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emergency department revisits

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https://www.readbyqxmd.com/read/28926508/racial-ethnic-variation-in-emergency-department-care-for-children-with-asthma
#1
Heather G Zook, Nathaniel R Payne, Susan E Puumala, Katherine M Ziegler, Anupam B Kharbanda
OBJECTIVE: To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS: This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28884986/corticosteroids-in-management-of-anaphylaxis-a-systematic-review-of-evidence
#2
C K Liyanage, P Galappatthy, S L Seneviratne
As anaphylaxis is a medical emergency, there are no randomized controlled clinical trials on its emergency management. Therefore, current guidelines are mostly based on data from observational studies, animal and laboratory studies. Although epinephrine is the mainstay of recommended treatment, corticosteroids are also frequently used. This review evaluates the evidence on the use of corticosteroids in emergency management of anaphylaxis from published human and animal or laboratories studies. Thirty original research papers were found with 22 human studies and eight animal or laboratory studies...
September 2017: European Annals of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28874950/appropriateness-of-bolus-antihypertensive-therapy-for-elevated-blood-pressure-in-the-emergency-department
#3
Joseph B Miller, Andrew Arter, Suprat S Wilson, Alexander T Janke, Aaron Brody, Brian P Reed, Phillip D Levy
INTRODUCTION: While moderate to severely elevated blood pressure (BP) is present in nearly half of all emergency department (ED) patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874939/rapid-primary-care-follow-up-from-the-ed-to-reduce-avoidable-hospital-admissions
#4
Amanda S Carmel, Peter Steel, Robert Tanouye, Aleksey Novikov, Sunday Clark, Sanjai Sinha, Judy Tung
INTRODUCTION: 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...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28872981/sex-differences-in-outcomes-after-discharge-from-alberta-emergency-departments-for-asthma-a-large-population-based-study
#5
Rhonda J Rosychuk, Maria Ospina, Jingbin Zhang, Richard Leigh, Andrew Cave, Brian H Rowe
OBJECTIVE: Asthma exacerbations frequently result in emergency department (ED) visits. While sex differences have been identified in some asthma studies, there is a paucity of literature on sex differences in the ED setting, especially population-based ones. This study examines sex differences in important outcomes of patients discharged from EDs for acute asthma in Alberta, Canada. METHODS: Alberta residents aged 2 to 55 years discharged from EDs with a primary diagnosis of asthma during 1999- 2011 were identified from administrative databases from a single-payer health care system for the entire geographic region of Alberta...
September 5, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28855065/predicting-72-hour-emergency-department-revisits
#6
Gene Pellerin, Kelly Gao, Laurence Kaminsky
OBJECTIVES: To develop a predictive model that hospitals or healthcare systems can use to identify patients at high risk of revisiting the ED within 72h so that appropriate interventions can be delivered. METHODS: This study employed multivariate logistic regression in developing the predictive model. The study data were from four Veterans medical centers in Upstate New York; 21,141 patients in total with ED visits were included in the analysis. Fiscal Year (FY) 2013 data were used to predict revisits in FY 2014...
August 25, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28832434/perceived-facilitators-and-barriers-to-local-health-department-workers-participation-in-infectious-disease-emergency-responses
#7
Lainie Rutkow, Amy Paul, Holly A Taylor, Daniel J Barnett
CONTEXT: Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood...
August 21, 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28830636/the-relationship-between-emergency-department-volume-and-patient-complexity
#8
Barry Hahn, Batya Zuckerman, Milazim Durakovic, Seleshi Demissie
INTRODUCTION: 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...
August 17, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28816890/improving-timeliness-of-%C3%AE-agonist-and-corticosteroid-administration-in-patients-with-acute-wheezing
#9
Mandisa McIver, William Stoudemire, Cherrelle Smith-Ramsey, Mousumee Panigrahi, Christine Walsh-Kelly, Lori E Rutman
OBJECTIVE: Timely delivery of β-agonists and steroids to patients with acute recurrent wheezing is a key component of the National Heart, Lung, and Blood Institute recommended emergency department (ED) asthma care. We conducted an ED improvement initiative to standardize asthma care and improve time to treatments. METHODS: Our multidisciplinary team identified key contributing factors to timeliness, developed key driver diagrams, implemented and refined a management pathway, designed and executed rapid cycle improvements, and implemented interventions...
September 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28814479/early-prediction-of-hospital-admission-for-emergency-department-patients-a-comparison-between-patients-younger-or-older-than-70-years
#10
Jacinta A Lucke, Jelle de Gelder, Fleur Clarijs, Christian Heringhaus, Anton J M de Craen, Anne J Fogteloo, Gerard J Blauw, Bas de Groot, Simon P Mooijaart
OBJECTIVE: The aim of this study was to develop models that predict hospital admission to ED of patients younger and older than 70 and compare their performance. METHODS: Prediction models were derived in a retrospective observational study of all patients≥18 years old visiting the ED of a university hospital during the first 6 months of 2012. Patients were stratified into two age groups (<70 years old and ≥70 years old). Multivariable logistic regression analysis was used to identify predictors of hospital admission among factors available immediately after patient arrival to the ED...
August 16, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28809587/severe-asthma-emergency-care-patient-driven-solutions
#11
Karen Newell, Chris Corrigan, Geoffrey Punshon, Alison Leary
Purpose Patients with severe asthma were choosing not to use the emergency department (ED) in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue reflected a nationwide situation. The purpose of this paper is to better understand the reasons behind patients' reluctance to attend ED and to consider practical solutions in a structured way. Design/methodology/approach Systems thinking (soft systems methodology) was used to examine the issues resulting in this reluctance to attend the ED...
