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"Observation unit"

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https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-healthcare-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#1
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome (ACS) are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the healthcare system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice decision aid (CPC) on overall healthcare utilization as well as utilization of specific services both during the index emergency department visit and in the subsequent 45 days...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29189590/management-of-pediatric-isolated-skull-fractures-a-decision-tree-and-cost-analysis-on-emergency-department-disposition-strategies
#2
Daniel C Williams, W Scott Russell, Annie L Andrews, Kit N Simpson, William T Basco, Ronald J Teufel
OBJECTIVE: Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)-based disposition scenarios for a pediatric patient presenting with ISF. METHODS: We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29159958/evaluation-of-a-low-risk-mild-traumatic-brain-injury-and-intracranial-hemorrhage-emergency-department-observation-protocol
#3
Brian J Yun, Pierre Borczuk, Lulu Wang, Stephen Dorner, Benjamin A White, Ali S Raja
OBJECTIVES: Among emergency physicians, there is wide variation in admitting practices for patients who suffered a mild traumatic brain injury (TBI) with an intracranial hemorrhage (ICH). The purpose of this study was to evaluate the effects of implementing a protocol in the emergency department (ED) observation unit for patients with mild TBI and ICH. METHODS: This retrospective cohort study was approved by the Institutional Review Board. Study subjects were patients ≥18 years of age with an International Classification of Diseases (ICD) code corresponding to a traumatic IC, and admitted to an ED observation unit (EDOU) of an urban, academic level 1 trauma center between February 1, 2015 and January 31, 2017...
November 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29135623/patient-ethnicity-predicts-poor-health-access-and-gaps-in-perception-of-personal-cardiovascular-risk-factors
#4
Yeunjung Kim, Kathryn Hogan, Gail D'Onofrio, Sharon Chekijian, Basmah Safdar
BACKGROUND: Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one's own cardiovascular risk. METHODS: A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29135621/efficacy-of-implementation-of-a-chest-pain-center-at-a-community-hospital
#5
Alexandra Davis, Jason Chiu, Stanley K Lau, Yih Jen Kok, Jonathan Y H Wu
INTRODUCTION: Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0-3) and high (7-10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29079375/allergic-like-contrast-reactions-in-the-ed-incidence-management-and-impact-on-patient-disposition
#6
Ravi V Gottumukkala, McKinley Glover, Brian J Yun, Jonathan D Sonis, Mannudeep K Kalra, Alexi Otrakji, Ali S Raja, Anand M Prabhakar
PURPOSE: Determine the incidence, management, and impact on patient disposition of allergic-like contrast reactions (ALCR) to intravenous iodinated contrast in the emergency department (ED). METHODS: All ED patients who developed an ALCR following contrast-enhanced CT (CECT) from June 2011-December 2016 were retrospectively identified. Medical records were reviewed and reaction severity, management, and disposition were quantified using descriptive statistics. The total number of consecutive CECTs performed in the ED were available from June 2011-March 2016 and were used to derive ALCR incidence over that time period...
October 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29023942/a-review-of-tensor-based-methods-and-their-application-to-hospital-care-data
#7
Paolo Giordani, Henk A L Kiers
In many situations, a researcher is interested in the analysis of the scores of a set of observation units on a set of variables. However, in medicine, it is very frequent that the information is replicated at different occasions. The occasions can be time-varying or refer to different conditions. In such cases, the data can be stored in a 3-way array or tensor. The Candecomp/Parafac and Tucker3 methods represent the most common methods for analyzing 3-way tensors. In this work, a review of these methods is provided, and then this class of methods is applied to a 3-way data set concerning hospital care data for a hospital in Rome (Italy) during 15 years distinguished in 3 groups of consecutive years (1892-1896, 1940-1944, 1968-1972)...
October 10, 2017: Statistics in Medicine
https://www.readbyqxmd.com/read/28982749/a-population-based-assessment-of-emergency-department-observation-status-for-older-adults-with-cancer
#8
Allison Lipitz-Snyderman, Adam Klotz, Renee L Gennarelli, Jeffrey Groeger
Background: Hospitals' use of observation status for patients with cancer presenting to the emergency department (ED) is not well understood. This model of care delivery may be a viable alternative to inpatient admission for patients with cancer presenting with certain conditions. Our objective was to assess the use of observation status among Medicare beneficiaries with and without cancer. Methods: Population-based SEER-Medicare data were used to assess differences in the use of observation status between Medicare beneficiaries aged ≥66 years with and without cancer using a matched analysis (n=151,183 per cohort)...
October 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28975679/an-emergency-department-observation-unit-is-a-feasible-setting-for-multidisciplinary-geriatric-assessments-in-compliance-with-the-geriatric-emergency-department-guidelines
#9
Lauren T Southerland, Anthony J Vargas, Lalitha Nagaraj, Tanya R Gure, Jeffery M Caterino
BACKGROUND: The Geriatric Emergency Department Guidelines recommend providing multidisciplinary geriatric assessment in the Emergency Department (ED), but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED Observation Unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit. METHODS: Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients...
October 4, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28954802/henry-ford-heart-score-randomized-trial-rapid-discharge-of-patients-evaluated-for-possible-myocardial-infarction
#10
Tiberio M Frisoli, Richard Nowak, Kaleigh L Evans, Michael Harrison, Maath Alani, Saira Varghese, Mehnaz Rahman, Samantha Noll, Katherine R Flannery, Alex Michaels, Mishel Tabaku, Gordon Jacobsen, James McCord
BACKGROUND: Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications. METHOD AND RESULTS: A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0...
