the most common characteristic of this patient group, suggesting a relationship between this social factor and frequent ED use.

  6. European visit

    CERN Multimedia

    2006-01-01

    The European Commissioner for Science and Research, Janez Potočnik, (on the right) visited the CMS assembly hall accompanied by Jim Virdee, Deputy Spokesman of CMS (on the left), and Robert Aymar, Director-General of CERN. The European Commissioner for Science and Research, Janez Potočnik, visited CERN on Tuesday 31 January. He was welcomed by the Director-General, Robert Aymar, who described the missions and current activities of CERN to him, in particular the realisation of the LHC with its three components: accelerator, detectors, storage and processing of data. The European Commissioner then visited the CMS assembly hall, then the hall for testing the LHC magnets and the ATLAS cavern. During this first visit since his appointment at the end of 2004, Janez Potočnik appeared very interested by the operation of CERN, an example of successful scientific co-operation on a European scale. The many projects (30 on average) that CERN and the European Commission carry out jointly for the benefit of res...

  7. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.

    Science.gov (United States)

    Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy

    2017-08-01

    Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option

  8. Prognostic factors in outcome of angioedema in the emergency department.

    Science.gov (United States)

    Felder, Sarah; Curtis, R Mason; Ball, Ian; Borici-Mazi, Rozita

    2014-01-01

    Angioedema is a transient, localized swelling caused by two distinct mechanisms, mediated by histamine and bradykinin, respectively, although a proportion of cases remain idiopathic. Studies that characterize undifferentiated angioedema presenting in emergency departments (EDs) are limited. This study investigates the presentation patterns of undifferentiated angioedema in the ED based on the presumed mechanism of swelling. Medical records from all ED visits to two tertiary care hospitals from July 2007 to March 2012 were electronically reviewed. Records with documented visible swelling on general inspection and/or fiberoptic laryngoscopy and a diagnostic code for anaphylactic shock, angioneurotic edema, allergy unspecified, defects in the complement system, or unspecified drug adverse effects were included. Demographic, clinical, and outcome data were collected via a standardized form. Data were analyzed descriptively, including frequencies and percentages for categorical data and means and SDs for continuous data. Predictors for admission were identified using multivariate logistic regression models. ED records from 527 visits for angioedema by 455 patients were included in the study. Annual rate of angioedema was 1 per 1000 ED visits. Urticaria was associated with peripheral (p = 0.008) and lip angioedema (p = 0.001), and the absence of urticaria correlated with tongue angioedema (p = 0.001) and trended toward correlation with pharyngeal angioedema (p = 0.056). Significant predictors of admission included nonsteroidal anti-inflammatory drug-induced angioedema (odds ratio [OR], 15.3), epinephrine treatment (OR, 8.34), hypotension (OR, 15.7), multiple-site angioedema (OR, 4.25), and pharyngeal (OR, 1.23) and tongue angioedema (OR, 4.62). Concomitant urticaria was associated with a significant longer stay in the ED (p urticaria correlated with the location of angioedema, need for airway management, length of ED visit, and recurrence. A detailed drug and family

  9. The financial consequences of lost demand and reducing boarding in hospital emergency departments.

    Science.gov (United States)

    Pines, Jesse M; Batt, Robert J; Hilton, Joshua A; Terwiesch, Christian

    2011-10-01

    Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  10. Utility of Procalcitonin (PCT and Mid regional pro-Adrenomedullin (MR-proADM in risk stratification of critically ill febrile patients in Emergency Department (ED. A comparison with APACHE II score

    Directory of Open Access Journals (Sweden)

    Travaglino Francesco

    2012-08-01

    Full Text Available Abstract Background The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. Methods This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient. Results MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P P . MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P  respectively. In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79. Conclusions The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and

  11. Armenian visit

    CERN Multimedia

    2003-01-01

    During his visit to CERN on 4 July 2003, Karen Chshmaritian, Armenian Minister for Trade and Economic Development, toured the ATLAS experimental cavern and assembly hall. From left to right: Aram Kotzinian, from the international organization JINR from Dubna, Marzio Nessi from ATLAS, Karen Chshmaritian, Armenian Minister for Trade and Economic Development, Zohrab Mnatsakanian, Ambassador at the Permanent Mission of the Republic of Armenia to the United Nations in Geneva, Alexandre Sissakian, Vice-Director of JINR and Peter Jenni, ATLAS spokesman.

  12. [Impact of the elderly patient in the emergency department].

    Science.gov (United States)

    Bermúdez Menéndez de la Granda, Manuel; Guzmán Gutiérrez, German; Fernández Fernández, María; Solano Jaurrieta, Juan José

    2017-09-07

    The aging of the population, chronic diseases, and non-urgent visits to the Emergency departments (ED) are considered the reasons for the increase of the demand of care. The aim of this study is to analyse the impact of the older population in the ED, when compared to a younger population. An observational, descriptive and retrospective study including an analysis of the 92,627 patients that attended the ED in Hospitals from Health Area IV belonging to the Principality of Asturias Health Services during 2009. The analysis included the number of visits, degree of urgency when arriving at the ED, length of stay (LOS), destination after ED assessment, demand of care per time of day, laboratory tests, and radiology, complaints, and social services consultation. A comparison was made between the data of patients over and below 70 years of age. At total of 28,965 (31.27%) patients were over 70 years of age, with a frequency rate in the ED of 52.29% (25.70% in those less than 70 years). Patients over 70 years had a higher priority attention through the Manchester triage scale, receiving more laboratory tests, with a higher LOS. They also had a higher probability of being seen by social services, of being admitted, and death. Older patients consult the ED with more justifiable reasons than the younger adult population. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Inform@ed space

    DEFF Research Database (Denmark)

    Bjerrum, Peter; Olsen, Kasper Nefer

    2001-01-01

    Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001.......Inform@ed space Sensorial Perception And Computer Enchancement - bidrag til Nordisk Arkitekturforskningsforenings IT-konference, AAA april 2001....

  14. Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: The elders risk assessment index

    Directory of Open Access Journals (Sweden)

    Chaudhry Rajeev

    2010-12-01

    Full Text Available Abstract Background The prevention of recurrent hospitalizations in the frail elderly requires the implementation of high-intensity interventions such as case management. In order to be practically and financially sustainable, these programs require a method of identifying those patients most at risk for hospitalization, and therefore most likely to benefit from an intervention. The goal of this study is to demonstrate the use of an electronic medical record to create an administrative index which is able to risk-stratify this heterogeneous population. Methods We conducted a retrospective cohort study at a single tertiary care facility in Rochester, Minnesota. Patients included all 12,650 community-dwelling adults age 60 and older assigned to a primary care internal medicine provider on January 1, 2005. Patient risk factors over the previous two years, including demographic characteristics, comorbid diseases, and hospitalizations, were evaluated for significance in a logistic regression model. The primary outcome was the total number of emergency room visits and hospitalizations in the subsequent two years. Risk factors were assigned a score based on their regression coefficient estimate and a total risk score created. This score was evaluated for sensitivity and specificity. Results The final model had an AUC of 0.678 for the primary outcome. Patients in the highest 10% of the risk group had a relative risk of 9.5 for either hospitalization or emergency room visits, and a relative risk of 13.3 for hospitalization in the subsequent two year period. Conclusions It is possible to create a screening tool which identifies an elderly population at high risk for hospital and emergency room admission using clinical and administrative data readily available within an electronic medical record.

  15. Dispelling an urban legend: frequent emergency department users have substantial burden of disease.

    Science.gov (United States)

    Billings, John; Raven, Maria C

    2013-12-01

    Urban legend has often characterized frequent emergency department (ED) patients as mentally ill substance users who are a costly drain on the health care system and who contribute to ED overcrowding because of unnecessary visits for conditions that could be treated more efficiently elsewhere. This study of Medicaid ED users in New York City shows that behavioral health conditions are responsible for a small share of ED visits by frequent users, and that ED use accounts for a small portion of these patients' total Medicaid costs. Frequent ED users have a substantial burden of disease, and they have high rates of primary and specialty care use. They also have linkages to outpatient care that are comparable to those of other ED patients. It is possible to use predictive modeling to identify who will become a repeat ED user and thus to help target interventions. However, policy makers should view reducing frequent ED use as only one element of more-comprehensive intervention strategies for frequent health system users.

  16. Comparison Between Emergency Department and Inpatient Nurses’ Perceptions of Boarding of Admitted Patients

    Directory of Open Access Journals (Sweden)

    Bryce C. Pulliam

    2013-03-01

    Full Text Available Introduction: The boarding of admitted patients in the emergency department (ED is a major causeof crowding and access block. One solution is boarding admitted patients in inpatient ward (Whallways. This study queried and compared ED and W nurses’ opinions toward ED and W boarding.It also assessed their preferred boarding location if they were patients.Methods: A survey administered to a convenience sample of ED and W nurses was performedin a 631-bed academic medical center (30,000 admissions/year with a 68-bed ED (70,000 visits/year. We identified nurses as ED or W, and if W, whether they had previously worked in the ED. Thenurses were asked if there were any circumstances where admitted patients should be boarded inED or W hallways. They were also asked their preferred location if they were admitted as a patient.Six clinical scenarios were then presented, and the nurses’ opinions on boarding based on eachscenario were queried.Results: Ninety nurses completed the survey, with a response rate of 60%; 35 (39% were currentED nurses (cED, 40 (44% had previously worked in the ED (pED. For all nurses surveyed 46(52% believed admitted patients should board in the ED. Overall, 52 (58% were opposed to Wboarding, with 20% of cED versus 83% of current W (cW nurses (P < 0.0001, and 28% of pEDversus 85% of nurses never having worked in the ED (nED were opposed (P < 0.001. If admittedas patients themselves, 43 (54% of all nurses preferred W boarding, with 82% of cED versus33% of cW nurses (P < 0.0001 and 74% of pED versus 34% nED nurses (P = 0.0007. The mostcommonly cited reasons for opposition to hallway boarding were lack of monitoring and patientprivacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existedin all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen,and an intubated, unstable sepsis patient.Conclusion: Inpatient nurses and those who have never worked in

  17. 2 February 2010-Bristol University Vice-Chancellor E. Thomas visiting SM18 hall with Beams Department Head P. Collier and Technology Department Senior Engineer R. Veness; signing the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    Caption for photograph 1239013 from left to right: University of Bristol and CMS Collaboration D. Newbold; University of Bristol Team Leader and LHCb Collaboration N. Brook; Bristol University Pro-Vice-Chancellor for Research G. Orpen; Beams Department Head P. Collier; Bristol University Vice-Chancellor E. Thomas;Technology Department Senior Engineer R. Veness in the SM18 hall.

  18. 28 November 2013 - N. N. Kudryavtsev, Russian Rector of the Moscow Institute of Physics and Technology signing an Agreement and the Guest Book with CERN Director-General R. Heuer; visiting the ATLAS cavern with ATLAS Deputy Spokesperson B. Heinemann and visiting the LHC tunnel at Point 1 with AGH University of Science and Technology A. Erokhin. M. Savino, Physics Department, Joint Institute for Nuclear Research also present.

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    28 November 2013 - N. N. Kudryavtsev, Russian Rector of the Moscow Institute of Physics and Technology signing an Agreement and the Guest Book with CERN Director-General R. Heuer; visiting the ATLAS cavern with ATLAS Deputy Spokesperson B. Heinemann and visiting the LHC tunnel at Point 1 with AGH University of Science and Technology A. Erokhin. M. Savino, Physics Department, Joint Institute for Nuclear Research also present.

  19. Spanish Visit

    CERN Multimedia

    2004-01-01

    On 23 January, CERN welcomed a visit by Pedro Morenés Eulate, Spanish Secretary of State for Scientific and Technological Policy. He was taken on a tour of the LHC Superconducting test facility, the CMS magnet assembly hall and the civil engineering works at Point 5. After a brief presentation on the AMS (Alpha Magnetic Spectrometer) experiment, delivered by Sam Ting, and lunch hosted by Director General Robert Aymar, he continued his tour of the ATLAS assembly hall and the ISOLDE experimental hall. Pedro Morenés finished his visit by meeting with the Spanish scientific community working at CERN. From left to right: Juan-Antonio Rubio, CERN, Responsible for the Education & Communication, Technology transfer and Scientific Information groups; Gonzalo León, General Secretary of the Spanish Ministry; Joaquín Pérez-Villanueva y Tovar, Ambassador, Permanent Representative of Spain to the United Nations Office; Robert Aymar, CERN Director General; Maria-José Garcia-Borge, ISOLDE and NTOF, CSIC Madrid Tea...

  20. Court-ordered emergency visitations for DUI offenders.

    Science.gov (United States)

    Leary, B F

    1991-01-01

    Emergency department (ED) and morgue visits to view the results of accidents have recently been instituted as an alternative sentence for adolescents convicted of driving under the influence of alcohol (DUI). Although many DUI offenders are alcoholic, and educational programs intended to reduce recidivism in adults are generally not effective, scant data exist on adolescent offenders. Initial assessment of 59 of our program participants diagnosed 41% as alcoholic. This finding prompted further participant evaluation to define our population. Fifty-four participants evaluated by self-administered diagnostic questionnaire revealed an alcoholism rate of 54%. Additionally, recidivism rates for alcohol-related moving violations for 176 program participants and matched controls were 28% and 23%, respectively. The significance of these findings represents the serious alcohol problems faced by the study population and indicates that visitation programs are not effective for addressing the problems of alcoholic offenders or in reducing recidivism.

  1. Who uses the emergency department for dermatologic care? A statewide analysis.

    Science.gov (United States)

    Chen, Cynthia L; Fitzpatrick, Laura; Kamel, Hooman

    2014-08-01

    Emergency department (ED) visits for skin symptoms are on the rise. The nature of these visits is not yet well characterized. We sought to conduct a longitudinal analysis comparing patients discharged from the ED with dermatologic primary diagnoses to those with nondermatologic primary diagnoses. Using the California State ED Database, we compared demographic variables and visit characteristics of patients discharged with dermatologic primary diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification codes 680-709) to those of patients discharged with nondermatologic primary diagnoses from 2005 to 2011. Patients given dermatologic primary diagnoses in the ED were more likely to be male, aged 18 to 54 years, white or Native American, and low income. They tended to be self-pay patients or have Medicaid, to live in less populous areas, and to visit the ED on the weekend. Results from California may not be generalizable nationally. The databases we used were based on administrative records, which have limited clinical detail. The population of patients discharged home from the ED with dermatologic primary diagnoses appears to differ significantly from the population receiving nondermatologic primary diagnoses. Copyright © 2014 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  2. Rotavirus-associated hospitalization and emergency department costs and rotavirus vaccine program impact.

    Science.gov (United States)

    Kilgore, April; Donauer, Stephanie; Edwards, Kathryn M; Weinberg, Geoffrey A; Payne, Daniel C; Szilagyi, Peter G; Rice, Marilyn; Cassedy, Amy; Ortega-Sanchez, Ismael R; Parashar, Umesh D; Staat, Mary Allen

    2013-08-28

    To determine the medical costs of laboratory-confirmed rotavirus hospitalizations and emergency department (ED) visits and estimate the economic impact of the rotavirus vaccine program. During 4 rotavirus seasons (2006-2009), children costs were obtained from hospital and physician billing data, and factors associated with increased costs were examined. Annual national costs were estimated using rotavirus hospitalization and ED visit rates and medical costs for rotavirus hospitalizations and ED visits from our surveillance program for pre- (2006-2007) and post-vaccine (2008-2009) time periods. Pre-vaccine, for hospitalizations, the median medical cost per child was $3581, the rotavirus hospitalization rate was 22.1/10,000, with an estimated annual national cost of $91 million. Post-vaccine, the median medical cost was $4304, the hospitalization rate was 6.3/10,000 and the estimated annual national cost was $31 million. Increased costs were associated with study site, age cost per child was $574, the ED visit rate was 291/10,000 resulting in an estimated annual national cost of $192 million. Post-vaccine, the median medical cost was $794, the ED visit rate was 71/10,000 with an estimated annual national cost of $65 million. After implementation of rotavirus immunization, the total annual medical costs decreased from $283 million to $96 million, an annual reduction of $187 million. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

    Science.gov (United States)

    Luniova, Anastasia; Abdelmoity, Ahmed

    2016-01-01

    Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD) on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months' period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED) visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males) were included. Their ages at time of KD initiation were (4.0 ± 2.78) years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p = 0.038). The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs. PMID:27752367

  4. Ketogenic Diet Decreases Emergency Room Visits and Hospitalizations Related to Epilepsy

    Directory of Open Access Journals (Sweden)

    Husam R. Kayyali

    2016-01-01

    Full Text Available Background. Approximately, one-third of patients with epilepsy are refractory to pharmacological treatment which mandates extensive medical care and imposes significant economic burden on patients and their societies. This study intends to assess the impact of the treatment with ketogenic diet (KD on reducing seizure-related emergency room visits and hospitalizations in children with refractory epilepsy. Methods. This is a retrospective review of children treated with the KD in one tertiary center. We compared a 12 months’ period prior to KD with 12 months after the diet was started in regard to the number of emergency department (ED visits, hospitalizations, and hospital days as well as their associated charges. Results. 37 patients (57% males were included. Their ages at time of KD initiation were (4.0±2.78 years. Twelve months after the KD initiation, the total number of ED visits was reduced by 36% with a significant decrease of associated charges (p=0.038. The number of hospital admissions was reduced by 40% and the number of hospital days was reduced by 39%. The cumulative charges showed net cost savings after 9 months when compared to the prediet baseline. Conclusion. In children with refractory epilepsy, treatment with the ketogenic diet reduces the number of ED visits and hospitalizations and their corresponding costs.

  5. EU Commissioner visits CERN

    CERN Multimedia

    2005-01-01

    European Commissioner Viviane Reding in front of one of the computers showing how the Grid works and, from left to right, Robert Aymar, CERN's Director-General, Wolfgang von Rüden, Head of the Information Technology Department, and Bob Jones, the newly appointed director of the EGEE project since 1st November. Viviane Reding, European Commissioner for Information Society and Media, visited CERN on 28 October. Accompanied throughout by CERN's Director-General, Robert Aymar, and the Head of the Information Technology Department, Wolfgang von Rüden, the Commissioner visited the ATLAS cavern before going on to the Information Technology Department, where she was given a complete overview of CERN's activities in the strategic field of Grid computing. Viviane Reding's visit coincided with the end of the EGEE (Enabling Grids for E-sciencE) conference, which took place in Pisa in Italy. Co-ordinated by CERN and funded by the European Commission, the EGEE project aims to set up a worldwide grid infrastructure for sc...

  6. Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

    OpenAIRE

    2012-01-01

    Objective We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). Materials and Methods We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 y...

  7. Effectiveness of organizational interventions to reduce emergency department utilization: a systematic review.

    Directory of Open Access Journals (Sweden)

    Gemma Flores-Mateo

    Full Text Available BACKGROUND: Emergency department (ED utilization has dramatically increased in developed countries over the last twenty years. Because it has been associated with adverse outcomes, increased costs, and an overload on the hospital organization, several policies have tried to curb this growing trend. The aim of this study is to systematically review the effectiveness of organizational interventions designed to reduce ED utilization. METHODOLOGY/PRINCIPAL FINDINGS: We conducted electronic searches using free text and Medical Subject Headings on PubMed and The Cochrane Library to identify studies of ED visits, re-visits and mortality. We performed complementary searches of grey literature, manual searches and direct contacts with experts. We included studies that investigated the effectiveness of interventions designed to reduce ED visits and the following study designs: time series, cross-sectional, repeated cross-sectional, longitudinal, quasi-experimental studies, and randomized trial. We excluded studies on specific conditions, children and with no relevant outcomes (ED visits, re-visits or adverse events. From 2,348 potentially useful references, 48 satisfied the inclusion criteria. We classified the interventions in mutually exclusive categories: 1 Interventions addressing the supply and accessibility of services: 25 studies examined efforts to increase primary care physicians, centers, or hours of service; 2 Interventions addressing the demand for services: 6 studies examined educational interventions and 17 examined barrier interventions (gatekeeping or cost. CONCLUSIONS/SIGNIFICANCE: The evidence suggests that interventions aimed at increasing primary care accessibility and ED cost-sharing are effective in reducing ED use. However, the rest of the interventions aimed at decreasing ED utilization showed contradictory results. Changes in health care policies require rigorous evaluation before being implemented since these can have a high

  8. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    Directory of Open Access Journals (Sweden)

    Jill M. Huded

    2015-12-01

    Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  9. 34 CFR 85.942 - ED Deciding Official.

    Science.gov (United States)

    2010-07-01

    ...) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has delegated authority under the procedures of the Department of Education to decide whether to affirm a suspension or enter a debarment. Authority: E.O. 12549 (3 CFR, 1986 Comp., p. 189), E.O. 12689 ( 3 CFR, 1989 Comp., p...

  10. VA Outpatient Visits by Administrative Parent, FY2010-2014

    Data.gov (United States)

    Department of Veterans Affairs — Outpatient visits by Administrative Parent. A visit is counted as a visit to one or more clinics or units within 1 calendar day at the site of care level. A patient...