August 14, 2017: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/28764160/revisiting-nitrofurantoin-for-vancomycin-resistant-enterococci
#12
Suneeta Meena, Sarita Mohapatra, Seema Sood, Benu Dhawan, Bimal Ku Das, Arti Kapil
INTRODUCTION: Enterococcal infection has emerged as a major therapeutic challenge. Emergence of High Level Aminoglycoside Resistance (HLAR) and Vancomycin-Resistant Enterococcus (VRE) has further limited the drug therapy in enterococcal infections. However, nitrofuratoin being an old drug reported to have less resistance in comparison to the other classes of antimicrobial agents. AIM: To detect susceptibility of nitrofurantoin against VRE isolates from Urinary Tract Infection (UTI) of outdoor and indoor patient departments...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28757746/characteristics-and-outcomes-of-patients-with-emergency-department-revisits-within-72-hours-and-subsequent-admission-to-the-intensive-care-unit
#13
I-Ting Tsai, Cheuk-Kwan Sun, Chao-Sung Chang, Kuo-Hsin Lee, Chih-Yu Liang, Chih-Wei Hsu
OBJECTIVE: This study aimed to investigate the characteristics and outcomes of patients with emergency department (ED) revisits within 72 hours and subsequent admission to the intensive care unit (ICU). MATERIALS AND METHODS: The medical records of all adult patients revisiting the ED of a single tertiary referral medical center with ICU admissions between January 2012 and September 2014 were reviewed in terms of patient characteristics, clinical manifestations, diagnoses, triage according to the Taiwan Triage and Acuity Scale, causes of revisits, and mortality...
October 2016: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28702257/the-relationship-between-diabetes-mellitus-and-30-day-readmission-rates
#14
Stephanie Ostling, Jennifer Wyckoff, Scott L Ciarkowski, Chih-Wen Pai, Hae Mi Choe, Vinita Bahl, Roma Gianchandani
BACKGROUND: It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14...
2017: Clinical Diabetes and Endocrinology
https://www.readbyqxmd.com/read/28688769/revisit-subsequent-hospitalization-recurrent-fall-and-death-within-6-months-after-a-fall-among-elderly-emergency-department-patients
#15
Jiraporn Sri-On, Gregory P Tirrell, Jonathan F Bean, Lewis A Lipsitz, Shan W Liu
STUDY OBJECTIVE: We seek to describe the risk during 6 months and specific risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations, and death within 6 months after a fall-related ED presentation. METHODS: This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 years and older who had an ED fall visit in 2012. We examined the frequency and risk factors of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalization, and death, selected a priori) at 6 months...
June 29, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28655589/identification-of-seniors-at-risk-isar-in-the-emergency-room-a-prospective-study
#16
João Paulo de Almeida Tavares, Pedro Sá-Couto, Marie Boltz, Elizabeth Capezuti
INTRODUCTION: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. METHODS: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered...
June 24, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28634181/outcomes-after-observation-stays-among-older-adult-medicare-beneficiaries-in-the-usa-retrospective-cohort-study
#17
Kumar Dharmarajan, Li Qin, Maggie Bierlein, Jennie E S Choi, Zhenqiu Lin, Nihar R Desai, Erica S Spatz, Harlan M Krumholz, Arjun K Venkatesh
Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays.Design Retrospective cohort study.Setting 4750 hospitals in the USA.Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11...
June 20, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28628705/time-to-appendectomy-and-risk-of-complicated-appendicitis-and-adverse-outcomes-in-children
#18
Stephanie K Serres, Danielle B Cameron, Charity C Glass, Dionne A Graham, David Zurakowski, Mahima Karki, Seema P Anandalwar, Shawn J Rangel
Importance: Management of appendicitis as an urgent rather than emergency procedure has become an increasingly common practice in children. Controversy remains as to whether this practice is associated with increased risk of complicated appendicitis and adverse events. Objective: To examine the association between time to appendectomy (TTA) and risk of complicated appendicitis and postoperative complications. Design, Setting, and Participants: In this retrospective cohort study using the Pediatric National Surgical Quality Improvement Program appendectomy pilot database, 2429 children younger than 18 years who underwent appendectomy within 24 hours of presentation at 23 children's hospitals from January 1, 2013, through December 31, 2014, were studied...
August 1, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28562277/reducing-hospitalization-rates-for-children-with-anaphylaxis
#19
Karen S Farbman, Kenneth A Michelson, Mark I Neuman, Timothy E Dribin, Lynda C Schneider, Anne M Stack
BACKGROUND AND OBJECTIVES: Most children with anaphylaxis in the emergency department (ED) are hospitalized. Opportunities exist to safely reduce the hospitalization rate for children with anaphylaxis by decreasing unnecessary hospitalizations. A quality improvement (QI) intervention was conducted to improve care and reduce hospitalization rates for children with anaphylaxis. METHODS: We used the Model for Improvement and began with development and implementation in 2011 of a locally developed evidence-based guideline based on national recommendations for the management of anaphylaxis...
June 2017: Pediatrics
https://www.readbyqxmd.com/read/28559030/the-effect-of-utilization-review-on-emergency-department-operations
#20
Shoma Desai, Phillip F Gruber, Erick Eiting, Seth A Seabury, Wendy J Mack, Christian Voyageur, Veronica Vasquez, Hyung T Kim, Sophie Terp
STUDY OBJECTIVE: Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. METHODS: In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria...
May 27, 2017: Annals of Emergency Medicine
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