October 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28925925/entrustable-professional-activities-for-residency-training-in-physical-medicine-and-rehabilitation
#11
Michael Mallow, Heather Baer, Alex Moroz, Vu Q C Nguyen
Entrustable professional activities are observable units of professional practice that can potentially provide a link between competency-based medical education and clinical practice. The authors, part of a subcommittee of the Association of Academic Physiatrists Education Committee, identified a set of entrustable professional activities that would serve residency training programs in the specialty of physical medicine and rehabilitation. Using a modified Delphi process, residency program directors in the field reviewed and validated a set of entrustable professional activities...
October 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28876570/cohort-study-on-emergency-general-surgery-patients-and-an-observation-unit
#12
M Dickfos, H Ibrahim, A Evans, R Franz
BACKGROUND: Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28874928/magnetic-resonance-imaging-utilization-in-an-emergency-department-observation-unit
#13
Yadiel Sánchez, Brian J Yun, Anand M Prabhakar, McKinley Glover, Benjamin A White, Theodore I Benzer, Ali S Raja
INTRODUCTION: Emergency department observation units (EDOUs) are a valuable alternative to inpatient admissions for ED patients needing extended care. However, while the use of advanced imaging is becoming more common in the ED, there are no studies characterizing the use of magnetic resonance imaging (MRI) examinations in the EDOU. METHODS: This institutional review board-approved, retrospective study was performed at a 999-bed quaternary care academic Level I adult and pediatric trauma center, with approximately 114,000 ED visits annually and a 32-bed adult EDOU...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28869147/challenges-and-factors-likely-to-promote-coping-as-anticipated-by-nurses-preparing-for-a-merger-of-intensive-and-intermediate-care-units
#14
Mari Salminen-Tuomaala, Liisa Ala-Hynnilä, Kati Hämäläinen, Heikki Ruohomäki
OBJECTIVE: To describe challenges and factors that support coping as anticipated by nursing staff preparing for a merger of intensive and intermediate care units. RESEARCH METHODOLOGY: The method of empathy-based stories was employed to collect data from staff. The stories (n=20) were analysed using inductive content analysis. SETTING: Nursing staff from the cardiac observation and evaluation, intensive care and surgical observation units in a central hospital in Finland...
August 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28811209/prevalence-of-pulmonary-embolism-in-patients-presenting-to-the-emergency-department-with-syncope
#15
Alison Frizell, Nicole Fogel, Jacob Steenblik, Margaret Carlson, Joseph Bledsoe, Troy Madsen
OBJECTIVES: A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population. METHODS: We performed a retrospective, secondary analysis of prospectively gathered data from patients presenting with syncope to an academic emergency department (ED) from July 2010 to December 2015. We analyzed baseline information from the time of the ED visit, recorded outcomes during the hospital stay, and contacted patients by phone at least 30days after the ED visit...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28768699/use-of-a-23-hour-emergency-department-observation-unit-for-the-management-of-patients-with-toxic-exposures
#16
Rupeng Mong, Gabriel Joseph Arciaga, Hock Heng Tan
BACKGROUND: A significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay observation unit. We describe the management and outcomes of these patients in a 23-hour ED observation unit (EDOU). METHODS: A retrospective chart review of all patients with toxic exposures admitted to the EDOU in Singapore between 1 April 2013 and 31 March 2015 was performed...
November 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28748625/multiple-risk-factor-counseling-to-promote-heart-healthy-lifestyles-in-the-chest-pain-observation-unit-pilot-randomized-controlled-trial
#17
David A Katz, Mark Graber, Patricia Lounsbury, Mark W Vander Weg, Emily K Phillips, Christina Clair, Phillip A Horwitz, Xueya Cai, Alan J Christensen
OBJECTIVE: Admission to the chest pain observation unit (CPOU) may be an advantageous time for patients to consider heart-healthy lifestyle changes while undergoing diagnostic evaluation to rule out myocardial ischemia. The aim of this pragmatic trial was to assess the effectiveness of a multiple risk factor intervention in changing CPOU patients' health beliefs and readiness to change health behaviors. A secondary aim was to obtain preliminary estimates of the intervention's effect on diet, physical activity, and smoking...
August 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28742647/the-dis-utility-of-a-change-in-troponin-i-for-diagnosis-of-non-st-segment-elevation-myocardial-infarction-in-an-observation-unit
#18
Iani Patsias, Benjamin Swanson, Michael Hudson, Sachin Parikh, Khaled Nour, Gordon Jacobsen, James McCord
BACKGROUND: Observation units (OUs) may be an efficient and effective setting to diagnose and risk stratify patients with coronary ischemia and myocardial infarction (MI). Given improved cardiac troponin I (cTnI) assays and expanded utilization of OUs, it is not uncommon for patients with mildly elevated cTnI to be evaluated in OUs. We investigated the serial cTnI results in OU patients to determine whether absolute or relative cTnI changes were useful for the diagnosis of MI. METHODS: This was a retrospective study of 260 patients placed in the OU from a single center in 2007, with an initial cTnI in the indeterminate range of 0...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28711132/additional-conditions-amenable-to-observation-care
#19
REVIEW
Matthew A Wheatley
ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28711131/care-of-special-populations-in-an-observation-unit-pediatrics-and-geriatrics
#20
REVIEW
Sharon E Mace
Infants and children and the elderly comprise a large and growing (especially the elderly) segment of the US population. The benefits of observation medicine have been documented in these two age groups: Based on the success of observation medicine, and recognizing the growth of these special populations, it is likely that observation medicine will be expanding in the future, especially within the pediatric and geriatric populations. Future studies should be able to provide further evidence regarding the value of observation medicine in these two diverse population age groups...
August 2017: Emergency Medicine Clinics of North America
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