  11. Practical implications of implementing emergency department crowding interventions: summary of a moderated panel.

    Science.gov (United States)

    Pines, Jesse M; Pilgrim, Randy L; Schneider, Sandra M; Siegel, Bruce; Viccellio, Peter

    2011-12-01

    Emergency department (ED) crowding continues to be a major public health problem in the United States and around the world. In June 2011, the Academic Emergency Medicine consensus conference focused on exploring interventions to alleviate ED crowding and to generate a series of research agendas on the topic. As part of the conference, a panel of leaders in the emergency care community shared their perspectives on emergency care, crowding, and some of the fundamental issues facing emergency care today. The panel participants included Drs. Bruce Siegel, Sandra Schneider, Peter Viccellio, and Randy Pilgrim. The panel was moderated by Dr. Jesse Pines. Dr. Siegel's comments focused on his work on Urgent Matters, which conducted two multihospital collaboratives related to improving ED crowding and disseminating results. Dr. Schneider focused on the future of ED crowding measures, the importance of improving our understanding of ED boarding and its implications, and the need for the specialty of emergency medicine (EM) to move beyond the discussion of unnecessary visits. Dr. Viccellio's comments focused on several areas, including the need for a clear message about unnecessary ED visits by the emergency care community and potential solutions to improve ED crowding. Finally, Dr. Pilgrim focused on the effect of effective leadership and management in crowding interventions and provided several examples of how these considerations directly affected the success or failure of well-constructed ED crowding interventions. This article describes each panelist's comments in detail.

  12. Emergency department patient satisfaction: customer service training improves patient satisfaction and ratings of physician and nurse skill.

    Science.gov (United States)

    Mayer, T A; Cates, R J; Mastorovich, M J; Royalty, D L

    1998-01-01

    Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. This study investigates the effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive market advantage, as well as improve the patients' perception of quality and outcome.

  13. [A prospective study to assess the burden of influenza-related hospitalizations and emergency department visits among children in Bilbao, Spain (2010-2011)].

    Science.gov (United States)

    Ortiz-Lana, Naiara; Garrote, Elisa; Arístegui, Javier; Rementeria, Joseba; García-Martínez, Juan-Antonio; McCoig, Cynthia; García-Corbeira, Pilar; Devadiga, Raghavendra; Tafalla, Mónica

    2017-03-28

    This study was undertaken to estimate the burden of morbidity associated with laboratory-confirmed influenza in children below 15 years of age. Children presenting with acute respiratory infection and/or isolated fever at the Basurto University Hospital, Bilbao, Spain between November 2010 and May 2011 were included in this study (NCT01592799). Two nasopharyngeal secretion samples were taken from each; one for a rapid influenza diagnostic test in the emergency department, and the second for laboratory analysis using real-time polymerase chain reaction and viral culture. A total of 501 children were recruited, of whom 91 were hospitalized. Influenza diagnosis was confirmed in 131 children (26.1%); 120 of 410 (29.3%) treated as outpatients and 11 of 91 (12.1%) hospitalized children. A total of 370 of 501 children (73.9%) had no laboratory test positive for influenza. The proportion of subjects with other respiratory viruses was 145/501 (28.9%) cases and co-infection with the influenza virus plus another respiratory virus was detected in 7/501 (1.4%) cases. Influenza virus types were: A (H1N1 and H3N2) 53.2% (67/126); B (Victoria and Yamagata) 46.0% (58/126); A+B 0.8% (1/126). The median direct medical costs associated with each case of laboratory-confirmed influenza was €177.00 (N=131). No significant differences were observed between the medical costs associated with influenza A and B. Almost half of the cases were influenza virus B type. The administration of a vaccine containing influenza A and B types to children below 15 years of age might reduce the overall burden of the illness. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  14. The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study.

    Science.gov (United States)

    Grover, Casey A; Crawford, Elizabeth; Close, Reb J H

    2016-11-01

    Case management is an effective short-term means to reduce Emergency Department (ED) visits in frequent users of the ED. Our study aimed to assess the long-term efficacy of intensive case management in frequent users of the ED. This was an observational study of ED usage conducted at a community hospital that has an ED case management program in which frequent users of the ED are enrolled and provided with intensive care management to reduce ED use. We identified 199 patients that were enrolled for 6 or more years. Patients averaged 16 visits per person per year in the year prior to enrollment. Patients averaged the following number of visits per person per year after enrollment: year 1 (7.1), year 2 (4.1), year 3 (3.1), year 4 (3.3), year 5 (3.1), year 6 (2.0), year 7 (2.1), and year 8 (1.9), all statistically significant compared to the year prior to enrollment. Twenty-nine patients, despite case management, continued their frequent use, and required a revision to their plan of care. Five patients required a second revision to their plan of care secondary to recurrent ED usage. Persistent use despite case management was primarily due to prescription medication misuse and chronic pain. Case management of ED frequent users seems to be an effective means to reduce ED usage in both the short and long term. Patients with prescription drug misuse or chronic pain may continue to demonstrate frequent use despite case management, and may require revisions to their plan of care. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. A randomized trial exploring the effect of a telephone call follow-up on care plan compliance among older adults discharged home from the emergency department.

    Science.gov (United States)

    Biese, Kevin; Lamantia, Michael; Shofer, Frances; McCall, Brenda; Roberts, Ellen; Stearns, Sally C; Principe, Stephanie; Kizer, John S; Cairns, Charles B; Busby-Whitehead, Jan

    2014-02-01

    Older patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35 days of the index ED visit and to determine potential cost savings of this intervention. This was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3 days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8 days and 30 to 35 days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up. A total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75 years (standard deviation [SD] ± 7.58 years). Intervention patients were more likely to follow up with medical providers within 5 days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p = 0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35 days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27

  16. Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

    Science.gov (United States)

    Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

    2017-03-01

    To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; pdiet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [pketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Indian President visits CERN

    CERN Multimedia

    Katarina Anthony

    2011-01-01

    On 1 October, her Excellency Mrs Pratibha Devisingh Patil, President of India, picked CERN as the first stop on her official state visit to Switzerland. Accompanied by a host of Indian journalists, a security team, and a group of presidential delegates, the president left quite an impression when she visited CERN’s Point 2!   Upon arrival, Pratibha Patil was greeted by CERN Director General Rolf Heuer, as well as senior Indian scientists working at CERN, and various department directors. After a quick overview of the Organization, Rolf Heuer and the President addressed India’s future collaboration with CERN. India is currently an Observer State of the Organization, and is considering becoming an Associate Member State. A short stop in LHC operations gave Steve Myers and the Accelerator team the opportunity to take the President on a tour through the LHC tunnel. From there, ALICE’s Tapan Nayak and Spokesperson Paolo Giubellino took Pratibha Patil to the experiment&am...

  18. Patient satisfaction with triage nursing in a rural hospital emergency department.

    Science.gov (United States)

    Elder, Regina; Neal, Carolyn; Davis, Barbara A; Almes, Elizabeth; Whitledge, Lynn; Littlepage, Nancy

    2004-01-01

    This study examined what relationships or differences exist between patient and nurse characteristics, satisfaction with triage nurse caring behaviors, general satisfaction with the triage nurse, and intent to return to a rural hospital emergency department (ED). The ED, located at a 401-bed teaching hospital in a small southern city, averages 28,000 visits annually. Samples of ED nurses (N = 11) and ED patients (N = 65) were asked to respond to demographic forms and the Consumer Emergency Care Satisfaction Scale (CECSS) Adapted. Findings indicated that the nurse's acuity rating and the patient's perception of condition had a positive relationship. The patient's perception of condition, patient satisfaction, and caring satisfaction were predictors of intent to return. When patients perceived themselves as seriously ill or injured, they expressed less intent to return to that ED.

  19. Emergency Department of a Rural Hospital in Ecuador

    Directory of Open Access Journals (Sweden)

    Tara Johnson, MD, MPH

    2016-01-01

    Full Text Available Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%, fever (15.1% and trauma (10.8%. Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%, upper extremity radiograph (9.4%, and electrocardiogram (9.0%. There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study

  20. Self-referred patients at the Emergency Department: patient characteristics, motivations, and willingness to make a copayment

    NARCIS (Netherlands)

    J. de Valk (Janneke); E.M. Taal (Elisabeth); M.S. Nijhoff (Mariette); M.H. Harms (Maren); E.M.M. van Lieshout (Esther); P. Patka (Peter); P.P.M. Rood (Pleunie)

    2014-01-01

    textabstractBackground In many countries, including the Netherlands, a substantial number of patients visit the Emergency Department (ED) without a referral by a general practitioner. The goal of this study was to determine the characteristics and motivations of self-referred patients (SRPs) at the

  1. Well-child visits

    Science.gov (United States)

    ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 5. ... Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 32. ...

  2. ED services: the impact of caring behaviors on patient loyalty.

    Science.gov (United States)

    Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth

    2010-09-01

    This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P loyalty but that occurred least frequently. The study showed through factor analysis that some caring

  3. Medical clearance of the psychiatric patient in the emergency department.

    Science.gov (United States)

    Janiak, Bruce D; Atteberry, Suzanne

    2012-11-01

    As part of the emergency department (ED) evaluation of patients with psychiatric complaints, emergency physicians are often asked to perform screening laboratory tests prior to admitting psychiatric patients, the value of which is questionable. To determine if routine screening laboratory studies performed in the ED on patients with a psychiatric chief complaint would alter ED medical clearance (evaluation, management or disposition) of such patients. In this retrospective chart review, the patient charts were reviewed for triage notes, history and physical examination, laboratory study results, and patient disposition. The study investigators subjectively determined if any of the laboratory abnormalities identified after admission would have changed ED management or disposition of the patient had they been identified in the ED. Subjects were 519 consecutive adult patients (18 years of age and older) admitted to the Medical College of Georgia's inpatient psychiatric ward through the ED. There were 502 patients who met inclusion criteria, and 50 of them had completely normal laboratory studies. Laboratory studies were performed in the ED for 148 patients. The most common abnormalities identified were positive urine drug screen (n = 221), anemia (n = 136), and hyperglycemia (n = 139). There was one case (0.19%) identified in which an abnormal laboratory value would have changed ED management or disposition of the patient had it been found during the patient's ED visit. Patients presenting to the ED with a psychiatric chief complaint can be medically cleared for admission to a psychiatric facility by qualified emergency physicians using an appropriate history and physical examination. There is no need for routine medical screening laboratory tests. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Test–retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study

    Directory of Open Access Journals (Sweden)

    Parshall Mark B

    2012-07-01

    Full Text Available Abstract Background Dyspnea is among the most common reasons for emergency department (ED visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. Methods Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154 completed the Multidimensional Dyspnea Profile (MDP several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68. The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP or at the time of administration (“now” MDP. The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach’s alpha. Test–retest reliability was assessed with intraclass correlation coefficients (ICCs for absolute agreement for individual items and domains. Results PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach’s alpha = .89 to .94; Emotional Response, 5 items; Cronbach’s alpha = .81 to .85. Test–retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66 and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively. Conclusions During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for

  5. The Impact of Bundled Payment on Emergency Department Utilization: Alternative Quality Contract Effects After Year One

    Science.gov (United States)

    Sharp, Adam L.; Song, Zirui; Safran, Dana G.; Chernew, Michael E.; Fendrick, A. Mark

    2014-01-01

    Objective Identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield of Massachusetts (BCBS) in 2009, on emergency department (ED) utilization. Methods BCBS claims from 2006–2009 for 332,624 enrollees whose primary care physician (PCP) enrolled in the AQC, and 1,296,399 whose PCP was not enrolled in the AQC were evaluated. We used a pre-post, intervention-control, propensity scored difference-in-difference approach to isolate the AQC effect on ED utilization. The analysis adjusted for age, sex, health status and secular trends to compare ED utilization between the treatment and control groups. Results Overall, secular trends showed ED utilization decreased slightly for both treatment and control groups. The adjusted analysis of the AQC group showed decreases from 0.131 to 0.127 visits per member/quarter, and the control group decreased from 0.157 to 0.152 visits per member/quarter. The difference-in-difference analysis showed the AQC had no statistically significant effect on total ED utilization compared to the control group. Conclusion In its first year, the AQC had no significant effect on ED utilization. Similar global budget programs may not alter ED use in the initial implementation period. PMID:24050802

  6. Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015.

    Science.gov (United States)

    Bemis, Kelley; Frias, Mabel; Patel, Megan Toth; Christiansen, Demian

    Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance. We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016. Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year. Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

  7. A Web Site to Improve Management of Patients with Inherited Bleeding Disorders in the Emergency Department: Results at 2 Years.

    Science.gov (United States)

    Tagliaferri, Annarita; Di Perna, Caterina; Biasoli, Chiara; Rivolta, Gianna Franca; Quintavalle, Gabriele; Cervellin, Gianfranco; Barozzi, Marco; Benedettini, Laura; Pattacini, Corrado

    2016-07-01

    Treatment of patients with inherited bleeding disorders (PWIBD) in the emergency department (ED) is challenging. In 2010, a project was started involving all eight hemophilia centers (HC) and all 44 EDs of the Region of Emilia-Romagna (Italy) to improve emergency care for PWIBD. The project incorporates guidelines for emergency treatment, education for ED staff, and a dedicated Web site providing extensive information, proposing treatments, and sharing data with patients' electronic clinical records. A Web algorithm, accessible to PWIBD as well as ED and HC staff, suggests the first dose of concentrate for each type and severity of bleed or trauma. Following training courses in each ED, the network was activated. During 2012 and 2013, the site was visited 14,000 times, the EDs accessed the Web site 1,739 times, and used the algorithms 206 times. In two reference EDs, triage-assessment and triage-treatment times were reduced in 2013 and 2012 (27/20 and 110/71.5 minutes, respectively) and medical advice from the HC increased (54 vs. 24% cases). The main advantages of this system are better management of patients in ED (shorter triage-to-treatment times) and improved collaboration between HCs and EDs. The most critical point remaining is staff turnover in EDs, necessitating continual training.

  8. PREFACE: EDS2010 Preface

    Science.gov (United States)

    Heggie, Malcolm I.

    2011-03-01

    The biennial international conference on Extended Defects in Semiconductors started in 1978 with a meeting in Hünfeld, Germany. Subsequent meetings rotated between Poland, France, Great Britain, Germany, Russia and Italy, culminating in EDS2004 in Chernogolovka, EDS2006 in Halle and EDS2008 in Poitiers. EDS2010 was held at the University of Sussex at Brighton, UK from September 19th to 24th. An extension of the tabulation of this history, which first appeared on the EDS2006 website, is given in the attached PDF. It is with sadness that we note one of the founders of the series, Prof. Dr Helmut Alexander, passed away on 3 December 2009 and we were proud to dedicate EDS2010 to his memory. It has become a tradition to make an award in his name, and this year it was made to Ivan Isacov for his poster "Electrical levels of dislocation networks in p- and n-type silicon". A short and warm celebration of Prof. Dr Alexander's life by his friends and colleagues, Prof. Drs Helmut Gottschalk, Eicke Weber and Wolfgang Schröter, is included in this volume. The conference was a forum for the state-of-the-art of investigation and modelling of extended defects in semiconductors. Scientists from universities, research institutes and industry made contributions to a deeper understanding of extended defects, their interaction with point defects and their role in the development of semiconductor technology. The remit of the conference included extended defects, nanostructures, nanoparticles, quantum dots and interfaces within semiconducting materials ranging from narrow to wide band gaps, including graphene-derived materials and diamond. Scientific interests range from defect geometry, electronic structure, dynamics, spectroscopy, microscopy, reactions and chemistry to introduction mechanisms, such as implantation and strained layers and the operation of devices such as integrated circuits, heterostructures, and solar cells. The organisers were confronted with a long period between

  9. Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments

    Directory of Open Access Journals (Sweden)

    Baumann, Brigitte M

    2011-05-01

    Full Text Available Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02. Abscess incision and drainage occurred in 225 (57% children, with the lowest rate at the academic pediatric hospital EDs (51% despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92% and the general academic ED (86% were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%, (p<0.0001. At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23% and told to return to the ED for ongoing wound care (65%. Of all sites, the community ED also had the highest percentage of follow-up visits (37

  10. Preventing infections when visiting

    Science.gov (United States)

    ... Dockrell H, Zuckerman M, et al. Hospital infection, sterilization and disinfection. In: Goering R, Dockrell H, Zuckerman M, et al., eds. Mims' Medical Microbiology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap ...

  11. Stroke Risk After Non-Stroke ED Dizziness Presentations: A Population-Based Cohort Study

    Science.gov (United States)

    Kerber, Kevin A.; Zahuranec, Darin B.; Brown, Devin L.; Meurer, William J.; Burke, James F.; Smith, Melinda A.; Lisabeth, Lynda D.; Fendrick, A. Mark; McLaughlin, Thomas; Morgenstern, Lewis B.

    2014-01-01

    Objective Acute stroke is a serious concern in Emergency Department (ED) dizziness presentations. Prior studies, however, suggest that stroke is actually an unlikely cause of these presentations. Lacking are data on short- and long-term follow-up from population-based studies to establish stroke risk after presumed non-stroke ED dizziness presentations. Methods From 5/8/2011 to 5/7/2012, patients ≥ 45 years of age presenting to EDs in Nueces County, Texas, with dizziness, vertigo, or imbalance were identified, excluding those with stroke as the initial diagnosis. Stroke events after the ED presentation up to 10/2/2012 were determined using the Brain Attack Surveillance in Corpus Christi (BASIC) study, which uses rigorous surveillance and neurologist validation. Cumulative stroke risk was calculated using Kaplan-Meier estimates. Results 1,245 patients were followed for a median of 347 days (IQR 230- 436 days). Median age was 61.9 years (IQR, 53.8-74.0 years). After the ED visit, fifteen patients (1.2%) had a stroke. Stroke risk was 0.48% (95% CI, 0.22%-1.07%) at 2 days; 0.48% (95% CI, 0.22%-1.07%) at 7 days; 0.56% (95% CI, 0.27%-1.18%) at 30 days; 0.56% (95% CI, 0.27%-1.18%) at 90 days; and 1.42% (95% CI, 0.85%-2.36%) at 12 months. Interpretation Using rigorous case ascertainment and outcome assessment in a population-based design, we found that the risk of stroke after presumed non-stroke ED dizziness presentations is very low, supporting a non-stroke etiology to the overwhelming majority of original events. High-risk subgroups likely exist, however, because most of the 90-day stroke risk occurred within 2-days. Vascular risk stratification was insufficient to identify these cases. PMID:24788511

  12. Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

    Directory of Open Access Journals (Sweden)

    Chun Nok Lam

    2016-09-01

    Full Text Available Introduction: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital. Methods: We conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions. Results: Study included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino. Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds of hospital readmission, compared to non-homeless, non-mental health (NHNM patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3

  13. CPAFFC Delegation Visits New Zealand

    Institute of Scientific and Technical Information of China (English)

    Xu; Fenghua

    2016-01-01

    In early December 2015,a CPAFFC delegation,with representatives from six departments,visited New Zealand at the host’s invitation.Members conducted work exchanges with the New Zealand-China Maori Friendship Trust and held talks with the

  14. 5 February 2010: Romanian Former Minister of Justice V. Stoica (4th from left) visiting SM18 with, from left to right, University of Bucharest Faculty of Physics A. Costescu, DESY Hamburg C. Diaconu; Mrs Valeriu Stoica; Université de Montpellier II S. Ciulli; Technology Department Vacuum, Surfaces and Coatings group S. Ilie; Technology Department Head F. Bordry and Adviser for Russian Federation, Central and Eastern Europe T. Kurtyka.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    5 February 2010: Romanian Former Minister of Justice V. Stoica (4th from left) visiting SM18 with, from left to right, University of Bucharest Faculty of Physics A. Costescu, DESY Hamburg C. Diaconu; Mrs Valeriu Stoica; Université de Montpellier II S. Ciulli; Technology Department Vacuum, Surfaces and Coatings group S. Ilie; Technology Department Head F. Bordry and Adviser for Russian Federation, Central and Eastern Europe T. Kurtyka.

  15. 6th July 2010 - United Kingdom Science and Technology Facilities Council W. Whitehorn signing the guest book with Head of International relations F. Pauss, visiting the Computing Centre with Information Technology Department Head Deputy D. Foster, the LHC superconducting magnet test hall with Technology Department P. Strubin,the Centre Control Centre with Operation Group Leader M. Lamont and the CLIC/CTF3 facility with Project Leader J.-P. Delahaye.

    CERN Multimedia

    Teams : M. Brice, JC Gadmer

    2010-01-01

    6th July 2010 - United Kingdom Science and Technology Facilities Council W. Whitehorn signing the guest book with Head of International relations F. Pauss, visiting the Computing Centre with Information Technology Department Head Deputy D. Foster, the LHC superconducting magnet test hall with Technology Department P. Strubin,the Centre Control Centre with Operation Group Leader M. Lamont and the CLIC/CTF3 facility with Project Leader J.-P. Delahaye.

  16. The effect of hospital occupancy on emergency department length of stay and patient disposition.

    Science.gov (United States)

    Forster, Alan J; Stiell, Ian; Wells, George; Lee, Alexander J; van Walraven, Carl

    2003-02-01

    Emergency department (ED) overcrowding is a common problem. Despite a widespread belief that low hospital bed availability contributes to ED overcrowding, there are few data demonstrating this effect. To identify the effect of hospital occupancy on ED length of stay for admitted patients and patient disposition. This was an observational study design using administrative data at a 500-bed acute care teaching hospital. All patients presenting to the ED between April 1993 and June 1999 were included in the study. The predictor variable was daily hospital occupancy. Outcome measures included daily ED length of stay for admitted patients, daily consultation rate, and daily admission rate. The models controlled for the average daily age of ED patients and the average daily "arrival density" index, which adjusts for patient volume and clustering of patient arrivals. The average hospital occupancy was 89.7%. On average 155 patients visited the ED daily; 21% were referred to hospital physicians and 19% were admitted. The median ED length of stay for admitted patients was 5 hours 54 minutes (interquartile range 5 hr 12 min to 6 hr 42 min). Daily ED length of stay for admitted patients increased 18 minutes (95% CI = 12 to 24) when there was an absolute increase in occupancy of 10%. The ED length of stay appeared to increase extensively when hospital occupancy exceeded a threshold of 90%. Consultation and admission rates were not influenced by hospital occupancy. Increased hospital occupancy is strongly associated with ED length of stay for admitted patients. Increasing hospital bed availability might reduce ED overcrowding.

  17. Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

    Directory of Open Access Journals (Sweden)

    Keith Boniface

    2011-05-01

    Full Text Available Introduction: To assess characteristics, satisfaction, and disposition of emergency department (ED patients who successfully received ultrasound (US-guided peripheral intravenous (IV access. Methods: This is a prospective observational study among ED patients who successfully received US-guided peripheral IV access by ED technicians. Nineteen ED technicians were taught to use US guidance to obtain IV access. Training sessions consisted of didactic instruction and hands-on practice. The US guidance for IV access was limited to patients with difficult access. After successfully receiving an US-guided peripheral IV, patients were approached by research assistants who administered a 10-question survey. Disposition information was collected after the conclusion of the ED visit by accessing patients’ electronic medical record. Results: In total, 146 surveys were completed in patients successfully receiving US-guided IVs. Patients reported an average satisfaction with the procedure of 9.2 of 10. Forty-two percent of patients had a body mass index (BMI of greater than 30, and 17.8% had a BMI of more than 35. Sixty-two percent reported a history of central venous catheter placement. This patient population averaged 3 ED visits per year in the past year. Fifty-three percent of the patients were admitted. Conclusion: Patients requiring US-guided IVs in our ED are discharged home at the conclusion of their ED visit about half of the time. These patients reported high rates of both difficult IV access and central venous catheter placement in the past. Patient satisfaction with US-guided IVs was very high. These data support the continued use of US-guided peripheral IVs in this patient population. [West J Emerg Med. 2011;12(4:475–477.

  18. Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department.

    Science.gov (United States)

    Horeczko, Timothy; Green, Jeffrey P; Panacek, Edward A

    2014-05-01

    Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness. This was a retrospective analysis of ED visits by adults from 2007 to 2010 in the National Hospital Ambulatory Medical Care Survey (NHAMCS). We estimated the incidence of SIRS using initial ED vital signs and a Bayesian construct to estimate white blood cell count based on test ordering. We report estimates with Bayesian modified credible intervals (mCIs). We used 103,701 raw patient encounters in NHAMCS to estimate 372,844,465 ED visits over the 4-year period. The moderate estimate of SIRS in the ED was 17.8% (95% mCI: 9.7 to 26%). This yields a national moderate estimate of approximately 16.6 million adult ED visits with SIRS per year. Adults with and without SIRS had similar demographic characteristics, but those with SIRS were more likely to be categorized as emergent in triage (17.7% versus 9.9%, pSIRS patients. Traumatic causes of SIRS comprised 10% of presentations; other traditional categories of SIRS were rare. SIRS is very common in the ED. Infectious etiologies make up only a quarter of adult SIRS cases. SIRS may be more useful if modified by clinician judgment when used as a screening test in the rapid identification and assessment of patients with the potential for sepsis. [West J Emerg Med. 2014;15(3):329-336.].

  19. Kofi Annan visits CERN

    CERN Document Server

    Katarina Anthony

    2011-01-01

    On Tuesday 13 September, former Secretary-General of the United Nations and Nobel Peace Laureate Kofi Annan paid a visit to CERN.   Arriving in the early afternoon, Kofi Annan and his family were greeted by Director-General Rolf Heuer on the steps of Building 500. After a quick introduction to the Laboratory, they were whisked off to SM18 for a tour of the LHC’s superconducting magnet test hall, guided by Technology Department Head Frédérick Bordry. After a light lunch in Restaurant 2, Kofi Annan added his signature to CERN’s Guest Book. He is the second UN Secretary-General to add their name to CERN’s roster; his successor Ban Ki-Moon’s visited CERN in 2008.  Kofi Annan was then guided by spokesperson Fabiola Gianotti on a tour of ATLAS’s Visitor Centre. This was an opportunity for some of the younger members of the ATLAS collaboration to meet the former Secretary-General and to answer his questions about the exper...

  20. Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients

    Directory of Open Access Journals (Sweden)

    Durand Anne-Claire

    2012-09-01

    Full Text Available Abstract Background For several decades, overcrowding in emergency departments (EDs has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of “nonurgency”. Results Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1 fulfilled health care needs, (2 barriers to primary care providers (PCPs, and (3 convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1 the problem of defining a nonurgent visit, (2 explanations for patients’ use of EDs for nonurgent complaints, (3 consequences of nonurgent visits, and (4 solutions to counter this tendency. Conclusions Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred. In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed

  1. Abdominal Computed Tomography Utilization and 30‐day Revisitation in Emergency Department Patients Presenting With Abdominal Pain

    National Research Council Canada - National Science Library

    Patterson, Brian W; Venkatesh, Arjun K; AlKhawam, Lora; Pang, Peter S; Carpenter, Christopher R

    2015-01-01

    ...) visitation within 30 days of ED discharge for patients presenting with abdominal pain. A retrospective, observational study was conducted at a single, academic, urban ED with over 85,000 annual visits...

  2. The Impact of Psychiatric Patient Boarding in Emergency Departments

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  3. Modification of the effect of ambient air pollution on pediatric asthma emergency visits: susceptible subpopulations

    Science.gov (United States)

    Strickland, Matthew J; Klein, Mitchel; Flanders, W Dana; Chang, Howard H; Mulholland, James A; Tolbert, Paige E; Darrow, Lyndsey A

    2016-01-01

    Background Children may have differing susceptibility to ambient air pollution concentrations depending on various background characteristics of the children. Methods Using emergency department (ED) data linked with birth records from Atlanta, Georgia, we identified ED visits for asthma or wheeze among children aged 2–16 years from 1 January 2002 through 30 June 2010 (n=109,758). We stratified by preterm delivery, term low birth weight, maternal race, Medicaid status, maternal education, maternal smoking, delivery method, and history of a bronchiolitis ED visit. Population-weighted daily average concentrations were calculated for 1-hour maximum carbon monoxide and nitrogen dioxide; 8-hour maximum ozone; and 24-hour average particulate matter less than 10 microns in diameter, particulate matter less than 2.5 microns in diameter (PM2.5), and the PM2.5 components sulfate, nitrate, ammonium, elemental carbon, and organic carbon, using measurements from stationary monitors. Poisson time-series models were used to estimate rate ratios for associations between three-day moving average pollutant concentrations and daily ED visit counts and to investigate effect-measure modification by the stratification factors. Results Associations between pollutant concentrations and asthma exacerbations were larger among children born preterm and among children born to African American mothers. Stratification by race and preterm status together suggested that both factors affected susceptibility. The largest estimated effect size (for an interquartile-range increase in pollution) was observed for ozone among preterm births to African American mothers: rate ratio=1.138 (95% confidence interval=1.077–1.203). In contrast, the rate ration for the ozone association among full-term births to mothers of other races was 1.025 (0.970–1.083). Conclusions Results support the hypothesis that children vary in their susceptibility to ambient air pollutants. PMID:25192402

  4. Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and Recommendations

    Science.gov (United States)

    Kroll, David S.; Smallwood, Jennifer; Chang, Grace

    2013-01-01

    Objective To better understand how toxicology screening for psychiatric patients in the emergency department (ED) setting affects diagnostic decisions. Methods Retrospective chart review of 439 ED visits of adult patients receiving psychiatry consultations at two hospitals, one an academic medical center (n = 224) and the other a community hospital (n = 220), between July 2008 and February 2009. Clinical, demographic, and ED length of stay (LOS) information was abstracted from the psychiatry consultation notes and the medical records. Results Positive urine toxicology results, when combined with a basic substance abuse history, were not associated independently with a patient’s receiving a substance-related diagnosis as part of the psychiatric assessment. By contrast, a positive blood alcohol level was associated independently with a patient’s receiving one of these diagnoses while a positive alcohol use history was not. Conclusions Urine toxicology screens do not add significant diagnostic value to all ED psychiatric evaluations when combined with standard substance use histories. PMID:23194932

  5. High Feasibility of Empiric HIV Treatment for Patients With Suspected Acute HIV in an Emergency Department.

    Science.gov (United States)

    Jacobson, Kathleen R; Arora, Sanjay; Walsh, Kristin B; Lora, Meredith; Merjavy, Stephen; Livermore, Shanna; Menchine, Michael

    2016-07-01

    Earlier intervention in acute HIV infection limits HIV reservoirs and may decrease HIV transmission. We developed criteria for empiric antiretroviral therapy (ART) in an emergency department (ED) routine HIV screening program. We assessed the feasibility and willingness of patients with suspected acute HIV infection in the ED to begin ART. A suspected acute HIV infection was defined as a positive HIV antigen antibody combination immunoassay with pending HIV-antibody differentiation test results and HIV RNA viral load. During the study period, there were 16 confirmed cases of acute HIV infection: 11 met our criteria for empiric ART and agreed to treatment, 10 were prescribed ART, and 1 left the ED against medical advice without a prescription for ART. Eight patients completed at least one follow-up visit. Empiric HIV treatment in an ED is feasible, well received by patients, and offers a unique entry point into the HIV care continuum.

  6. Ambient Particulate Matter (PM2.5/PM10) Exposure and Emergency Department Visits for Acute Myocardial Infarction in Chaoyang District, Beijing, China During 2014: A Case-Crossover Study

    Science.gov (United States)

    Zhang, Qian; Qi, Weipeng; Yao, Wei; Wang, Mei; Chen, Yiyong; Zhou, Yujie

    2016-01-01

    Background Epidemiology studies have shown a consistently increased risk of acute myocardial infarction (AMI) correlated with particulate matter (PM) exposure. However, little is known about the association with specific AMI subtypes. In this work, we investigated the association between short-term PM exposure and emergency department visits (EDVs) for AMI, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). Methods We based this case-crossover study on 2749 patients from Chaoyang District hospitalized with AMI in Anzhen Hospital during 2014. Meteorological and air pollution data were collected during this period. We used a time-stratified case-crossover design with lag model, adjusted for meteorological conditions and/or other gaseous pollutants, to estimate risk of EDVs for AMI, STEMI, and NSTEMI. We conducted stratified analyses by gender, age, season, and comorbid conditions to examine potential effect modification. Results We found that each 10 µg/m3 increment of PM2.5 concentration (1-day lagged) was associated with an increased risk of EDVs for STEMI (OR 1.05; 95% CI, 1.00–1.11). We found no association of PM2.5 concentration with overall AMI or NSTEMI. No effect modification was found when stratified by gender, season, or comorbid conditions, even though the effect size was larger in patients who were male, smokers, and comorbid with hypertension. Patients aged ≥65 years showed a significantly increased risk of STEMI associated with PM2.5 in the previous day than those aged <65 years. Conclusions Our study indicated a transient effect of short-term PM2.5 exposure on EDVs for STEMI. Patients aged ≥65 years appeared to be particularly susceptible. Our findings suggest that studies of the association between PM exposure and AMI should consider AMI subtypes, lag times, and individual characteristics. PMID:27064131

  7. Cognitive Impairment among Older Adults in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hirschman, Karen

    2011-02-01

    Full Text Available Background: Within the next 30 years, the number of visits older adults will make to emergency departments (EDs is expected to double from 16 million, or 14% of all visits, to 34 million and comprise nearly a quarter of all visits.Objective: The objectives of this study were to determine prevalence rates of cognitive impairment among older adults in the ED and to identify associations, if any, between environmental factors unique to the ED and rates of cognitive impairment.Methods: A cross-sectional observational study of adults 65 and older admitted to the ED of a large, urban, tertiary academic health center was conducted between September 2007 and May 2008. Patients were screened for cognitive impairment in orientation, recall and executive function using the Six-Item Screen (SIS and the CLOX1, clock drawing task. Cognitive impairment among this ED population was assessed and both patient demographics and ED characteristics (crowding, triage time, location of assessment, triage class were compared through adjusted generalized linear models.Results: Forty-two percent (350/829 of elderly patients presented with deficits in orientation and recall as assessed by the SIS. An additional 36% of elderly patients with no impairment in orientation or recall had deficits in executive function as assessed by the CLOX1. In full model adjusted analyses patients were more likely to screen deficits in orientation and recall (SIS if they were 85 years or older (Relative Risk [RR]=1.63, 95% Confidence Interval [95% CI]=1.3-2.07, black (RR=1.85, 95% CI=1.5-2.4 and male (RR=1.42, 95% CI=1.2-1.7. Only age was significantly associated with executive functioning deficits in the ED screened using the clock drawing task (CLOX1 (75-84 years: RR=1.35, 95% CI= 1.2-1.6; 85+ years: RR=1.69, 95% CI= 1.5-2.0.Conclusion: These findings have several implications for patients seen in the ED. The SIS coupled with a clock drawing task (CLOX1 provide a rapid and simple method for

  8. Demographic Analysis of Emergency Department Patients at the Ruijin Hospital, Shanghai

    Directory of Open Access Journals (Sweden)

    Wim Lammers

    2011-01-01

    Full Text Available Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED. The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%, stomach/abdominal pain (15%, vertigo/dizziness (11%, and cough (10%. Following triage, patients were predominantly referred to an internist (41%, neurologist (14%, pulmonologist (11%, or general surgeon (9%. This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.

  9. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

    Directory of Open Access Journals (Sweden)

    Buylaert Walter

    2010-11-01

    Full Text Available Abstract Background Overuse of emergency departments (ED is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

  10. Emergency department crowding: Factors influencing flow

    NARCIS (Netherlands)

    van der Linden, M.C.

    2015-01-01

    This thesis focuses on emergency department (ED) crowding. In the first part (ED crowding in the Netherlands) the current state of EDs regarding patients’ length of stay and ED managers’ experiences of crowding are described. Part two (input factors) contains three studies which describe the case lo

  11. 12 December 2013 - Sir Konstantin Novoselov, Nobel Prize in Physics 2010, signing the guest book with International Relations Adviser E. Tsesmelis; visiting the ATLAS experimental cavern with Spokesperson D. Charlton; in the LHC tunnel with Technology Department Head F. Bordry. I. Antoniadis, CERN Theory Group Leader, accompanies throughout.

    CERN Document Server

    Anna Pantelia

    2013-01-01

    12 December 2013 - Sir Konstantin Novoselov, Nobel Prize in Physics 2010, signing the guest book with International Relations Adviser E. Tsesmelis; visiting the ATLAS experimental cavern with Spokesperson D. Charlton; in the LHC tunnel with Technology Department Head F. Bordry. I. Antoniadis, CERN Theory Group Leader, accompanies throughout.

  12. 5 December 2011 - Chilean President of the Comision Nacional de Investigacion Cientifica y Tecnologica J. M. Aguilera in the ATLAS visitor centre with Adviser J. Salicio Diez and ATLAS Collaboration G. Mikenberg; signing the guest book with Head of International Relations F. Pauss; visiting the LHC superconducting magnet test hall with Department Head F. Bordry.

    CERN Multimedia

    VMO Team

    2011-01-01

    5 December 2011 - Chilean President of the Comision Nacional de Investigacion Cientifica y Tecnologica J. M. Aguilera in the ATLAS visitor centre with Adviser J. Salicio Diez and ATLAS Collaboration G. Mikenberg; signing the guest book with Head of International Relations F. Pauss; visiting the LHC superconducting magnet test hall with Department Head F. Bordry.

  13. 2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2012-01-01

    2 March 2012 - US Google Management Team Executive Chairman E. Schmidt visiting the LHC superconducting magnet test hall with Director for Accelerators and Technology S. Myers and Head of Technology Department F. Bordry; signing the guest book with CERN Director-General R. Heuer.

  14. 30th November 2010 - Norwegian Ministry of Government Administration, Reform and Church Affairs State Secretary R. Valle signing the guest book with Head of International Relations F. Pauss and Director for Research and Scientific Computing S. Bertolucci; visiting CERN Computer Centre with Information Technology Department Head F. Hemmer.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    30th November 2010 - Norwegian Ministry of Government Administration, Reform and Church Affairs State Secretary R. Valle signing the guest book with Head of International Relations F. Pauss and Director for Research and Scientific Computing S. Bertolucci; visiting CERN Computer Centre with Information Technology Department Head F. Hemmer.

  15. 26th August 2010 - World Meteorological Organization Secretary-General M. Jarraud signing the guest book with CERN Director-General R. Heuer and visiting the LHC superconducting magnet test hall with Technology Department Head F. Bordry; throughout accompanied by M. Bona, CERN Relations with International Organisations

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    26th August 2010 - World Meteorological Organization Secretary-General M. Jarraud signing the guest book with CERN Director-General R. Heuer and visiting the LHC superconducting magnet test hall with Technology Department Head F. Bordry; throughout accompanied by M. Bona, CERN Relations with International Organisations

  16. 6 June 2012 - British Member of Parliament for Bromsgrove Parliamentary Private Secretary to George Osborne, Chancellor of the Exchequer S. Javid MP signing the guest book with Adviser E. Tsesmelis and visiting the LHC superconducting magnet test hall with Beams Department Head P. Collier, Head of Operations M. Lamont and Adviser E. Tsesmelis.

    CERN Document Server

    Maximilien Brice

    2012-01-01

    6 June 2012 - British Member of Parliament for Bromsgrove Parliamentary Private Secretary to George Osborne, Chancellor of the Exchequer S. Javid MP signing the guest book with Adviser E. Tsesmelis and visiting the LHC superconducting magnet test hall with Beams Department Head P. Collier, Head of Operations M. Lamont and Adviser E. Tsesmelis.

  17. 16 December 2013 - Hooke Professor of Experimental Physics and Pro Vice Chancellor University of Oxford Prof. I. Walmsley visiting the ATLAS cavern with ATLAS Collaboration Deputy Spokesperson T. Wengler, Physics Department, ATLAS Collaboration P. Wells and Chair, CMS Collaboration Board, Oxford University and Purdue University I. Shipsey

    CERN Multimedia

    Anna Pantelia

    2013-01-01

    16 December 2013 - Hooke Professor of Experimental Physics and Pro Vice Chancellor University of Oxford Prof. I. Walmsley visiting the ATLAS cavern with ATLAS Collaboration Deputy Spokesperson T. Wengler, Physics Department, ATLAS Collaboration P. Wells and Chair, CMS Collaboration Board, Oxford University and Purdue University I. Shipsey

  18. 17 January 2014 - Y. Sakurada Japanese Senior Vice Minister of Education, Culture, Sports, Science and Technology signing the Guest book with CERN Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head J.M. Jiménez. Head of International Relations R. Voss present throughout.

    CERN Multimedia

    Pantelia, Anna

    2014-01-01

    17 January 2014 - Y. Sakurada Japanese Senior Vice Minister of Education, Culture, Sports, Science and Technology signing the Guest book with CERN Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head J.M. Jiménez. Head of International Relations R. Voss present throughout.

  19. 27 June 2012 - Ambassador K. Pierce, Permanent Representative of the United Kingdom of Great Britain and Northern Ireland to the United Nations Office and other international organisations in Geneva visiting the LHC tunnel at Point 5 with Department Head P. Collier and CMS control room with Former Collaboration Spokesperson J. Virdee.

    CERN Document Server

    Laurent Egli

    2012-01-01

    27 June 2012 - Ambassador K. Pierce, Permanent Representative of the United Kingdom of Great Britain and Northern Ireland to the United Nations Office and other international organisations in Geneva visiting the LHC tunnel at Point 5 with Department Head P. Collier and CMS control room with Former Collaboration Spokesperson J. Virdee.

  20. 18 February 2013 - Foundation for Polish Science President M. Zylicz signing the guest book with CERN Director for Research and Scientific Computing S. Bertolucci; visiting the ALICE experimental cavern with K. Safarik and L. Graczykowskind LHC tunnel with Technology Department A. Siemko.

    CERN Multimedia

    Samuel Morier-Genoud

    2013-01-01

    18 February 2013 - Foundation for Polish Science President M. Zylicz signing the guest book with CERN Director for Research and Scientific Computing S. Bertolucci; visiting the ALICE experimental cavern with K. Safarik and L. Graczykowskind LHC tunnel with Technology Department A. Siemko.

  1. 18 December 2013 - P. Kron Chairman and Chief Executive Officer of ALSTOM signing the Guest Book with the Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry. Accompanied by P. Fassnacht throughout.

    CERN Document Server

    Jean-Claude Gadmer

    2013-01-01

    18 December 2013 - P. Kron Chairman and Chief Executive Officer of ALSTOM signing the Guest Book with the Director-General R. Heuer and visiting the LHC tunnel at Point 1 with Technology Department Head F. Bordry. Accompanied by P. Fassnacht throughout.

  2. 14th March 2011 - Australian Senator the Hon. K. Carr Minister for Innovation, Industry, Science and Research in the ATLAS Visitor Centre with Collaboration Spokesperson F. Gianotti,visiting the SM18 area with G. De Rijk,the Computing centre with Department Head F. Hemmer, signing the guest book with Director-General R. Heuer with Head of International relations F. Pauss

    CERN Multimedia

    Jean-claude Gadmer

    2011-01-01

    14th March 2011 - Australian Senator the Hon. K. Carr Minister for Innovation, Industry, Science and Research in the ATLAS Visitor Centre with Collaboration Spokesperson F. Gianotti,visiting the SM18 area with G. De Rijk,the Computing centre with Department Head F. Hemmer, signing the guest book with Director-General R. Heuer with Head of International relations F. Pauss

  3. 1 April 2014 - President of the Parliament of the Principality of Liechtenstein A. Frick and his delegation visiting the LHC tunnel at Point 1 with Technology Department Head J.M. Jiménez and signing the Guest book with CERN Director-General R. Heuer. Deputy Head of International Relations E. Tsesmelis present throughout.

    CERN Document Server

    Pantelia, Anna

    2014-01-01

    1 April 2014 - President of the Parliament of the Principality of Liechtenstein A. Frick and his delegation visiting the LHC tunnel at Point 1 with Technology Department Head J.M. Jiménez and signing the Guest book with CERN Director-General R. Heuer. Deputy Head of International Relations E. Tsesmelis present throughout.

  4. 20th May 2010 - Malaysian Minister for Science, Technology and Innovation H. F: B. H. Yusof signing the guest book with Coordinator for External Relations F. Pauss and CMS Collaboration Deputy Spokesperson A. De Roeck; visiting the LHC superconducting magnet test hall with Technology Department Head F. Bordry; throughout accompanied by CERN Advisers J. Ellis and E. Tsesmelis.

    CERN Document Server

    Maximilien brice

    2010-01-01

    20th May 2010 - Malaysian Minister for Science, Technology and Innovation H. F: B. H. Yusof signing the guest book with Coordinator for External Relations F. Pauss and CMS Collaboration Deputy Spokesperson A. De Roeck; visiting the LHC superconducting magnet test hall with Technology Department Head F. Bordry; throughout accompanied by CERN Advisers J. Ellis and E. Tsesmelis.

  5. 14 November 2013 - Director of Indian Institute of Technology Indore P. Mathur with members of the Indian community working at CERN; visiting the LHC tunnel at Point 2, the ALICE experimental area and SM18 with ALICE Collaboration Spokesperson, Istituto Nazionale Fisica Nucleare P. Giubellino and Technology Department, Accelerator Beam Transfer Group Leader V. Mertens

    CERN Multimedia

    Jean-Claude Gadmer

    2013-01-01

    14 November 2013 - Director of Indian Institute of Technology Indore P. Mathur with members of the Indian community working at CERN; visiting the LHC tunnel at Point 2, the ALICE experimental area and SM18 with ALICE Collaboration Spokesperson, Istituto Nazionale Fisica Nucleare P. Giubellino and Technology Department, Accelerator Beam Transfer Group Leader V. Mertens

  6. 15 January 2010 - Vice-Chancellor & Chief Executive C. Snowden, University of Surrey, United Kingdom and Mrs Snowden visiting ALICE exhibition and experimental undeground area with Collabortion Spokesperson J. Schukraft and Beams Department Head P. Collier; Signature of the guest book with CERN Director-General R. Heuer.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    15 January 2010 - Vice-Chancellor & Chief Executive C. Snowden, University of Surrey, United Kingdom and Mrs Snowden visiting ALICE exhibition and experimental undeground area with Collabortion Spokesperson J. Schukraft and Beams Department Head P. Collier; Signature of the guest book with CERN Director-General R. Heuer.

  7. 1st September 2010 - British Vice-Chancellor, Liverpool University Sir Newby and Lady Newby signing the Guest Book with Head of International Relations F. Pauss; visiting the LHC superconducting magnet test hall with P. Cruikshank; accompanied by Beams Department Head P. Collier and Liverpool University T. Bowcock and P. Allport.

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    1st September 2010 - British Vice-Chancellor, Liverpool University Sir Newby and Lady Newby signing the Guest Book with Head of International Relations F. Pauss; visiting the LHC superconducting magnet test hall with P. Cruikshank; accompanied by Beams Department Head P. Collier and Liverpool University T. Bowcock and P. Allport.

  8. Factors associated with healthcare visits by young children for nontoxic poisoning exposures.

    Science.gov (United States)

    Polivka, Barbara J; Casavant, Marcel; Baker, S David

    2010-12-01

    Poison control centers have been shown to be a cost-effective alternative to healthcare visits for poisoning exposures, yet emergency departments (ED) and urgent care centers (UCC) continue to be frequently accessed for poisoning exposures in young children. We sought to identify predictors of young children who obtain healthcare for a nontoxic poisoning exposure. Poisoning exposure cases for children ≤5 years old who sought ED, UCC, or clinic care between 2001 and 2005 from an urban regional pediatric hospital system were identified from poisoning ICD-9 codes in the hospital administrative data and from a poisoning designation in the National Electronic Injury Surveillance System (NEISS) data. Cases (n = 2,494) were reviewed and categorized as either toxic or nontoxic. Toxic exposures were those with more than minimal potential for clinical effects. Most cases were between 1 and 2 years old, male, White, enrolled in Medicaid, sought ED care, had no referring physician, and brought to the facility by a parent/guardian. Logistic regression analysis revealed that the odds of seeking healthcare for a nontoxic poisoning exposure were significantly greater if the child was African American, enrolled in Medicaid, had a non-medication related poisoning, and was brought to the healthcare site by a parent/guardian. Healthcare costs and unnecessary use of healthcare resources for nontoxic poisoning exposures could be reduced by educating parents and providers of children at high risk for inappropriate healthcare visits for nontoxic poisonings to initially contact the poison control center (1-800-222-1222).

  9. Challenging the dominant logic of Emergency Departments: guidelines from chaos theory.

    Science.gov (United States)

    Chinnis, A; White, K R

    1999-01-01

    Chaos is order without predictability (1 ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one's tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. The mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (2). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.

  10. Problems and barriers of pain management in the emergency department: Are we ever going to get better?

    Directory of Open Access Journals (Sweden)

    Sergey M Motov

    2008-12-01

    Full Text Available Sergey M Motov2, Abu NGA Khan1,21Morgan Stanley Children Hospital of New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY, USA; 2Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USAAbstract: Pain is the most common reason people visit emergency rooms. Pain does not discriminate on the basis of gender, race or age. The state of pain management in the emergency department (ED is disturbing. ED physicians often do not provide adequate analgesia to their patients, do not meet patients’ expectations in treating their pain, and struggle to change their practice regarding analgesia. A review of multiple publications has identified the following causes of poor management of painful conditions in the ED: failure to acknowledge pain, failure to assess initial pain, failure to have pain management guidelines in ED, failure to document pain and to assess treatment adequacy, and failure to meet patient’s expectations. The barriers that preclude emergency physicians from proper pain management include ethnic and racial bias, gender bias, age bias, inadequate knowledge and formal training in acute pain management, opiophobia, the ED, and the ED culture. ED physicians must realize that pain is a true emergency and treat it as such.Keywords: oligoanalgesia, emergency department, pain management

  11. One In Five Inpatient Emergency Department Cases May Lead To Surprise Bills.

    Science.gov (United States)

    Garmon, Christopher; Chartock, Benjamin

    2017-01-01

    A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In 2014, 20 percent of hospital inpatient admissions that originated in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill. Project HOPE—The People-to-People Health Foundation, Inc.

  12. Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States' settings.

    Science.gov (United States)

    Lai, Anita; Tenpenny, Elliott; Nestler, David; Hess, Erik; Stiell, Ian G

    2016-03-01

    Introduction The objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients. This was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses. In total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0). The U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

  13. Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis.

    Science.gov (United States)

    Akenroye, Ayobami T; Baskin, Marc N; Samnaliev, Mihail; Stack, Anne M

    2014-01-01

    Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS). There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge. A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.

  14. ViSIT: Visitor Survey Information Tool

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — ViSIT is an interactive web tool created by USGS to visualize the data collected as part of the National Wildlife Refuge Visitor Survey. The national survey was...

  15. 76 FR 59659 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2011-09-27

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of public meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT or Committee), National Institute of Standards...

  16. 76 FR 29195 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2011-05-20

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of Public Meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT or Committee), National Institute of Standards...

  17. 77 FR 59592 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2012-09-28

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of public meeting. ] SUMMARY: The Visiting Committee on Advanced Technology (VCAT or Committee), National Institute of Standards...

  18. 78 FR 57839 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2013-09-20

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of public meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT or Committee), National Institute of Standards...

  19. 75 FR 60082 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2010-09-29

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of Public Meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT), National Institute of Standards and...

  20. 78 FR 29704 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2013-05-21

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of Public Meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT or Committee), National Institute of Standards...

  1. 76 FR 2662 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2011-01-14

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of partially closed meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT), National Institute of Standards...

  2. 75 FR 28785 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2010-05-24

    ... National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of Partially Closed Meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT), National Institute of Standards...

  3. Differences in access to services in rural emergency departments of Quebec and Ontario.

    Directory of Open Access Journals (Sweden)

    Richard Fleet

    Full Text Available Rural emergency departments (EDs are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher's exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013. There were no significant differences between Quebec and Ontario's local population and small town population density. Quebec's EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001 and most the consultant support and ICU (92% vs 31%, p < .0001. Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.

  4. Quantitative sensory testing measures individual pain responses in emergency department patients

    Directory of Open Access Journals (Sweden)

    Duffy KJ

    2017-05-01

    Full Text Available Kevin J Duffy, Katharyn L Flickinger, Jeffrey T Kristan, Melissa J Repine, Alexandro Gianforcaro, Rebecca B Hasley, Saad Feroz, Jessica M Rupp, Jumana Al-Baghli, Maria L Pacella, Brian P Suffoletto, Clifton W Callaway Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Background: Refining and individualizing treatment of acute pain in the emergency department (ED is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients. Materials and methods: In three studies, we 1 describe performance characteristics of brief quantitative sensory testing (QST in 50 healthy volunteers, 2 test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3 measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT, pressure pain response (PPR, and cold pain tolerance (CPT tests. Results: First, all QST measures had high inter-rater reliability and test–retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16% ED subjects relative to healthy volunteers. In 173 (88% ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen’s dz 0.10–0.19. Verbal pain scores (0–10 for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6 (Cohen’s dz 0.97 but did not covary with the changes in PPT and PPR (r=0.05–0.13. Treatment effects were greatest in ED subjects

  5. Pediatric overtriage as a consequence of the tachycardia responses of children upon ED admission.

    Science.gov (United States)

    Chang, Yu-Che; Ng, Chip-Jin; Wu, Chang-Teng; Chen, Li-Chin; Chen, Jih-Chang; Hsu, Kuang-Hung

    2015-01-01

    Overtriage has been observed among pediatric patients in emergency departments (EDs) under 5-level acuity pediatric triage systems. This study aimed to investigate the causes of overtriage and to provide suggestions for future amendments to such systems. This study has a retrospective follow-up design in which 42000 pediatric patients who were admitted to the ED of the largest medical center in Taiwan between January and December of 2010 were recruited. The study variables included patient demographics, chief concerns, individual vital signs (ie, blood pressure, heart rate, body temperature, respiratory rate, and O2 saturation), triage level, ED final disposition, ED expenses, and total medical expenses. A logistic regression model was applied to explore the causes of overtriage and the effectiveness of a modified acuity system. Approximately 13.6% of the pediatric ED visits were upgraded to acuity level 1 based on vital signs that included heart rate (97.3%). The strength of the trend association (odds ratio) between decreasing acuity urgency (from levels 1 to 5) and hospitalization increased from 0.73 (95% confidence interval, 0.72-0.75) with the Pediatric Triage and Acuity System (Ped-TTAS) to 0.57 (95% confidence interval, 0.55-0.59) with the modified Ped-TTAS, which downgraded acuity levels by excluding the weighting of vital signs. Further validation was accomplished by comparing the trend association between decreasing acuity urgency and total medical expenses (Ped-TTAS: β = -0.13; modified Ped-TTAS: β = -0.18). Heart rate is prone to be affected by emotional responses among pediatric patients in certain specific age groups. Appropriate revisions of the pediatric triage system are suggested. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Design and evaluation of analytical tools for emergency department management based on machine learning techniques

    OpenAIRE

    2016-01-01

    The Spanish National Healthcare System (NHS) is mostly publicly funded and provided. It is considered highly cost-efficient according to international studies based on World Health Organization (WHO) data. However, the contention of healthcare costs increases while maintaining adequate levels of quality of care, is still a largely unsolved problem. In recent years, Emergency Departments (EDs) of specialized care hospitals have been subjected to budget restrictions, increased visits and increa...

  7. Homelessness: patterns of emergency department use and risk factors for re-presentation.

    Science.gov (United States)

    Moore, G; Gerdtz, M F; Hepworth, G; Manias, E

    2011-05-01

    To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31; 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an individual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.

  8. ICU visitation policies.

    Science.gov (United States)

    Cleveland, A M

    1994-09-01

    Critically ill patients need their families more than ever, but rigid policies often restrict family visitation in ICU. Family visitation is not a "privilege" granted by hospitals, it is a necessary adjunct to the therapeutic regimen. Though changing outdated visitation policies can be difficult, it must be done. The clinical nurse specialist can play an important role in planning and implementing needed change.

  9. Evaluating an Alternative to the Emergency Department for Adults in Mental Health Crisis.

    Science.gov (United States)

    Heyland, Michelle; Johnson, Mary

    2017-04-07

    Adults with mental health issues lack clinically indicated options when in crisis. Historically, the emergency department (ED) has been the primary source of intervention largely due to funding cuts and decreased community resources in the USA. The literature highlights drastic mental health funding cuts alongside an increased prevalence of mental illness. A community-based alternative for adults in mental health crises was subsequently developed as a model of crisis care. The program has demonstrated impressive short-term outcomes, typically avoiding ED admissions in over 95% of the clients. This number benefits both the consumers who otherwise rely on the ED and the State of Illinois in terms of cost savings for avoidable ED visits. The current deflection rate only reflects ED admissions deflected on the day of the visit to the crisis respite program. To establish the long-term outcomes for this model, follow-up phone calls were conducted to determine whether or not the individual required an ED visit for a psychiatric reason within 30 days of utilization of the program. The follow-up phone calls began in May and continued for eight weeks. At this time, the data collected were analyzed and the outcomes of the program were further evaluated. Based on the follow-up survey results, the positive long-term outcomes validate this model as a cost-saving and clinically indicated alternative to the ED. Establishing such outcomes was necessary to ensure continued funding and to support establishment of similar models of crisis care.

  10. Safe Handling of Snakes in an ED Setting.

    Science.gov (United States)

    Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

    2017-01-01

    Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED.

  11. Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010

    Directory of Open Access Journals (Sweden)

    Daniel J. Pallin

    2014-05-01

    Full Text Available Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA. The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs and analyze potential quality measures. Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation. Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4% were for skin infection, and 2.7% (2.6-2.9% were first visits for skin infection, with no increase over time (p=0.80. However, anti-CA-MRSA antibiotic use increased, from 61% (56-66% to 74% (71-78% of antibiotic regimens (p<0.001. Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06. Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse. Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse. Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for

  12. Structured classification for ED presenting complaints – from free text field-based approach to ICPC-2 ED application

    Directory of Open Access Journals (Sweden)

    Malmström Tomi

    2012-11-01

    Full Text Available Abstract Background Although there is a major need to record and analyse presenting complaints in emergency departments (EDs, no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification. Methods Presenting complaints in a free text field of ED admissions during a one-year period (n=40610 were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED. Results The presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use. Conclusions ICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.

  13. Systematic review of emergency department crowding: causes, effects, and solutions.

    Science.gov (United States)

    Hoot, Nathan R; Aronsky, Dominik

    2008-08-01

    Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. We conducted a comprehensive PubMed search to identify articles that (1) studied causes, effects, or solutions of ED crowding; (2) described data collection and analysis methodology; (3) occurred in a general ED setting; and (4) focused on everyday crowding. Two independent reviewers identified the relevant articles by consensus. We applied a 5-level quality assessment tool to grade the methodology of each study. From 4,271 abstracts and 188 full-text articles, the reviewers identified 93 articles meeting the inclusion criteria. A total of 33 articles studied causes, 27 articles studied effects, and 40 articles studied solutions of ED crowding. Commonly studied causes of crowding included nonurgent visits, "frequent-flyer" patients, influenza season, inadequate staffing, inpatient boarding, and hospital bed shortages. Commonly studied effects of crowding included patient mortality, transport delays, treatment delays, ambulance diversion, patient elopement, and financial effect. Commonly studied solutions of crowding included additional personnel, observation units, hospital bed access, nonurgent referrals, ambulance diversion, destination control, crowding measures, and queuing theory. The results illustrated the complex, multifaceted characteristics of the ED crowding problem. Additional high-quality studies may provide valuable contributions toward better understanding and alleviating the daily crisis. This structured overview of the literature may help to identify future directions for the crowding research agenda.

  14. A qualitative exploration of which resident skills parents in pediatric emergency departments can assess.

    Science.gov (United States)

    Moreau, Katherine A; Eady, Kaylee; Frank, Jason R; Hamstra, Stanley J; Karwowska, Anna; Murnaghan, Aleisha; Pound, Catherine M; Tse, Sandy; Jabbour, Mona

    2016-11-01

    Residents must strive for excellence in their nontechnical skills (NTS). However, NTS have not traditionally been well-assessed in pediatric emergency departments (EDs). One underutilized assessment strategy is to have parents assess the residents caring for their children. Prior to involving parents in resident assessment, it is essential to identify which NTS parents in pediatric EDs can assess. To explore which resident NTS parents in pediatric EDs can assess. An exploratory qualitative study design was used. It included interviews with faculty members involved in the supervision and assessment of residents in a pediatric ED and residents who had experience working in a pediatric ED, as well as focus groups with parents who had visited a pediatric ED at least twice in the past year. Participants in this study suggested that parents, if provided with the opportunity, can assess residents' communication skills, comfort in a pediatric setting, adaptability, and collaboration. This study demystifies how parents can become involved in the assessment of residents' NTS. The findings will inform the development of assessment strategies and could be used to develop assessment instruments that enable parents to become actively involved in the assessment of residents in pediatric EDs.

  15. The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients.

    Science.gov (United States)

    Sikka, Neal; Carlin, Katrina N; Pines, Jesse; Pirri, Michael; Strauss, Ryan; Rahimi, Faisil

    2012-01-01

    There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.

  16. Access to and Use of Point-of-Care Ultrasound in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Jason L. Sanders

    2015-10-01

    Full Text Available Introduction: Growing evidence supports emergency physician (EP-performed point-of-care ultrasound (PoC US. However, there is a utilization gap between academic emergency departments (ED and other emergency settings. We elucidated barriers to PoC US use in a multistate sample of predominantly non-academic EDs to inform future strategies to increase PoC US utilization, particularly in non-academic centers. Methods: In 2010, we surveyed ED directors in five states (Arkansas, Hawaii, Minnesota, Vermont, and Wyoming; n=242 EDs about general ED characteristics. In four states we determined barriers to PoC US use, proportion of EPs using PoC US, use privileges, and whether EPs can bill for PoC US. Results: Response rates were >80% in each state. Overall, 47% of EDs reported PoC US availability. Availability varied by state, from 34% of EDs in Arkansas to 85% in Vermont. Availability was associated with higher ED visit volume, and percent of EPs who were board certified/board eligible in emergency medicine. The greatest barriers to use were limited training (70%, expense (39%, and limited need (perceived or real (32%. When PoC US was used by EPs, 50% used it daily, 44% had privileges not requiring radiology confirmation, and 34% could bill separately for PoC US. Only 12% of EPs used it ≥80% of the time when placing central venous lines. Conclusion: Only 47% of EDs in our five-state sample of predominantly non-academic EDs had PoC US immediately available. When available, the greatest barriers to use were limited training, expense, and limited need. Recent educational and technical advancements may help overcome these barriers.

  17. 门诊支气管哮喘患者就诊情况分析%Investigation on the visit clinic of outpatients with bronchial asthma in respiratory department

    Institute of Scientific and Technical Information of China (English)

    左震华; 管希周

    2014-01-01

    [ABSTRACT]Objective: To investigate regularity of medical visit and medication of the outpatients with bronchial asthma, in order to provide reference for improving work quality in clinic.Methods: A total of 132 outpatients with bronchial asthma collected from our hospital during January 25, 2013 and May 31, 2013 were investigated. According to the history inquiry and outpatient medical records review, the patients were divided into two groups, regular visit group and intermittent visit group. The education background, frequencies of medical visit, treatment, asthma knowledge education, and pulmonary function test of the patients with bronchial asthma were investigated.Results:There were 76 patients in intermittent visit group, and 56 patients in regular visit group. The main visit reason for irregular visit group was asthma exacerbation. Only 24.2% of the patients regularly received pulmonary function test. The number of patients receiving the asthma education accounted for 42.0%, the numbers of patients with bachelor degree or above in intermittent visit group and regular visit group accounted for 38.1%, 73.2%, respectively. Conclusion: Delayed diagnosis, irregular treatment, and under application of pulmonary function test are common defects in management of asthma. It is important to strengthen the education of asthma for patients and doctor-patient communication to better control the disease.%目的:了解门诊支气管哮喘患者的就诊规律及用药情况等,以期为临床工作质量提高提供参考。方法:对我院呼吸科军人门诊2013年1月25日–5月31日期间就诊的132例支气管哮喘患者进行调查,采用询问病史和复习门诊病历的方法,将调查病例分为两组,一组为规律就诊组,另一组为非规律就诊组。调查内容包括:教育背景、就诊规律、治疗情况、哮喘知识教育、肺功能定期复查情况等。结果:76例患者不规律就诊,56例患者为规律就诊

  18. President of Ecuador visits CERN

    CERN Multimedia

    Rosaria Marraffino

    2014-01-01

    On Friday, 24 October, Dr. Rafael Correa Delgado, President of the Republic of Ecuador, visited CERN.   Visiting Geneva to deliver a lecture at the UN, Ecuadorian President Rafael Correa Delgado seized the chance to have a short but intense visit of the Laboratory. The President was met at LHC Point 1 by the Director for Research and Scientific Computing Sergio Bertolucci, who gave him an introduction to CERN’s activities.He was also introduced to the Director for Accelerators and Technology, Frédérick Bordry, and Department Heads José Miguel Jiménez (TE), Livio Mapelli (PH) and Roberto Saban (EN). President Correa Delgado also met with Martijn Mulders, co-organiser of the CERN Latin America School of High-Energy Physics, which will be held in Ecuador from 4 to 17 March 2015. Shortly after that, he visited the ATLAS experimental cavern which he toured with ATLAS Collaboration Spokesperson David Charlton and Fernando Monticelli of t...

  19. Voluntary Medical Incident Reporting Tool to Improve Physician Reporting of Medical Errors in an Emergency Department

    Directory of Open Access Journals (Sweden)

    Nnaemeka G. Okafor

    2015-12-01

    Full Text Available Introduction: Medical errors are frequently under-reported, yet their appropriate analysis, coupled with remediation, is essential for continuous quality improvement. The emergency department (ED is recognized as a complex and chaotic environment prone to errors. In this paper, we describe the design and implementation of a web-based ED-specific incident reporting system using an iterative process. Methods: A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. Results: The utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012. This is an increase in rate of reported events from 0.07% of all ED visits to 0.44% of all ED visits. In 2012, faculty reported 60% of all incidents, while residents and midlevel providers reported 24% and 16% respectively. The most commonly reported incidents were delays in care and management concerns. Conclusion: Error reporting frequency can be dramatically improved by using a web-based, userfriendly, voluntary, and non-punitive reporting system.

  20. Patients Hospitalized in General Wards via the Emergency Department: Early Identification of Predisposing Factors for Death or Unexpected Intensive Care Unit Admission—A Historical Prospective

    Directory of Open Access Journals (Sweden)

    Thierry Boulain

    2014-01-01

    Full Text Available Background. To identify, upon emergency department (ED admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU admission during the first 15 days of hospitalization on regular wards. Methods. Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model. Results. Among 4,619 included patients, 77 (1.67% target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9 predictors of the target event including the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s. All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model for hospital mortality prediction (death of all causes still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s as risk factors. Conclusion. The “use of oxygen therapy on the ED,” the “current use of psychoactive drug(s”, and the “lack of knowledge of current medications taken by the patients” were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit.

  1. Prospective study of violence against ED workers.

    Science.gov (United States)

    Kowalenko, Terry; Gates, Donna; Gillespie, Gordon Lee; Succop, Paul; Mentzel, Tammy K

    2013-01-01

    Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events. The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity. A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used. Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P stress than the MDs (P stress reduced productivity (P stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Berliner Philarmoniker ATLAS visit

    CERN Multimedia

    ATLAS Collaboration

    2017-01-01

    The Berliner Philarmoniker in on tour through Europe. They stopped on June 27th in Geneva, for a concert at the Victoria Hall. An ATLAS visit was organised the morning after, lead by the ATLAS spokesperson Karl Jakobs (welcome and overview talk) and two ATLAS guides (AVC visit and 3D movie).

  3. Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016.

    Science.gov (United States)

    Lall, Ramona; Abdelnabi, Jasmine; Ngai, Stephanie; Parton, Hilary B; Saunders, Kelly; Sell, Jessica; Wahnich, Amanda; Weiss, Don; Mathes, Robert W

    The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

  4. Rebooting the EdD

    Science.gov (United States)

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  5. EDS becoms CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS announced that it has become an official contributor to CERN openlab. The purpose of the joint project beteween CERN and EDS is to carry out research and development in the field of monitoring, management and operation of grid services." (1 page)

  6. EDS becomes CERN Openlab contributor

    CERN Multimedia

    2007-01-01

    "EDS today announced that it has become an official contributor to CERN openlab. The purpose of the joint project between CERN and EDS is to carry out research and development in the field of monitoring, management and operaiton of grid services." (2/3 page)

  7. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    Science.gov (United States)

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  8. The relationship between emergency department volume and patient complexity.

    Science.gov (United States)

    Hahn, Barry; Zuckerman, Batya; Durakovic, Milazim; Demissie, Seleshi

    2017-08-17

    Forecasting emergency department (ED) visits is a well-studied topic. The importance of understanding the complexity of patients along with the days and times of varying patient volumes is critical for planning medical and ancillary staffing. Though multiple studies stratify their results based on severity of disease, severity was determined by triage status. The goal of this study was to utilize a novel method to evaluate the correlation between daily emergency department patient complexity, based on Current Procedure Terminology (CPT) code, and day of the week. This was a retrospective study of subjects presenting to the ED between January 1, 2010 and December 31, 2015. We identified the correlation between subjects with each CPT code who were evaluated on a specific day of the week and evaluated the day before, the day of and the day after a legal holiday. During the study period 312,550 (48%) male and 336,348 (52%) female subjects were identified. No correlation between daily ED patient complexity, based on CPT code, and day of the week (p=0.75) or any legal holidays were identified. Individual significant differences were noted among day of the week and particular CPT code as well as legal holiday and particular CPT code with no appreciable trend or pattern. There was no correlation between daily ED patient complexity based on CPT code and day of the week or daily ED patient acuity and legal holiday. In light of these data, emergency department staffing and resource allocation patterns may need to be revisited. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department.

    Directory of Open Access Journals (Sweden)

    Hye Won Jeong

    Full Text Available BACKGROUND: Influenza virus infection is a common reason for visits to the emergency department (ED during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS. METHODS: Data from patients suffering from an influenza-like illness (ILI and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010-2011, when IVRAT was not used in the ED, and 2011-2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared. RESULTS: The number of antibiotic prescriptions was significantly lower in 2011-2012 (54/216, 25.0% than in 2010-2011 (97/221, 43.9%; P<0.01. However, the median ED LOS for patients in 2011-2012 was much longer than that of patients in 2010-2011 (213 minutes vs. 257 minutes; P<0.01. During the 2011-2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1% ILI patients with a negative IVRAT result, but to only 7/73 (9.6% patients with a positive IVRAT result (P<0.01. CONCLUSIONS: Performing IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season.

  10. The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department.

    Science.gov (United States)

    Flannery, Dustin D; Stephens, Clare L; Thompson, Amy D

    2016-01-01

    High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors' institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6-10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.

  11. Low-back pain at the emergency department: still not being managed?

    Science.gov (United States)

    Rizzardo, Alessandro; Miceli, Luca; Bednarova, Rym; Guadagnin, Giovanni Maria; Sbrojavacca, Rodolfo; Della Rocca, Giorgio

    2016-01-01

    Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients' demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS), numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis. Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone-naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately €200 in the ED, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days. There is not yet a defined therapeutic care process for the patient with LBP with clear criteria for an ED visit. It is to this end that we need a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient.

  12. A flexible simulation platform to quantify and manage emergency department crowding.

    Science.gov (United States)

    Hurwitz, Joshua E; Lee, Jo Ann; Lopiano, Kenneth K; McKinley, Scott A; Keesling, James; Tyndall, Joseph A

    2014-06-09

    Hospital-based Emergency Departments are struggling to provide timely care to a steadily increasing number of unscheduled ED visits. Dwindling compensation and rising ED closures dictate that meeting this challenge demands greater operational efficiency. Using techniques from operations research theory, as well as a novel event-driven algorithm for processing priority queues, we developed a flexible simulation platform for hospital-based EDs. We tuned the parameters of the system to mimic U.S. nationally average and average academic hospital-based ED performance metrics and are able to assess a variety of patient flow outcomes including patient door-to-event times, propensity to leave without being seen, ED occupancy level, and dynamic staffing and resource use. The causes of ED crowding are variable and require site-specific solutions. For example, in a nationally average ED environment, provider availability is a surprising, but persistent bottleneck in patient flow. As a result, resources expended in reducing boarding times may not have the expected impact on patient throughput. On the other hand, reallocating resources into alternate care pathways can dramatically expedite care for lower acuity patients without delaying care for higher acuity patients. In an average academic ED environment, bed availability is the primary bottleneck in patient flow. Consequently, adjustments to provider scheduling have a limited effect on the timeliness of care delivery, while shorter boarding times significantly reduce crowding. An online version of the simulation platform is available at http://spark.rstudio.com/klopiano/EDsimulation/. In building this robust simulation framework, we have created a novel decision-support tool that ED and hospital managers can use to quantify the impact of proposed changes to patient flow prior to implementation.

  13. A cross-sectional study of the self-report of stress among emergency department patients

    Directory of Open Access Journals (Sweden)

    Nirenberg Ted

    2009-01-01

    Full Text Available Background: There is a lack of information about the prevalence of stress and types of stressors experienced by Emergency Department (ED patients. Objective: The present aim is to study the prevalence of stress, types of stressful situations and the relationship with other health issues within the ED population. Materials and Methods: This is a cross-sectional study performed in an ED at a level-1 urban trauma center for four months. An anonymous survey was offered to adult non critically ill patients who were admitted in the ED. They were divided on the basis of gender, age and level of stress and were asked about their demographics, reasons for their ED visit and health issues including stress, tobacco, alcohol and marijuana use, weight concern and health. Chi-square for the categorical variables and unpaired t-tests for continuous variables were conducted. Results: We interviewed 1797 patients, over 66% reported that they felt stressed on at least a weekly basis, and over 45% indicated that they felt stressed more than twice per week. While both young and old were equally stressed, females reported significantly more stress. Family, finances and work are the most frequently cited stressors. Different age groups reported different types of stressors. Overall, those patients reporting being stressed more frequently reported more high risk behaviors including cigarette and marijuana use and health problems including being overweight, being depressed, and having sleeping problems and chronic fatigue. Conclusions: Considering the high frequency of ED patients that report frequent stress and high risk behaviors, their ED visit may be an excellent opportunity to provide a referral or an intervention for stress reduction.

  14. Electronic Emergency-Department Whiteboards

    DEFF Research Database (Denmark)

    Hertzum, Morten

    2011-01-01

    Purpose. Many emergency departments (EDs) are in a process of transitioning from dry-erase to electronic whiteboards. This study investigates differences in ED clinicians’ perception and assessment of their electronic whiteboards across departments and staff groups and at two points in time. Method....... We conducted a survey consisting of a questionnaire administered when electronic whiteboards were introduced and another questionnaire administered when they had been in use for 8-9 months. The survey involved two EDs and, for reasons of comparison, a paediatric department. Results. The ED...... respondents consider the whiteboard information important to their overview, and they approve of the introduction of electronic whiteboards. With the electronic whiteboards, the ED respondents experience a better overall overview of their work than with dry-erase whiteboards. They also experience...

  15. Expanding The INSPIRED COPD Outreach ProgramTM to the emergency department: a feasibility assessment

    Directory of Open Access Journals (Sweden)

    Gillis D

    2017-05-01

    Full Text Available Darcy Gillis,1 Jillian Demmons,1 Graeme Rocker1,2 1Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada; 2Division of Respirology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80% reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD who avoid hospital admission.Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.Results: Referral rates were 0.5/week. Among eligible patients (n=174 33 (19% were referred of whom 15 (M=4, F=11 enrolled in INSPIRED-ED. Mean (SD age was 68 (7 years, post-bronchdilator FEV1 44.2 (15.5 % predicted, and Medical Research Council (MRC dyspnea score 3.8 (0.41. We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD Care Transition Measure (CTM-3 improved from 8.6 (2.0 to 11.3 (1.3, P=0.0004, and of 14 patients responding 12 (86% found the program very helpful. An additional 34

  16. CPAFFC Delegation Visits Ukraine

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    <正>A3-member delegation led by Su Guang, vice president of the CPAFFC and the China-Ukraine Friendship Association (CUFA), paid a goodwill working visit to Kiev, capital of Ukraine, and Yalta from June 20 to 27.

  17. CPAFFC Delegation Visits Ukraine

    Institute of Scientific and Technical Information of China (English)

    NiuYingli

    2004-01-01

    A3-member delegation led by Su Guang, vice president of the CPAFFC and the ChinaUkraine Friendship Association (CUFA), paid a goodwill working visit to Kiev, capital of Ukraine,and Yalta from June 20 to 27.

  18. Visits from two ministers

    CERN Multimedia

    2005-01-01

    Two ministers have recently paid visits to CERN. On 30 June, Mosibudi Mangena, South Africa's Minister for Science and Technology, was welcomed by CERN's Chief Scientific Officer, Jos Engelen. He also visited the ALICE experiment down at Point 2, accompanied by the ALICE spokesman, Jürgen Schukraft. Physicists from the University of Cape Town are members of the ALICE collaboration. Jürgen Schukraft, ALICE spokesman, accompanies Mosibudi Mangena, South Africa's Minister for Science and Technology. The Vice-Minister-President of the Flemish Government, Fientje Moerman, visited the CMS cavern and assembly hall, followed by Building SM18, where the LHC superconducting magnets are being tested. After lunch with the CERN Management, her visit ended with a tour of the ISOLDE facilities. Fientje Moerman, Flemish Vice-Minister-President, with members of her delegation and the CMS collaboration in front of the CMS detector.

  19. Visit by two Ministers

    CERN Document Server

    2008-01-01

    Last December CERN received visits from two Ministers. Bulgaria’s Deputy Prime Minister and Minister of Science and Education, Daniel Vylchev, visited the CMS experiment in the company of the CMS Spokesman, T. Virdee, and several Bulgarian physicists. From left to right: J. Stamenov, M. Mateev, S. Stavrev, T. Virdee, V. Genchev, the Minister Daniel Vylchev, A. Hristova Vutsova, L. Litov and G. Soultanov. CERN Director-General, Robert Aymar, and Montenegro’s Minister of Education and Science, Slobodan Backović. On 18 December, Robert Aymar welcomed Bulgaria’s Deputy Prime Minister and Minister of Science and Education, Daniel Vylchev. A particular highlight of his visit was a tour of the CMS site, during which he met the many Bulgarian physicists working on the experiment. He also attended a presentation of the LHC Computing Grid and visited the Computer Centre. Bulgaria has been a CERN ...

  20. 77 FR 3232 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2012-01-23

    ... No: 2012-1184] DEPARTMENT OF COMMERCE National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of public meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT...

  1. 78 FR 292 - Visiting Committee on Advanced Technology

    Science.gov (United States)

    2013-01-03

    ...: 2012-31597] DEPARTMENT OF COMMERCE National Institute of Standards and Technology Visiting Committee on Advanced Technology AGENCY: National Institute of Standards and Technology, Department of Commerce. ACTION: Notice of Public Meeting. SUMMARY: The Visiting Committee on Advanced Technology (VCAT or...

  2. Moving toward comprehensive acute heart failure risk assessment in the emergency department: the importance of self-care and shared decision making.

    Science.gov (United States)

    Collins, Sean P; Storrow, Alan B

    2013-08-01

    Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation.

  3. A Successful Visit

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    A state visit to China during the first year in office is unprecedented for a U. S.president, but Barack Obama has made it. Moreover, the fact that President Obama spent four days and three nights of his seven-day visit to four Asian nations in Beijing and Shanghai has demonstrated the importance his administration attaches to China and to Sino-U.S. relations in its global strategy.

  4. Effect of a Multi-Diagnosis Observation Unit on Emergency Department Length of Stay and Inpatient Admission Rate at Two Canadian Hospitals.

    Science.gov (United States)

    Cheng, Amy H Y; Barclay, Neil G; Abu-Laban, Riyad B

    2016-12-01

    Observation units (OUs) have been shown to reduce emergency department (ED) lengths of stay (LOS) and admissions. Most published studies have been on OUs managing single complaints. Our aim was to determine whether an OU reduces ED LOS and hospital admission rates for adults with a variety of presenting complaints. We comparatively evaluated two hospitals in British Columbia, Canada (hereafter ED A and ED B) using a pre-post design. Data were extracted from administrative databases. The post-OU cohort included all adults presenting 6 months after OU implementation. The pre-OU cohort included all adults presenting in the same 6-month period 1 year before OU implementation. There were 109,625 patient visits during the study period. Of the 56,832 visits during the post-OU period (27,512 to ED A and 29,318 to ED B), 1.9% were managed in the OU in ED A and 1.4% in ED B. Implementation was associated with an increase in the median ED LOS at ED A (179.0 min pre vs. 192.0 min post [+13.0 min]; p < 0.001; mean difference -12.5 min, 95% confidence interval [CI] -15.2 to -9.9 min), but no change at ED B (182.0 min pre vs. 182.0 min post; p = 0.55; mean difference +2.0 min, 95% CI -0.7 to +4.7 min). Implementation significantly decreased the hospital admission rate for ED A (17.8% pre to 17.0% post [-0.8%], 95% CI -0.18% to 0.15%; p < 0.05) and did not significantly change the hospital admission rate at ED B (18.9% pre to 18.3% post [-0.6%], 95% CI -1.19% to -0.09%; p = 0.09). A multi-diagnosis OU can reduce hospital admission rate in a site-specific manner. In contrast to previous studies, we did not find that an OU reduced ED LOS. Further research is needed to determine whether OUs can reduce ED overcrowding. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Effects of emergency department expansion on emergency department patient flow.

    Science.gov (United States)

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

    2014-05-01

    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  6. Effect of an emergency department-based electronic system for musculoskeletal consultation on facilitating care for common injuries.

    Science.gov (United States)

    Mears, Simon C; Pantle, Hardin A; Bessman, Edward S; Lifchez, Scott D

    2015-05-01

    Access to musculoskeletal consultation in the emergency department (ED) is a nationwide problem. In addition, consultation from a subspecialist may be delayed or may not be available, which can slow down the ED flow and reduce patient satisfaction. The purpose of this study was to review the 1-year results of a change in the authors' institutional practice to reduce subspecialty consultation for select musculoskeletal problems while still ensuring adequate patient follow-up in orthopedic or plastic surgery clinics for patients not seen by these services in the ED. The authors hypothesized that select injuries could be safely managed in the ED by using an electronic system to ensure appropriate follow-up care. Using Kaizen methodology, a multidisciplinary group (including ED staff, orthopedics, plastic surgery, pediatrics, nursing, radiology, therapy, and administration) met to improve care for select musculoskeletal injuries. A system was agreed on in which ED providers managed select musculoskeletal injuries without subspecialist consultation. Follow-up was organized using an electronic system, which facilitated communication between the ED staff and the secretarial staff of the subspecialist departments. Over a 1-year period, 150 patients were treated using this system. Charts and radiographs were reviewed for missed injuries. Radiographic review revealed 2 missed injuries. One patient had additional back pain and a lumbar spine fracture was found during the subspecialist follow-up visit; it was treated nonoperatively. Another patient appeared to have scapholunate widening on the injury radiograph that was not appreciated in the ED. Of the 150 patients, 51 were seen in follow-up by a subspecialist at the authors' institution. An electronic system to organize follow-up with a subspecialist allowed the ED providers to deliver safe and effective care for simple musculoskeletal injuries. Copyright 2015, SLACK Incorporated.

  7. Pediatric emergency department census during major sporting events.

    Science.gov (United States)

    Kim, Tommy Y; Barcega, Besh B; Denmark, T Kent

    2012-11-01

    Our study attempted to evaluate the effects of major sporting events on the census of a pediatric emergency department (ED) in the United States specifically related to the National Football League Super Bowl, National Basketball Association (NBA) Finals, and Major League Baseball World Series. We performed a retrospective data analysis of our pediatric ED census on the number of visits during major sporting events over a 5-year period. Data during the same period 1 week after the major sporting event were collected for comparison as the control. We evaluated the medians of 2-hour increments around the event start time. Subgroup analysis was performed for games involving the local sporting teams. Our results showed no significant difference in ED census during the sporting events, except in the post 6 to 8 hours of the NBA finals. Subgroup analysis of the Los Angeles Lakers showed the same significant findings in the post 6 to 8 hours of the NBA finals. No major difference in pediatric ED census is observed during the most major sporting events in the United States.

  8. Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics.

    Science.gov (United States)

    Haran, John Patrick; Hayward, Gregory; Skinner, Stephen; Merritt, Chris; Hoaglin, David C; Hibberd, Patricia L; Lu, Shan; Boyer, Edward W

    2014-10-01

    Antibiotic-associated diarrhea (AAD) and Clostridium difficile infection (CDI) are well-known outcomes from antibiotic administration. Because emergency department (ED) visits frequently result in antibiotic use, we evaluated the frequency of AAD/CDI in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring AAD/CDI. This prospective multicenter cohort study enrolled adult patients who received antibiotics in the ED and were discharged with a new prescription for antibiotics. Antibiotic-associated diarrhea was defined as 3 or more loose stools for 2 days or more within 30 days of starting the antibiotic. C difficile infection was defined by the detection of toxin A or B within this same period. We used multivariate logistic regression to assess predictors of developing AAD. We enrolled and followed 247 patients; 45 (18%) developed AAD, and 2 (1%) developed CDI. Patients who received intravenous (IV) antibiotics in the ED were more likely to develop AAD/CDI than patients who did not: 25.7% (95% confidence interval [CI], 17.4-34.0) vs 12.3% (95% CI, 6.8-17.9). Intravenous antibiotics had adjusted odds ratio of 2.73 (95% CI, 1.38-5.43), and Hispanic ethnicity had adjusted odds ratio of 3.04 (95% CI, 1.40-6.58). Both patients with CDI had received IV doses of broad-spectrum antibiotics. Intravenous antibiotic therapy administered to ED patients before discharge was associated with higher rates of AAD and with 2 cases of CDI. Care should be taken when deciding to use broad-spectrum IV antibiotics to treat ED patients before discharge home. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. TechEdSat Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The overall goal of the Technical Education Satellite (TechEdSat) is to employ a small spacecraft to evaluate, demonstrate, and validate two new technologies for...

  10. Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey.

    Science.gov (United States)

    Okunseri, Christopher; Okunseri, Elaye; Xiang, Qun; Thorpe, Joshua M; Szabo, Aniko

    2014-01-01

    The aim of this study was to examine trends and associated factors in the prescription of opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates. We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997-2000 and 2003-2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid analgesics, nonopioid analgesics, or a combination of both, compared with receiving no analgesics for NTDC-related visits. During 1997-2000 and 2003-2007, prescription of opioid analgesics and combinations of opioid and nonopioid analgesics increased, and that of no analgesics decreased over time. The prescription rates for opioid analgesics, nonopioid analgesics, opioid and nonopioid analgesic combinations, and no analgesics for NTDC-related visits in EDs were 43 percent, 20 percent, 12 percent, and 25 percent, respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid analgesics and opioid and nonopioid analgesic combinations. Prescription of opioid analgesics increased over time. ED physicians were more likely to prescribe opioid analgesics and opioid and nonopioid analgesic combinations for NTDC-related visits with reported severe pain. © 2014 American Association of Public Health Dentistry.

  11. Prescription of Opioid and Non-opioid Analgesics for Dental Care in Emergency Departments: Findings from the National Hospital Ambulatory Medical Care Survey

    Science.gov (United States)

    Okunseri, Christopher; Okunseri, Elaye; Xiang, Qun; Thorpe, Joshua M.; Szabo, Aniko

    2014-01-01

    Objective The aim of this study was to examine trends and associated factors in the prescription of opioid analgesics, non-opioid analgesics, opioid and non-opioid analgesic combinations and no analgesics by emergency physicians for nontraumatic dental condition (NTDC)-related visits. Our secondary aim was to investigate whether race/ethnicity is a possible predictor of receiving a prescription for either type of medication for NTDC visits in emergency departments (EDs) after adjustment for potential covariates. Methods We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997–2000 and 2003–2007, and used multinomial multivariate logistic regression to estimate the probability of receiving a prescription for opioid analgesics, non-opioid analgesics, or a combination of both compared to receiving no analgesics for NTDC-related visits. Results During 1997–2000 and 2003–2007, prescription of opioid analgesics and combinations of opioid and non-opioid analgesics increased and that of no analgesics decreased over time. The prescription rates for opioid analgesics, non-opioid analgesics, opioid and non-opioid analgesic combinations and no analgesics for NTDC-related visits in EDs were 43%, 20%, 12% and 25% respectively. Majority of patients categorized as having severe pain received prescriptions for opioids for NTDC-related visits in EDs. After adjusting for covariates, patients with self-reported dental reasons for visit and severe pain had a significantly higher probability of receiving prescriptions for opioid analgesics and opioid and non-opioid analgesic combinations. Conclusion Prescription of opioid analgesics increased over time. ED physicians were more likely to prescribe opioid analgesics and opioid and non-opioid analgesic combinations for NTDC-related visits with reported severe pain. PMID:24863407

  12. Process Improvements to Reform Patient Flow in the Emergency Department.

    Science.gov (United States)

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  13. Course of Untreated High Blood Pressure in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Daniel J Feaster

    2011-05-01

    Full Text Available Introduction: No clear understanding exists about the course of a patient’s blood pressure (BP during an emergency department (ED visit. Prior investigations have demonstrated that BP can be reduced by removing patients from treatment areas or by placing patients supine and observing them for several hours. However, modern EDs are chaotic and noisy places where patients and their families wait for long periods in an unfamiliar environment. We sought to determine the stability of repeated BP measurements in the ED environment. Methods: A prospective study was performed at an urban ED. Research assistants trained and certified in BP measurement obtained sequential manual BPs and heart rates on a convenience sample of 76 patients, beginning with the patient arrival in the ED. Patients were observed through their stay for up to 2 hours, and BP was measured at 10-minute intervals. Data analysis with SAS PROC MIXED (SAS Institute, Cary, North Carolina for regression models with correlated data determined the shape of the curve as BP changed over time. Patients were grouped on the basis of their presenting BP as normal (less than 140/90, elevated (140–160/90–100, or severely elevated (greater than 160/100 for the regression analysis. Results: A statistically significant downward trend in systolic and diastolic BP was observed only for those patients presenting with severely elevated BPs (ie, greater than 160/100. Conclusion: We demonstrate a statistically significant decline in systolic and diastolic BP over time spent in the ED only for patients with severely elevated presenting BPs. [West J Emerg Med. 2011;12(4:421–425.

  14. Impact of an Expeditor on Emergency Department on Patient Throughput

    Directory of Open Access Journals (Sweden)

    Handel, Daniel A

    2011-05-01

    Full Text Available Objective: Our hypothesis was that an individual whose primary role was to assist with patient throughput would decrease emergency department (ED length of stay (LOS, elopements and ambulance diversion. The objective of this study was to measure how the use of an expeditor affected these throughput metrics.Methods: This pre- and post-intervention study analyzed ED patients > 21-years-old between June 2008 and June 2009, at a level one trauma center in an academic medical center with an annual ED census of 40,000 patients. We created the expeditor position as our study intervention in December 2008, by modifying the job responsibilities of an existing paramedic position. An expeditor was on duty from 1PM-1AM daily. The pre-intervention period was June to November 2008, and the post-intervention period was January to June 2009. We used multivariable to assess the impact of the expeditor on throughput metrics after adjusting for confounding variables.Results: We included a total of 13,680 visits in the analysis. There was a significant decrease in LOS after expeditor implementation by 0.4 hours, despite an increased average daily census (109 vs. 121, p<0.001. The expeditor had no impact on elopements. The probability that the ED experienced complete ambulance diversion during a 24-hour period decreased from 55.2% to 16.0% (OR:0.17, 95%CI:0.05-0.67.Conclusion: The use of an expeditor was associated with a decreased LOS and ambulance diversion. These findings suggest that EDs may be able to improve patient flow by using expeditors. This tool is under the control of the ED and does not require larger buy-in, resources, or overall hospital changes. [West J Emerg Med. 2011;12(2:198-203.

  15. NOTE FROM VISITS SERVICE

    CERN Multimedia

    ETT Division; Division ETT; Service des visites

    2000-01-01

    The Visit Service noticed that for many years countries such as Great Britain, Germany, Spain, Portugal, the Netherlands and the Scandinavian countries visit CERN less than other member countries and that is due to the high price of the trip for the students. To improve the situation the Visit Service plans to create a network of 'Family-Accommodation' ('Famille-Accueil') in Geneva and in France nearbywith the aim to facilitate the trip to foreign students especially from the more distant member countries and to encourage them to visit our unique laboratory. We expect this exchange to be an interesting experience for both the students and the welcoming family ('famille d'accueil'). If you are interested in participating in this family network, please fill in the questionnaire below. The questionnaire is to be returned to the Visit Service, Mrs Christine Fromm, e-mail Christine.Fromm@cern.ch.Name: First name: CERN address: E-mail: Portable phone number: Home address...

  16. Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Steffie H A Brouns

    Full Text Available To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS in elderly ED patients (226565 years old and in younger patients (1 consultation during the emergency department visit (odds ratio (OR 3.2, 95% confidence interval (CI 2.3-4.3, a higher number of diagnostic tests (OR 1.2, 95% CI 1.16-1.33 and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0-8.8 and OR 2.3, 95% CI 1.4-3.9. In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4-4.6. Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.

  17. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  18. ATLAS Virtual Visits

    CERN Document Server

    Goldfarb, Steven; The ATLAS collaboration

    2015-01-01

    ATLAS Virtual Visits is a project initiated in 2011 for the Education & Outreach program of the ATLAS Experiment at CERN. Its goal is to promote public appreciation of the LHC physics program and particle physics, in general, through direct dialogue between ATLAS physicists and remote audiences. A Virtual Visit is an IP-based videoconference, coupled with a public webcast and video recording, between ATLAS physicists and remote locations around the world, that typically include high school or university classrooms, Masterclasses, science fairs, or other special events, usually hosted by collaboration members. Over the past two years, more than 10,000 people, from all of the world’s continents, have actively participated in ATLAS Virtual Visits, with many more enjoying the experience from the publicly available webcasts and recordings. We present an overview of our experience and discuss potential development for the future.

  19. Dutch ministerial visit

    CERN Multimedia

    2007-01-01

    Dutch Minister of Education, Culture and Science R. Plasterk (third from left) in the ATLAS cavern with NIKHEF Director F. Linde, CERN Chief Scientific Officer J. Engelen, Ambassador J. van Eenennaam, ATLAS Collaboration Spokesperson P. Jenni, Mission Representative G. Vrielink and ATLAS Magnet Project Leader H. ten Kate.Minister of Education, Culture and Science from the Kingdom of the Netherlands, Ronald Plasterk, visited CERN on 25th October. With Jos Engelen, CERN Scientific Director, as his guide he visited Point 1 of the LHC tunnel and ATLAS, where Nikhef (the national institute for subatomic physics, a Dutch government and university collaboration) constructed all 96 of the largest muon drift chambers in the barrel as well as parts of the magnet system, the inner detector, the DAQ and triggering. Overall the Netherlands contribute 4.5% to the annual CERN budget and the minister’s visit celebrated the contributions of the 79 ...

  20. Visit by two Ministers

    CERN Multimedia

    2007-01-01

    Two European ministers have recently paid visits to CERN. On 11 June, the Austrian Minister for Science and Research, Johannes Hahn, visited the CMS cavern and assembly hall, before being given a tour of the CERN Control Centre. Following a lunch with the Ambassador, he was shown the LHC Computing Grid. His visit was rounded off with meetings with Robert Aymar and with Austrian students working at CERN. The Austrian Minister for Science and Research, Johannes Hahn, and Felicitas Pauss, Deputy Chair of the CMS Collaboration Committee, in front of one of the sections of the CMS detector. Jos Engelen, CERN’s Chief Scientific Officer, Jens Jorgen Gaardhoje, a physicist from the Niels Bohr Institute and a member of the ALICE collaboration, and the Danish Employment Minister, Claus Hjort Frederiksen, in front of the ALICE detector. On 12 June, Claus Hjort Frederiksen, the Danish Employment Minister,...

  1. Factors affecting ED length-of-stay in surgical critical care patients.

    Science.gov (United States)

    Davis, B; Sullivan, S; Levine, A; Dallara, J

    1995-09-01

    To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite.

  2. Use of BPPV processes in Emergency Department Dizziness Presentations: A Population-Based Study

    Science.gov (United States)

    Kerber, Kevin A.; Burke, James F.; Skolarus, Lesli E.; Meurer, William J.; Callaghan, Brian C.; Brown, Devin L.; Lisabeth, Lynda D.; McLaughlin, Thomas J.; Fendrick, A. Mark; Morgenstern, Lewis B.

    2013-01-01

    Objective A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed and cured with the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We aimed to describe the use of these processes in Emergency Departments (ED), to assess for trends in use over time, and to determine provider level variability in use. Design Prospective population-based surveillance study Setting EDs in Nueces County, Texas, January 15, 2008 to January 14, 2011 Subjects and Methods Adult patients discharged from EDs with dizziness, vertigo, or imbalance documented at triage. Clinical information was abstracted from source documents. A hierarchical logistic regression model adjusting for patient and provider characteristics was used to estimate trends in DHT use and provider level variability. Results 3,522 visits for dizziness were identified. A DHT was documented in 137 visits (3.9%). A CRM was documented in 8 visits (0.2%). Among patients diagnosed with BPPV, a DHT was documented in only 21.8% (34 of 156) and a CRM in 3.9% (6 of 156). In the hierarchical model (c statistic = 0.93), DHT was less likely to be used over time (odds ratio, 0.97, 95% CI [0.95, 0.99]) and the provider level explained 50% (ICC, 0.50) of the variance in the probability of DHT use. Conclusion BPPV is seldom examined for, and when diagnosed, infrequently treated in this ED population. DHT use is decreasing over time, and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize management in ED dizziness presentations. PMID:23264119

  3. Smoking, Cardiac Symptoms, and an Emergency Care Visit: A Mixed Methods Exploration of Cognitive and Emotional Reactions

    Directory of Open Access Journals (Sweden)

    Karyn A. Tappe

    2012-01-01

    Full Text Available Emergency departments and hospitals are being urged to implement onsite interventions to promote smoking cessation, yet little is known about the theoretical underpinnings of behavior change after a healthcare visit. This observational pilot study evaluated three factors that may predict smoking cessation after an acute health emergency: perceived illness severity, event-related emotions, and causal attribution. Fifty smokers who presented to a hospital because of suspected cardiac symptoms were interviewed, either in the emergency department (ED or, for those who were admitted, on the cardiac inpatient units. Their data were analyzed using both qualitative and quantitative methodologies to capture the individual, first-hand experience and to evaluate trends over the illness chronology. Reported perceptions of the event during semistructured interview varied widely and related to the individual’s intentions regarding smoking cessation. No significant differences were found between those interviewed in the ED versus the inpatient unit. Although the typical profile was characterized by a peak in perceived illness severity and negative emotions at the time the patient presented in the ED, considerable pattern variation occurred. Our results suggest that future studies of event-related perceptions and emotional reactions should consider using multi-item and multidimensional assessment methods rated serially over the event chronology.

  4. Motocross-associated head and spine injuries in adult patients evaluated in an emergency department.

    Science.gov (United States)

    Silva, Lucas Oliveira J E; Fernanda Bellolio, M; Smith, Elisa M; Daniels, David J; Lohse, Christine M; Campbell, Ronna L

    2017-10-01

    Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED). We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process. A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n=2), subdural hematoma (n=1), subarachnoid hemorrhage (n=4), intraparenchymal hemorrhage (n=3), and diffuse axonal injury (n=3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs. Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. Copyright © 2017. Published by Elsevier Inc.

  5. Why patients self-refer to the Emergency Department: A qualitative interview study.

    Science.gov (United States)

    Kraaijvanger, Nicole; Rijpsma, Douwe; Willink, Lisa; Lucassen, Peter; van Leeuwen, Henk; Edwards, Michael

    2017-06-01

    There have been multiple studies investigating reasons for patients to self-refer to the Emergency Department (ED). The majority made use of questionnaires and excluded patients with urgent conditions. The goal of this qualitative study is to explore what motives patients have to self-refer to an ED, also including patients in urgent triage categories. In a large teaching hospital in the Netherlands, a qualitative interview study focusing on reasons for self-referring to the ED was performed. Self-referred patients were included until no new reasons for attending the ED were found. Exclusion criteria were as follows: not mentally able to be interviewed or not speaking Dutch. Patients who were in need of urgent care were treated first, before being asked to participate. Interviews followed a predefined topic guide. Practicing cyclic analysis, the interview topic guide was modified during the inclusion period. Interviews were recorded on an audio recorder, transcribed verbatim, and anonymized. Two investigators independently coded the information and combined the codes into meaningful clusters. Subsequently, these were categorized into themes to build a framework of reasons for self-referral to the ED. Characteristic quotes were used to illustrate the acquired theoretical framework. Thirty self-referred patients were interviewed. Most of the participants were male (63%), with a mean age of 46 years. Two main themes emerged from the interviews that are pertinent to the patients' decisions to attend the ED: (1) health concerns and (2) practical issues. This study found that there are 2 clearly distinctive reasons for self-referral to the ED: health concerns or practical motives. Self-referral because of practical motives is probably most suitable for strategies that aim to reduce inappropriate ED visits. © 2016 John Wiley & Sons, Ltd.

  6. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

    Science.gov (United States)

    2014-01-01

    Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better

  7. Auger Physicists visit CMS

    CERN Multimedia

    Hoch, Michael

    2012-01-01

    Visit at CERN P5 CMS in the experimental cavern Alan Watson, Auger Spokesperson Emeritus, University of Leeds; Jim Cronin, Nobel Laureate, Auger Spokesperson Emeritus, University of Chicago; Jim Virdee, CMS Former Spokesperson, Imperial College; Jim Matthews, Auger Co-Spokesperson, Louisiana State University

  8. Albert Einstein visits Argentina

    CERN Document Server

    Gangui, A; Gangui, Alejandro; Ortiz, Eduardo L.

    2005-01-01

    This is a detailed, day by day, account of Albert Einstein's activities, both social and scientific, during his 30-day stay in Argentina in 1925, including his lectures on relativity at the various local universities and his visit to the National Academy of Sciences, as follows from his personal Diary of the trip to South-America and other contemporary documents.

  9. CPAFFC Delegation Visits Gabon

    Institute of Scientific and Technical Information of China (English)

    Tang; Ruimin

    2013-01-01

    <正>In March, when warm spring had come and flowers were in bloom, a CPAFFC delegation visited Gabon. It was accorded warm welcome from the Gabon-China Friendship Association (GCFA), with Ms. Pierrette Djouassa, former Procurator General of Gabon and President of the GCFA, leading all her members to greet the delegation at

  10. Pakistan Guest Visit HRC

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Companied by CMEC Beijing representative, Dr. Eng. S.M.Bhutta,a technical advisor of Alternative Energy Development Board (AEDB) in Pakistan, paid a visit to HRC during June 3-5, 2005. Both sides exchanged ideas on micro & small hydropower development, and intended to further strengthen the cooperation in micro & small hydropower fields as to push forward the rural electrification program in Pakistan.

  11. Thomas Kibble visits CERN

    CERN Multimedia

    Rosaria Marraffino

    2014-01-01

    Emeritus Professor Sir Thomas W.B. Kibble, from Imperial College London visited LHC for the first time last week and delivered a colloquium on the genesis of electroweak unification and the Brout-Englert-Higgs mechanism.   From left to right: Jim Virdee, Tiziano Camporesi, Tom Kibble and Austin Ball on the visit to CMS. On his way back from Trieste, where he received the Abdus Salam International Centre for Theoretical Physics' Dirac Medal, Tom Kibble stopped by CERN for his first visit to the LHC. Kibble had a standing invitation from Jim Virdee, former CMS spokesperson, who is also a researcher from Imperial College London. Peter Jenni (left) and Tom Kibble tour the ATLAS detector. (Image: Erwan Bertrand) Kibble made the trip to CERN a family outing and brought along 14 relatives,  including his children and grandchildren. He visited the ATLAS detector with Peter Jenni, its former spokesperson, on Friday 10 October. In the afternoon, Kibble delivered a colloquium in the...

  12. Italian Minister visits CERN

    CERN Multimedia

    2002-01-01

    Passing through Geneva, the Italian Deputy Minister for Productive Activities, Dr. Adolfo Urso, came to visit the SM18 hall where LHC magnets are tested. From left to right: Adolfo Urso, Deputy Minister for Productive Activities, CERN's Roberto Saban, Director General Luciano Maiani, Mario Gerbino, Director General of the Ministry and Lucio Rossi, LHC Main Magnet and Superconductors Group Leader.

  13. Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study.

    Science.gov (United States)

    Liu, Nan; Stone, Patricia W; Schnall, Rebecca

    2016-04-01

    To improve HIV screening rates, New York State in 2010 mandated that all persons 13-64 years receiving health care services, including care in emergency departments (EDs), be offered HIV testing. Little attention has been paid to the effect of screening on patient flow. Time-stamped ED visit data from patients eligible for HIV screening, 7,844 of whom were seen by providers and 767 who left before being seen by providers, were retrieved from electronic health records in one adult ED. During day shifts, 10% of patients left without being seen, and during evening shifts, 5% left without being seen. All patients seen by providers were offered testing, and 6% were tested for HIV. Queuing models were developed to evaluate the effect of HIV screening on ED length of stay, patient waiting time, and rate of leaving without being seen. Base case analysis was conducted using actual testing rates, and sensitivity analyses were conducted to evaluate the impact of increasing the testing rate. Length of ED stay of patients who received HIV tests was 24 minutes longer on day shifts and 104 minutes longer on evening shifts than for patients not tested for HIV. Increases in HIV testing rate were estimated to increase waiting time for all patients, including those who left without being seen. Our simulation suggested that incorporating HIV testing into ED patient visits not only adds to practitioner workload but also increases patient waiting time significantly during busy shifts, which may increase the rate of leaving without being seen. © 2016 Wiley Periodicals, Inc.

  14. Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

    Directory of Open Access Journals (Sweden)

    Marcello Zinelli

    2014-04-01

    Full Text Available The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants’ utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs. The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year, by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4% of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P<0.0001 and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P<0.0001. The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034. Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P<0.001. The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.

  15. [Nurse home visits in France].

    Science.gov (United States)

    Monguillon, Dominique; Gracia, Pierre-Benjamin

    2011-10-01

    Nurse home visits in France. More and more nurses carry out home visits, either as freelance nurses or employees of a nurse home visits service, a home hospital care structure or a nursing care centre. These home visits are both demanded by patients and encouraged by the health authorities. As a consequence, the service is expanding every year.

  16. Low-back pain at the emergency department: still not being managed?

    Directory of Open Access Journals (Sweden)

    Rizzardo A

    2016-02-01

    patient with LBP with clear criteria for an ED visit. It is to this end that we need a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient.Keywords: low-back pain, health policies, emergency department, cost analysis

  17. Hospital Factors Impact Variation in Emergency Department Length of Stay more than Physician Factors

    Science.gov (United States)

    Krall, Scott P.; Cornelius, Angela P.; Addison, J. Bruce

    2014-01-01

    Introduction To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval. Methods We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the “arrival to room” interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary. Results Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of “door to room (waiting room time)”, correlation coefficient (CC) (CC=0.000, p=0.96). “Room to doctor” had a low correlation to “door to room” CC=0.143, while “decision to admitted patients departing the ED time” had a moderate correlation of 0.29 (p <0.001). “New arrivals” (daily patient census) had a strong correlation to longer “door to room” times, 0.657, p<0.001. The “door to discharge” times had a very strong correlation CC=0.804 (p<0.001), to the extended “door to room” time. Conclusion Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The “door to room” interval was a significant component to the variation in “door to discharge” i.e. LOS. The hospital-influenced “admit decision to hospital bed” i.e. hospital inpatient capacity, interval had a correlation to

  18. Identification of women exposed to acute physical intimate partner violence in an emergency department setting in Finland.

    Science.gov (United States)

    Leppäkoski, Tuija; Astedt-Kurki, Päivi; Paavilainen, Eija

    2010-12-01

    Intimate partner violence (IPV) is seen as a serious health risk factor for women with significant acute and long-term health consequences and it affects women from all ethnic and socioeconomic groups. Knowledge of these consequences of IPV may help emergency department (ED) professionals to identify these women and provide them with appropriate care, including information on a variety of community services, and refer those women to such services if necessary. The study aimed to describe the frequency of ED visits by women exposed to physical intimate partner violence as estimated by ED professionals (nurses, practical nurses, emergency medical technicians) and identification of acute IPV. In this study 'partner' is defined as a woman's husband, former husband, current or former cohabitant or partner. This design was used as part of a larger, descriptive, cross-sectional multi-centre and multi-method study. Data were collected from 28 EDs in 13 Finnish hospital districts. Altogether 488 questionnaires were returned, which yielded a response rate of 51%. The data were analysed using descriptive statistics and quantitative content analysis. Findings showed that 48% (n = 231) of the ED professionals reported that they encountered women in IPV relationships at least once a month. Over one-fifth of the ED professionals reported having repeatedly encountered the same women visiting the ED for IPV related injuries. Over half of the participants reported having problems 'often' or 'now and then' when identifying women exposed to IPV. Those with training on IPV estimated that they had identified women exposed to IPV more often. To conclude, the research suggests that improvement of identification of acute IPV requires that training be arranged and jointly agreed written procedures for handling IPV be introduced. © 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.

  19. Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.

    Science.gov (United States)

    Tabit, Corey E; Coplan, Mitchell J; Spencer, Kirk T; Alcain, Charina F; Spiegel, Thomas; Vohra, Adam S; Adelman, Daniel; Liao, James K; Sanghani, Rupa Mehta

    2017-09-01

    Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Real-time demand forecasting in the emergency department.

    Science.gov (United States)

    Jones, Spencer S

    2007-10-11

    Shifts in the supply of and demand for emergency department (ED) services have led to ED overcrowding and make the efficient allocation of ED resources increasingly important. Reliable means of modeling and forecasting the demand for resources are critical to any ED resource planning strategy. Vector Autoregression (VAR) is a flexible multivariate time-series forecasting methodology that is well suited to modeling demand for resources in the ED.

  1. Swiss State Secretary visits CERN

    CERN Multimedia

    2008-01-01

    The new Swiss State Secretary for Education and Research recently visited CERN. Peter Jenni, the spokesperson for ATLAS, gave Mauro Dell’Ambrogio, the new Swiss State Secretary for Education and Research, a tour of ATLAS and the LHC tunnel.On 2 April, the newly appointed Swiss State Secretary for Education and Research, Mauro Dell’Ambrogio, was welcomed to CERN by Director-General Robert Aymar. On arrival the Swiss minister was given a guided tour of ATLAS and the adjoining LHC tunnel by Peter Jenni, the ATLAS spokesperson. Dr Dell’Ambrogio was then greeted by Swiss scientists and attended presentations by young post doc physicists about Swiss contributions to CMS and LHCb, in particular their work concerning hardware contribution and data analysis. There are 120 physicists from Swiss universities working on CERN’s experiments, and many more Swiss people working at CERN in other departments due to Switzerland’s special position as a host state. Also before ...

  2. A royal visit

    CERN Multimedia

    Katarina Anthony

    2014-01-01

    On Wednesday, 21 May, CERN received His Majesty Philippe, King of the Belgians, for a full-day visit of the Laboratory.   From left to right: Tiziano Camporesi, CMS Spokesperson; François Englert, Nobel Prize in Physics 2013; Rolf Heuer, CERN Director-General; His Majesty Philippe, King of the Belgians; Philippe Courard, Belgium's State Secretary for Scientific Policy and Walter Van Doninck, CERN Council Vice-President. Director-General Rolf Heuer welcomed King Philippe to CERN at Point 5 (Cessy). This was to be no small visit, with His Majesty accompanied by a host of diplomats, prominent Belgian physicists - including François Englert - and even members of Belgium's press corps. After quick introductions, the morning began with a tour of the CMS underground experimental area and the LHC tunnel at Point 5, guided by the CMS Collaboration Spokesperson, Tiziano Camporesi, and the Director for Accelerators and Technology, Frédérick Bord...

  3. Belgian Firms Visit CERN

    CERN Document Server

    2001-01-01

    Fifteen Belgian firms visited CERN last 2 and 3 April to present their know-how. Industrial sectors ranging from precision machining to electrical engineering and electronics were represented. And for the first time, companies from the Flemish and Brussels regions of the country joined their Walloon compatriots, who have come to CERN before. The visit was organised by Mr J.-M. Warêgne, economic and commercial attaché at the Belgian permanent mission for the French-speaking region, Mr J. Van de Vondel, his opposite number for the Flemish region, and Mrs E. Solowianiuk, economic and commercial counsellor at the Belgian permanent mission for the Brussels-Capital region.

  4. Romanian President Visits CERN

    CERN Multimedia

    2001-01-01

    Director General Luciano Maiani watches as Romanian President Ion Iliescu signs the CERN guest book. On Friday the 12th of October, Romanian President Ion Iliescu arrived at CERN and was warmly greeted by Director General Luciano Maiani at the steps of building 500. After initial greetings and a general presentation of the laboratory, President Iliescu and his entourage embarked on a whistle stop tour of the CERN facilities. They visited the CMS magnet assembly hall and civil engineering work where presentations were made by CMS spokesperson Michel Della Negra and the ATLAS Tile Calorimeter where the president was introduced to Romanian physicists working here at CERN. Michel Della Negra explains some of the general principles behind CMS to President Iliescu during his visit last week. The Romanian teams working on CERN projects make very visible contributions, for example to the construction of the ATLAS experiment and to the preparation of its eventual scientific exploitation. 'Those of us on the ATLAS ...

  5. Kandinsky College Visits CERN

    CERN Multimedia

    CERN Video productions; Angelos Alexopoulos

    2012-01-01

    This video documents the visit of nine senior high school students of the Kandinsky College in Nijmegen (Netherelands) to CERN. The students visited many of CERN's experimental facilities, took part in a Cloud Chamber workshop, attended talks and roundtable discussions of SpacePart12 and worked on the evaluation of the Microcosm exhibition as part of a school inquiry-based research project. The students and their teacher, Paul de Haas (a participant of the High School Teachers 2012 Programme at CERN) were connected with Prof. Christine Kourkoumelis and George Vasileiadis at the University of Athens and learned hands-on how to analyse real physics events, including Higgs-like ones, from the ATLAS experiment at the LHC using the HYPATIA Applet.

  6. German visits to CERN

    CERN Multimedia

    2007-01-01

    State secretary to Germany's Federal Ministry of Education and Research, Frieder Meyer-Krahmer, with CERN's Director-General Robert Aymar.On 21 February, Professor Frieder Meyer-Krahmer, State Secretary to Germany's Federal Ministry of Education and Research, came to CERN. He visited the ALICE and ATLAS experiments and the computing centre before meeting the CERN's Director-General, some German physicists and members of the top management. The Minister of Science, Research and the Arts of the Baden-Württemberg regional government, Peter Frankenberg, and CERN's Director-General, Robert Aymar, signing an agreement on education. In the background: Sigurd Lettow, CERN's Director of Finance and Human Resources, and Karl-Heinz Meisel, Rector of the Fachhochschule Karlsruhe. The Minister of Science, Research and the Arts of the Baden-Württemberg regional government, Prof. Peter Frankenberg, visited CERN on 23 February. He was accompanied by the Rector of the Fachhochschule Karlsruhe, Prof. Karl-Heinz Meisel, and b...

  7. Mitigating Higher Ed Cyber Attacks

    Science.gov (United States)

    Rogers, Gary; Ashford, Tina

    2015-01-01

    In this presentation we will discuss the many and varied cyber attacks that have recently occurred in the higher ed community. We will discuss the perpetrators, the victims, the impact and how these institutions have evolved to meet this threat. Mitigation techniques and defense strategies will be covered as will a discussion of effective security…

  8. Putin's Visit Bears Fruit

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The Russian President's trip to China marks progress in overall cooperation between the two countries If one word could be used to describe Russian President Vladimir Putin's recent visit to China, it would be "fruitful." During his brief two-day stay, which began March 21, Putin had a compact agenda-he met with his Chinese counterpart, President Hu Jintao, Chinese Premier Wen Jiabao and China's top legis-

  9. On Visiting Our Dead

    Directory of Open Access Journals (Sweden)

    Joanna Clapps Herman

    2013-08-01

    Full Text Available A redefining of the meaning of death and grief: this essay explores a rejection of conventional ideas about mourning and describes the experiences of two daughters after they have lost their beloved father. In the one case, it is an evocation of his spirit that feels like a conversation and, in the other, visits by the father to the daughter through palpable signs.

  10. 3rd February 2011-Science Museum Patrons-Kingdom of Great Britain and Northern Ireland-visiting CMS cavern and LHC Tunnel with A. De Roeck,CMS Collaboration Deputy Spokesperson and M. Lamont,Beams Department, Operation Group Leader

    CERN Multimedia

    Maximilien Brice

    2011-01-01

    The delegation: Mr Ian Blatchford,Director of the Science Museum and NMSI Mrs Susan Fisher,Director of Development, National Museum of Science and Industry (NMSI) Dr Douglas Gurr,Chairman of the Board of Trustees, NMSI Mr Martin Smith,Previous NMSI trustee Mrs Elise Smith,Spouse Mr Michael Wilson,NMSI trustee Mrs Jane Wilson,Spouse Mr Gregg Wilson,Son Dr Ann Coxon,UK Friends of the Science Museum Trustee Mr Nicholas Lewis,Contact of Martin Smith accompanied by P. Wells,Physics Department, ATLAS Inner Detector Group Leader and A. Koek,Communication group (International Arts Development, CERN Cultural Policy and Strategy with the Arts, The Collide Programme)

  11. Spanish Visit to CERN

    CERN Multimedia

    2002-01-01

    Last week CERN was visited by the Spanish Minister of Science and Technology, Josep Piqué i Camps. While here, he was able to visit the ATLAS assembly hall where many items of equipment are being built in collaboration with Spanish academic institutions or firms. These include the vacuum vessels for the ATLAS barrel toroid magnets supplied by the Spanish firm Felguera Construcciones Mechanics. Similarly, the Universidad Autónoma de Madrid is participating in the manufacture of the electromagnetic calorimeter endcaps, while the Barcelona Institute for High Energy Physics and the Valencia IFIC (Instituto de Física Corpuscular) are highly involved in the production of barrel modules for the tile calorimeter. The delegation, accompanied by Spanish scientists at CERN, also visited the LHC superconducting magnet test hall (photo). From left to right: Felix Rodriguez Mateos of CERN LHC Division, Josep Piqué i Camps, Spanish Minister of Science and Technology, César Dopazo, Director-General of CIEMAT (Spanish ...

  12. EUCYS prizewinner visits CERN

    CERN Multimedia

    Jennifer Toes

    2016-01-01

    Young Turkish student Baris Volkan Gürses visited CERN from 4 to 8 July after winning the prize in the 2015 European Contest for Young Scientists (EUCYS).    Baris Volkan Gürses, EUCYS prizewinner, visiting the Microcosm. After winning both regional and national competitions in Turkey, 18-year-old student Baris Volkan Gürses competed against 169 young scientists and was awarded a visit to CERN by EIROforum for his physics project in EUCYS 2015. His project, entitled “Generation of artificial gravity by using electrostatic force for prevention of muscle atrophy and osteoporosis occurring in gravity-free environments”, focused on the design of a mechanism to help with the impact of spaceflight on the human body. “My objective was to eliminate the negative effects of a gravity-free environment on astronauts who stay in space for longer periods of time, like in the International Space Station,” explained Volkan. &...

  13. A boost to visits

    CERN Multimedia

    2005-01-01

    Several guides were rewarded by CERN's Director-General and Secretary-General for their contributions in 2004. Left to right: Géraldine Chuste, the Director-General Robert Aymar, Klaus Batzner, Philippe Moret, Joanna Weng, Alberto Ribon, Head of the Visits Service, Emma Sanders, and the Secretary-General, Maximilian Metzger. Three other guides not in the photograph, Antonio Francano, Christoph Ilgner and Tzanko Spassoff, were also rewarded for their contributions. As every year, the CERN Visits Service has paid tribute to its guides, all of whom are volunteers and devote some of their time to showing people around their Laboratory. The guides were invited to a get-together in Microcosm during which the Director-General, Robert Aymar, expressed his special gratitude for their efforts and presented awards to the most dedicated among them. He encouraged members of the Laboratory to become guides and underlined that 2004 had been an exceptional year for visits, which had risen by 15% to almost 22,000. Including ...

  14. Serbian President visits CERN

    CERN Document Server

    Katarina Anthony

    2012-01-01

    On Tuesday 10 January, Serbian President Boris Tadić visited the Laboratory to sign the Agreement of granting the status of Associate Membership as the pre-stage to full Membership of CERN.    Before the signing ceremony, the President, welcomed by Director-General Rolf Heuer at CERN’s Point 5, took the opportunity to visit CERN. After a general introduction, the President took advantage of the shutdown to visit the LHC’s underground caverns. Leading the President through their respective experiments were spokespersons Fabiola Gianotti (ATLAS) and Joe Incandela (CMS).  After a morning of tours, President Tadić and Rolf Heuer signed the Agreement. Serbia’s status as an Associate Member as pre-stage to full Membership is expected to come into force following ratification by the Serbian Parliament. After a maximum period of five years, the CERN Council will decide on the admission of Serbia to full Membership. This new agreement continues Serbia&a...

  15. Nurses' evaluation of a new formalized triage system in the emergency department - a qualitative study

    DEFF Research Database (Denmark)

    Johansen, Mette Brehm; Forberg, Jakob Lundager

    2011-01-01

    Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED.......Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED....

  16. Thermally Induced Silane Dehydrocoupling on Silicon Nanostructures (International ed.)

    Science.gov (United States)

    2016-07-29

    Arkles Gelest Inc. 11 East Steel Rd., Morrisville, PA 19067 (USA) Y. W. Jun, Prof. Dr. K. H. Ahn Department of Chemistry Pohang University of Science...Figure 1a) and elemental analysis by energy-dispersive X-ray (EDS) analysis revealed strong carbon and oxygen signals (Table S2). By contrast, a

  17. 8 June 2010 - South Dakota Governor M. Rounds signing the guest book with External Relations Office Adviser R. Voss, visiting the LHC superconducting Magnet test hall with Technology Department L. Bottura, in the CERN Control Centre with Beams Department Head P. Collier, ATLAS visitor Centre with Deputy Collaboration Spokesperson A. Lankford and visiting CMS Control Centre with Deputy Collaboration Spokesperson J. Incandela. LHC Communications and FNAL member K. Yurkewicz accompanies throughout (see complete delegation list below).

    CERN Multimedia

    Teams (M. Brice/J.C. Gadmer)

    2010-01-01

    CERN-HI-1006100 24: from left to right: Permanent Mission Representative A. Shybut; External Relations Office Adviser R. Voss; LHC Communications and FNAL K. Yurkewicz, Washington CSG Director for internationl programmes S. Sutcliffe-Stephenson; Technology Department Representative L. Bottura; South Dakota State Patrol D. Svendsen; CSG Executive Director and Former State Senator from Kansas D. Atkins;Office of the First Lady L. Svendsen; Office of the Governor K. Mueller; First Lady J. Rounds; South Dakota Governor M. Rounds; Washington State Senator T. Eide;Judge M. Eide; Assemblyman J. Oceguera and G. Oceguera (with son Jackson Oceguera, 5 months).

  18. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue?

    Science.gov (United States)

    Chang, Wen; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Liu, Hsueh-Erh; Han, Chin-Yen

    2016-10-01

    Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.

  19. "How much will I get charged for this?" Patient charges for top ten diagnoses in the emergency department.

    Directory of Open Access Journals (Sweden)

    Nolan Caldwell

    Full Text Available OBJECTIVES: We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED. METHODS: We conducted a cross-sectional study of the 2006-2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18-64 patients with a single discharge diagnosis. RESULTS: We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from $740 (95% CI $651-$817 for an upper respiratory infection to $3437 (95% CI $2917-$3877 for a kidney stone. The median charge for all ten outpatient conditions in the ED was $1233 (95% CI $1199- $1268, with a high degree of charge variability. All diagnoses had an interquartile range (IQR greater than $800 with 60% of IQRs greater than $1550. CONCLUSION: Emergency department charges for common conditions are expensive with high charge variability. Greater acute care charge transparency will at least allow patients and providers to be aware of the emergency department charges patients may face in the current health care system.

  20. The Effect of Anthrax Bioterrorism on Emergency Department Presentation

    Directory of Open Access Journals (Sweden)

    Rodriguez, Robert M

    2005-01-01

    Full Text Available Study Objective: From September through December 2001, 22 Americans were diagnosed with anthrax, prompting widespread national media attention and public concern over bioterrorism. The purpose of this study was to determine the effect of the threat of anthrax bioterrorism on patient presentation to a West Coast emergency department (ED. Methods: This survey was conducted at an urban county ED in Oakland, CA between December 15, 2001 and February 15, 2002. During random 8-hour blocks, all adult patients presenting for flu or upper respiratory infection (URI symptoms were surveyed using a structured survey instrument that included standard visual numerical and Likert scales. Results: Eighty-nine patients were interviewed. Eleven patients (12% reported potential exposure risk factors. Eighty percent of patients watched television, read the newspaper, or listened to the radio daily, and 83% of patients had heard about anthrax bioterrorism. Fifty-five percent received a chest x-ray, 10% received either throat or blood cultures, and 28% received antibiotics. Twenty-one percent of patients surveyed were admitted to the hospital. Most patients were minimally concerned that they may have contracted anthrax (mean=3.3±3.3 where 0=no concern and 10=extremely concerned. Patient concern about anthrax had little influence on their decision to visit the ED (mean=2.8±3.0 where 0=no influence and 10=greatly influenced. Had they experienced their same flu or URI symptoms one year prior to the anthrax outbreak, 91% of patients stated they would have sought medical attention. Conclusions: After considerable exposure to media reports about anthrax, most patients in this urban West Coast ED population were not concerned about anthrax infection. Fear of anthrax had little effect on decisions to come to the ED, and most would have sought medical help prior to the anthrax outbreak.

  1. Perfil dos atendimentos a acidentes de transporte terrestre por serviços de emergência em São Paulo, 2005 Perfil de las atenciones a accidentes de transporte terrestre por servicios de emergencia en São Paulo, 2005 Land transport injuries among emergency department visits in the state of São Paulo, in 2005

    Directory of Open Access Journals (Sweden)

    Vilma Pinheiro Gawryszewski

    2009-04-01

    : Entre las prioridades para la reducción de las lesiones relacionadas al transporte terrestre deben figurar medidas dirigidas para la protección de los usuarios vulnerables del sistema.OBJECTIVE: To analyze the characteristics of visits resulting from land transport injuries. METHODS: A total of 5,934 visits in four hospital emergency departments (ED were analyzed, in the state of São Paulo, in 2005. A questionnaire based on the following three models was used to collect data: World Health Organization (WHO, Center for Disease Control and Prevention (CDC, and Pan American Health Organization (PAHO. Variables analyzed were as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist, sex, age group, and type of injury suffered. Logistic regression analysis was employed to test associations between variables. Odds ratios with their respective 95% confidence intervals were calculated. RESULTS: The majority of victims were males (74.2% in the 20-to-29-year age group (35.0%. Vulnerable road users totaled 72.4% of all cases (29.8% were motorcyclists, 24.1% pedestrians, and 18.5% cyclists. Victims aged between zero and 14 years who had suffered injuries were mostly pedestrians and cyclists; motorcyclists predominated among those aged between 15 and 39 years; and pedestrians among those aged over 50 years. About half of the cases suffered minor injuries (strains, dislocations, contusions and cuts, while the other half was comprised by fractures, traumatic brain injuries and internal injuries. Extremities were the most affected body parts, particularly among motorcyclists. The majority of victims were discharged at triage (87.6%. Compared to women, men were 1.5 times more likely to be admitted or transferred, or to die. Pedestrians, vehicle occupants and motorcyclists were, respectively, 2.7, 2.4 and 1.9 times more likely to be admitted or transferred, or to die than cyclists. CONCLUSIONS: Measures aimed to protect vulnerable road users should be

  2. Execution of diagnostic testing has a stronger effect on emergency department crowding than other common factors: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Takahisa Kawano

    Full Text Available STUDY OBJECTIVE: We compared the effects of execution of diagnostic tests in the emergency department (ED and other common factors on the length of ED stay to identify those with the greatest impacts on ED crowding. METHODS: Between February 2010 and January 2012, we conducted a cross-sectional, single-center study in the ED of a large, urban, teaching hospital in Japan. Patients who visited the ED during the study period were enrolled. We excluded (1 patients scheduled for admission or pharmaceutical prescription, and (2 neonates requiring intensive care transferred from other hospitals. Multivariate linear regression was performed on log-transformed length of ED stay in admitted and discharged patients to compare influence of diagnostic tests and other common predictors. To quantify the range of change in length of ED stay given a unit change of the predictor, a generalized linear model was used for each group. RESULTS: During the study period, 55,285 patients were enrolled. In discharged patients, laboratory blood tests had the highest standardized β coefficient (0.44 among common predictors, and increased length of ED stay by 72.5 minutes (95% CI, 72.8-76.1 minutes. In admitted patients, computed tomography (CT had the highest standardized β coefficient (0.17, and increased length of ED stay by 32.7 minutes (95% CI, 40.0-49.9 minutes. Although other common input and output factors were significant contributors, they had smaller standardized β coefficients in both groups. CONCLUSIONS: Execution of laboratory blood tests and CT had a stronger influence on length of ED stay than other common input and output factors.

  3. 26 CFR 521.114 - Visiting professors or teachers.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 19 2010-04-01 2010-04-01 false Visiting professors or teachers. 521.114 Section 521.114 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED... of Denmark and of Danish Corporations § 521.114 Visiting professors or teachers. Under Article XIV...

  4. [Relevance of eosinopenia as marker of sepsis in the Emergency Department].

    Science.gov (United States)

    Lavoignet, C E; Le Borgne, P; Slimani, H; Forato, M; Kam, C; Kauffmann, P; Lefebvre, F; Bilbault, P

    2016-11-01

    Several studies in internal medicine departments and in intensive care units have shown the interest of eosinopenia in the diagnosis of infected patients. The aim of the present study was to test the value of this marker in the Emergency Department (ED), either alone or associated with other common sepsis markers. We report on a retrospective and monocentric study. We reviewed the complete blood count (CBC) of all patients visiting the ED during one-week duration (in February 2014). Every element of the CBC and other inflammation markers (such as CRP) were analyzed. During the week of our study, 725 patients had a CBC (33 exclusions) and 692 patients were included for analysis. The median age was 59 years (IQR: 16-100). One hundred and twenty-five patients (18.1%) had a sepsis. The ROC curve demonstrated a cut off level of 10/mm(3) eosinophils for which the specificity for sepsis was 91%. The association of eosinopenia (sepsis. In the ED, with a "simple" CBC, a profound eosinopenia appears to be very specific for sepsis, alone or in association with other markers of inflammation. Eosinopenia may become a helpful tool in our daily practice in the ED. Further studies are needed to further evaluate this marker. Copyright © 2016 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  5. Overview of Deployed EDS Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Martz, H E; Crawford, C

    2009-09-24

    The term explosive detection system (EDS) is used by the TSA to describe equipment that is certified to detect explosives in checked bags. The EDS, as certified, by the TSL must consist of device for interrogating a bag and an automated detection algorithm (ATD) for evaluating the results of the interrogation. We only consider CT as the interrogation device in this report. A schematic drawing of a CT-based EDS is shown in Figure 2. The output of the ATD is the binary decision of alarm or non-alarm. Alarms may true- or false-positives. Non-alarms may be true- or false-negatives. False positives are also denoted false alarms. The true detection means that the ATD reports an alarm when a threat is present in the scanned bag. The probability of detecting a threat given that a threat is present is denoted the probability of detection (PD). The probability of false alarm (PFA) is the case when an alarm is reported when a threat is not present in a bag. Certification in this context means passing tests for PD and PFA at the TSL. The results of the EDS include CT cross-sectional images of the bag and specifics about the alarmed objects generated by ATD. These results are presented on a display so that a person may override the decision of ATD and declare the alarm to be a non-alarm. This process is denoted clearing. Bags that are not cleared by the person are sent to a secondary inspection process. Here the bags may be opened or assessed with explosive trace detection (ETD) in order to clear the bags. Bags that are not cleared at this point are evaluated by an ordinance disposal team. The CT scanner along with ATD is denoted Level 1 screening. The process of clearing on a display is denoted Level 2 screening. Secondary inspection is denoted Level 3 screening. Vendors of the deployed EDSs supply the TSA with equipment for all three levels. Therefore, the term EDS may include the equipment provided for Levels 1, 2 and 3. A schematic diagram of an EDS and the levels of

  6. Heat-related inpatient hospitalizations and emergency room visits among California residents, May-September, 2000-2010.

    Data.gov (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of heat-related inpatient hospitalizations and ED visits among California residents for the years...

  7. VIP Visit Her Excellency Dr Dalia Grybauskaite

    CERN Multimedia

    2016-01-01

    Her Excellency Dr Dalia Grybauskaite President Republic of Lithuania. Wednesday 20 January 2016. General introduction to CERN’s activities by CERN Director-General F. Gianotti. CERN Director-General introduces CMS Collaboration Deputy Spokesperson K. Borras and CMS Lithuanians A. Rinkevicius with V. Rapsevicius. Met by J. Shiers, IT Department Data Preservation Project Leader, and walk to 1st floor Data Centre Visit Point. CERN Data Centre Visit Point, 1st floor, building 513. View the robotic arms of the CERN IT data centre automated libraries (J. Shiers) CERN Computer Centre, building 513, level -1. Physics hands-on and virtual visit with a High School class in Lithuania (S. Schmeling) CERN S’cool Lab, building 143. Meeting with the Lithuanian community at CERN. Signature of the Guest Book with CERN Director-General witnessed by the Lithuanian community at CERN. Family photograph with the Lithuanian community at CERN.

  8. CPAFFC Delegation Visits India

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>A CPAFFC delegation headed by Wang Wenyuan,former vice chairman of the National Committee of the Chinese Peo-ple’s Political Consultative Conference and adviser to the CPAFFC,paid a goodwill visit to India from December 19 to 28,2007 at the invitation of the Indian Council for Cultural Relations(ICCR).Also on the delegation were CPAFFC President Chen Haosu and Vice President Feng Zuoku.It was the highest-level delegation the CPAFFC has sent to India over the last decade.

  9. Nonurgent patients in the emergency department? A French formula to prevent misuse

    Directory of Open Access Journals (Sweden)

    Gainotti Sabina

    2010-03-01

    Full Text Available Abstract Background Overcrowding in emergency department (EDs is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs: alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse. Methods We carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected. Results 85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years. Most patients went to the ED autonomously (76%; one third (31.8% had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%, feelings of pain (68.5%, and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%. Traumatisms and wounds were the main medical reasons for going to the ED (43.5%. More than two-thirds of responders (68% were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9. Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9. Conclusions Our study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond

  10. Post-Discharge Follow-Up Visits and Hospital Utilization

    Data.gov (United States)

    U.S. Department of Health & Human Services — Analysis reported in Post-Discharge Follow-Up Visits and Hospital Utilization by Medicare Patients, 2007-2010, published in Volume 4, Issue 2 of Medicare and...

  11. Optimal sampling schemes for vegetation and geological field visits

    CSIR Research Space (South Africa)

    Debba, Pravesh

    2012-07-01

    Full Text Available The presentation made to Wits Statistics Department was on common classification methods used in the field of remote sensing, and the use of remote sensing to design optimal sampling schemes for field visits with applications in vegetation...

  12. Measures of Rehospitalization, Emergency Room Visit, and Community Discharge

    Data.gov (United States)

    U.S. Department of Health & Human Services — Measures of the Rate of Rehospitalization, Emergency Room Visit, and Community Discharge for Medicare Beneficiaries. These rates are based on Medicare claims data.

  13. ED becomes 'lean' and cuts LBTC, LOS times.

    Science.gov (United States)

    2008-04-01

    Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

  14. New psych unit eases patient burden in ED.

    Science.gov (United States)

    2008-06-01

    Creating a special unit for psychiatric patients frees up beds in your ED, ensures better care for that patient population, and improves the atmosphere in the main department for the rest of your patients. Consider these suggestions: The creation of a psych unit can be extremely costly. Be prepared to demonstrate projected savings when pitching the idea to administration. Make sure an ED physician has overall responsibility for each patient at all times. Keep a regular group of nurses in rotation. This setup will help ensure smooth handoffs.

  15. Ed Watson - 1940-2006

    CERN Document Server

    2006-01-01

    Ed Watson passed away suddenly on 1 August in Geneva, he was 66. He leaves his wife and two children. Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The...

  16. Ed Watson 1940-2006

    CERN Multimedia

    2006-01-01

    Ed Watson arrived at CERN in March 1973 to work on digital electronics and CAMAC systems under Bob Dobinson, after many years at Rolls Royce in Scotland. He joined the European Muon Collaboration in 1976, where he played a major role in the design, deployment and running of its data acquisition system (DAQ) with David Botterill, Bob Dobinson, and Vicky White. The CAMAC-ROMULUS system was by far the largest and most advanced of its time, and it became a defining standard for DAQ systems for years to come. Ed was deeply involved in the detailed planning of the control rooms and the experiment cabling, as well as sharing the responsibility for the CAMAC readout system. He had a real talent for trouble shooting and played a vital part in supporting the experiment throughout its lifetime. He offered great moral support to the younger members of the collaboration and helped them a great deal with their work. The EMC had a wonderful social life to which Ed was a major contributor - who can forget its barbecues?  In...

  17. First dental visit of a child

    Directory of Open Access Journals (Sweden)

    Meera R

    2008-10-01

    Full Text Available Objectives: The aim of the study was to assess the common chief complaints of the Indian children and the average age group at which they report for in their first dental visit. Materials and Methods: A retrospective study was carried out using the case records of 716 children who reported to the postgraduate section of Department of Pediatric dentistry, Meenakshi Ammal Dental College, Chennai, in 2007. The age groups of the children were divided into three categories 0-3 years, 3-6 years and 6-12 years. The various chief complaints were categorised as follows, Orientation to prevention, Routine visit, Deposits / Discoloration, Habits, Unerupted / Missing or Extra Tooth, Pain, Dental caries, Malocclusion, Trauma, others. The average age group and most common complaint at the first dental visit was assessed. A prospective study was done in January 2008, were 215 children were screened. The assessment was made as explained above. Results: Retrospective study Maximum number of children who reported for their first dental visit was between 6-12 years (59.08%. Most common chief complaint for the visit was pain (42.04%. Second common complaint being dental caries (28.49%. Prospective study Maximum number of children who reported for their first dental visit was between 6-12 years (69.77%. Most common chief complaint was dental caries (34.88%. Second common complaint being pain (27.91%. Conclusion: Children report for the first dental visit most commonly only after 6 years and for complaints like pain and dental caries. Orientation to prevention is not considered and preventive dentistry is yet to reach the common population in India.

  18. Emergency presurgical visit

    Directory of Open Access Journals (Sweden)

    Alfredo Castro Díaz

    2009-07-01

    Full Text Available The objective has been to create a Protocol of Structured Presurgical Visit applicable to the patients who are undergoing an emergency surgery, to provide the user and his family all the necessary cares on the basis of those nursing diagnosis that prevail in all the cases of surgical emergency interventions. The used method has been an analysis of the emergency surgical interventions more prevalent from February 2007 until October 2008 in our area (a regional hospital, and statistic of those nursing diagnosis that more frequently appeared in these interventions, the previous moment to the intervention and in addition common to all of them. The results were the following ones: the more frequent emergency operations were: Caesarean, ginecological curettage, laparotomy, help in risk childbirth, orthopaedic surgery and appendectomy. The more frequent nursing diagnosis in all the emergency operations at the previous moment of the intervention were: risk of falls, pain, anxiety, deficit of knowledge, risk of infection, movement stress syndrome, risk of hemorrhage, cutaneous integrity deterioration. The conclusion is that users present at the previous moment to an emergency operation several problems, which force to the emergency surgical ward nurse to the introduction of the nursing methodology, in order to identify the problems, to mark results and to indicate the interventions to achieve those results, besides in a humanitarian way and with quality. This can be obtained by performing a Structured Emergency Presurgical Visit.

  19. Steven Weinberg visits CERN

    CERN Multimedia

    2009-01-01

    Steven Weinberg visiting the ATLAS cavern accompanied by Peter JenniIt was no surprise that the CERN audience arrived early in the Globe of Science and Innovation for the colloquium on 7 July. Nobel laureate Steven Weinberg is one of the major contributors to the Standard Model of particle physics. He received the Nobel Prize for Physics in 1979 for his work on the unified theory of the electromagnetic and weak interactions, one of the essential pillars of the Standard Model. After lunch at CERN and a visit to ATLAS, Weinberg gave a colloquium on "The Quantum Theory of Fields: Effective or Fundamental" to a packed audience. In his talk, he looked at how the use of quantum field theory in particle physics has fluctuated in popularity since Paul Dirac first introduced the approach to describe the interaction of particles with electromagnetic fields in the late 1920s. In particular, he posed the question: Is quantum field theory fundamental or does it a...

  20. k-visit Attribute Grammars

    DEFF Research Database (Denmark)

    Nielson, Hanne Riis; Skyum, S.

    1981-01-01

    It is shown that any well-defined attribute grammar is k-visit for some k. Furthermore, it is shown that given a well-defined grammar G and an integer k, it is decidable whether G is k-visit. Finally it is shown that the k-visit grammars specify a proper hierarchy with respect to translations...

  1. Establishing a nationwide emergency department-based syndromic surveillance system for better public health responses in Taiwan

    Directory of Open Access Journals (Sweden)

    Chiu Chan-Hsien

    2008-01-01

    Full Text Available Abstract Background With international concern over emerging infectious diseases (EID and bioterrorist attacks, public health is being required to have early outbreak detection systems. A disease surveillance team was organized to establish a hospital emergency department-based syndromic surveillance system (ED-SSS capable of automatically transmitting patient data electronically from the hospitals responsible for emergency care throughout the country to the Centers for Disease Control in Taiwan (Taiwan-CDC starting March, 2004. This report describes the challenges and steps involved in developing ED-SSS and the timely information it provides to improve in public health decision-making. Methods Between June 2003 and March 2004, after comparing various surveillance systems used around the world and consulting with ED physicians, pediatricians and internal medicine physicians involved in infectious disease control, the Syndromic Surveillance Research Team in Taiwan worked with the Real-time Outbreak and Disease Surveillance (RODS Laboratory at the University of Pittsburgh to create Taiwan's ED-SSS. The system was evaluated by analyzing daily electronic ED data received in real-time from the 189 hospitals participating in this system between April 1, 2004 and March 31, 2005. Results Taiwan's ED-SSS identified winter and summer spikes in two syndrome groups: influenza-like illnesses and respiratory syndrome illnesses, while total numbers of ED visits were significantly higher on weekends, national holidays and the days of Chinese lunar new year than weekdays (p Conclusion Taiwan's ED-SSS represents the first nationwide real-time syndromic surveillance system ever established in Asia. The experiences reported herein can encourage other countries to develop their own surveillance systems. The system can be adapted to other cultural and language environments for better global surveillance of infectious diseases and international collaboration.

  2. Estimated Lifetime Medical and Work-Loss Costs of Emergency Department-Treated Nonfatal Injuries--United States, 2013.

    Science.gov (United States)

    Florence, Curtis; Haegerich, Tamara; Simon, Thomas; Zhou, Chao; Luo, Feijun

    2015-10-02

    A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies.

  3. Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research.

    Science.gov (United States)

    Clevenger, Carolyn K; Chu, Thasha A; Yang, Zhou; Hepburn, Kenneth W

    2012-09-01

    The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care.

  4. The Highland Health Advocates: a preliminary evaluation of a novel programme addressing the social needs of emergency department patients.

    Science.gov (United States)

    Losonczy, Lia Ilona; Hsieh, Dennis; Wang, Michael; Hahn, Christopher; Trivedi, Tarak; Rodriguez, Marcela; Fahimi, Jahan; Alter, Harrison

    2017-09-01

    Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a 'medical home' (defined as a consistent, primary source of medical care such as a primary care doctor or clinic). ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1 and 6 months. Primary outcomes were linkages for the primary identified need and to a medical home within 1 month. Other outcomes at 6 months included whether a patient (1) felt helped; 2) had a decreased number of ED visits; (3) had the primary identified need met; (4) had a primary doctor; and (5) had a change in self-reported health status. We enrolled 459 subjects (intervention=154, control=305). Housing (41%), employment (23%) and inability to pay bills (22%) were participants' top identified needs. At baseline, 32% reported the ED as their medical home, with the intervention cohort having higher ED utilisation (>1 ED visit in the prior month: 49% vs 24%). At 1 month, 185 (40%) subjects were reached for follow-up, with more HHA subjects linked to a resource (59% vs 37%) and a medical home (92% vs 76%). At 6 months, 75% of subjects felt HHA was helpful and more subjects in the HHA group had a doctor (93% v 69%). No difference was found in ED utilisation, primary need resolution or self

  5. A screening tool to medically clear psychiatric patients in the emergency department.

    Science.gov (United States)

    Shah, Sachin J; Fiorito, Michael; McNamara, Robert M

    2012-11-01

    Emergency physicians are frequently called on to medically clear patients presenting with a psychiatric complaint. There is limited guidance on how to conduct this clearance. This study evaluated the usefulness of a screening tool in ruling out serious organic disease in emergency department (ED) patients with psychiatric complaints. A retrospective chart review was performed on 500 consecutive adult ED patients with primarily psychiatric complaints who were evaluated using the tool, and then subsequently transferred to a psychiatric crisis center. The screening tool consists of a series of historical and physical examination criteria derived from the literature intended to identify patients who have a psychiatric manifestation of an organic disease. The physician filled out the screening form and if the proper conditions were met, the patient was transferred to Psychiatry without further laboratory or imaging studies. We reviewed the charts of both the ED visit and the psychiatric crisis center visit to determine if any of the patients required further medical treatment or a medical admission rather than a psychiatric admission. Five hundred consecutive ED patient charts were reviewed. Fifteen of the corresponding charts from the psychiatric center could not be found. Of the remaining 485 patients, 6 patients were sent back to the ED for further evaluation. After laboratory work and imaging, none of these 6 patients required more than an outpatient prescription. The screening tool proved useful in determining if a psychiatric patient needed further medical evaluation beyond a history and physical examination before transfer for a psychiatric evaluation. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. HCUP Nationwide Emergency Department Database (NEDS) Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Nationwide Emergency Department Sample (NEDS) was created to enable analyses of emergency department (ED) utilization patterns and support public health...

  7. Management of traumatic wounds in the Emergency Department: a secondary publication

    Directory of Open Access Journals (Sweden)

    Carolina Prevaldi

    2016-11-01

    Full Text Available Traumatic wounds are among the most common problems leading people to the Emergency Department (ED, accounting for approximately 5.4% of all the visits, and up to 24% of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so-called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care and the World Society of Emergency Surgery.

  8. Clinical Management of Skin and Soft Tissue Infections in the U.S. Emergency Departments

    Directory of Open Access Journals (Sweden)

    Rakesh D. Mistry

    2014-07-01

    Full Text Available Introduction: Community-associated methicillin resistant Staphylococcus aureus (CA-MRSA has emerged as the most common cause of skin and soft-tissue infections (SSTI in the United States. A nearly three-fold increase in SSTI visit rates had been documented in the nation’s emergency departments (ED. The objective of this study was to determine characteristics associated with ED performance of incision and drainage (I+D and use of adjuvant antibiotics in the management of skin and soft tissue infections (SSTI. Methods: Cross-sectional study of the National Hospital Ambulatory Medical Care Survey, a nationally representative database of ED visits from 2007-09. Demographics, rates of I+D, and adjuvant antibiotic therapy were described. We used multivariable regression to identify factors independently associated with use of I+D and adjuvant antibiotics. Results: An estimated 6.8 million (95% CI: 5.9-7.8 ED visits for SSTI were derived from 1,806 sampled visits; 17% were for children <18 years of age and most visits were in the South (49%. I+D was performed in 27% (95% CI 24-31 of visits, and was less common in subjects <18 years compared to adults 19-49 years (p<0.001, and more common in the South. Antibiotics were prescribed for 85% of SSTI; there was no relationship to performance of I+D (p=0.72. MRSA-active agents were more frequently prescribed after I+D compared to non-drained lesions (70% versus 56%, p<0.001. After multivariable adjustment, I+D was associated with presentation in the South (OR 2.36; 95% CI 1.52-3.65 compared with Northeast, followed by West (OR 2.13; 1.31-3.45, and Midwest (OR 1.96; 1.96-3.22. Conclusion:Clinical management of most SSTIs in the U.S. involves adjuvant antibiotics, regardless of I+D. Although not necessarily indicated, CA-MRSA effective therapy is being used for drained SSTI. [West J Emerg Med. 2014;15(4:491–498.

  9. Changes in Emergency Department Imaging: Perspectives From National Patient Surveys Over Two Decades.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Hanna, Tarek N; Babb, James S; Duszak, Richard

    2017-05-05

    To use patient-generated data to assess the changing role of emergency department (ED) imaging for a spectrum of clinical indications. The Household Component Emergency Room Visits File was obtained from 1996 through 2014 for the Medical Expenditure Panel Survey, a nationally representative survey of US households. Percentage of visits associated with various imaging modalities was computed annually, stratified by respondents' self-reported primary condition during the visit. Modality characteristics were assessed for conditions most frequently imaged in 1996 or 2014. For most conditions, use of advanced imaging (defined by Medical Expenditure Panel Survey as CT or MRI) in the ED increased significantly (P calculus (from 0% to 48.5%) and headache (from 17.5% to 33.3%), which were the most commonly imaged conditions by CT or MRI in 2014. For ultrasound, the most commonly imaged condition was pregnancy in 1996 (32.9%) and 2014 (44.5%). No other condition was associated with ultrasound in >20% of visits. For radiography, the most commonly imaged conditions were extremity wounds and fractures in 1996 (range 84.5%-90.2%) and 2014 (range 93.4%-93.9%). Use of radiography decreased for urinary calculus from 67.4% to 24.2% (P advanced imaging increased significantly, though growth was variable across conditions. In certain scenarios, advanced ED imaging is adding to, rather than replacing, other modalities. Ultrasound and radiography utilization was overall unchanged. That national patient survey data mirror traditional claims-based studies suggests an expanded role for patient-generated data in identifying areas of imaging utilization that may benefit from targeted optimization efforts. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. American Las Vegas Sands Corp. Visiting Beijing

    Institute of Scientific and Technical Information of China (English)

    Li Yinghong; Liu Jinliang

    2006-01-01

    @@ On August 29, Wan Jifei, Chairman of CCPIT, meets the visiting delegation led by Sheldon G. Adelson,Chairman of the Board and principal owner of Las Vegas Sands Corp. in CCPIT. Zhao Zhenge, Vice Director of International Connection Department of CCPIT, Luo Guoxiong from Beijing China Exhibition Investment Company, Xu Jingyi, Assistant Director of American and Oceanian Affairs Division of CCPIT, also attended the meeting.

  11. Boston children's hospital community asthma initiative: Five-year cost analyses of a home