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emergency department revisits

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https://www.readbyqxmd.com/read/29123857/importance-of-respiratory-rate-for-the-prediction-of-clinical-deterioration-after-emergency-department-discharge-a-single-center-case-control-study
#1
Katsunori Mochizuki, Ryosuke Shintani, Kotaro Mori, Takahisa Sato, Osamu Sakaguchi, Kanako Takeshige, Kenichi Nitta, Hiroshi Imamura
Aim: The purpose of the present study was to investigate the predictors of clinical deterioration soon after emergency department (ED) discharge. Methods: We undertook a case-control study using the ED database of the Nagano Municipal Hospital (Nagano, Japan) from January 2012 to December 2013. We selected adult patients with medical conditions who revisited the ED with deterioration within 2 days of ED discharge (deterioration group). The deterioration group was compared with a control group...
April 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29117873/implementation-of-an-emergency-department-atrial-fibrillation-and-flutter-pathway-improves-rates-of-appropriate-anticoagulation-reduces-length-of-stay-and-thirty-day-revisit-rates-for-congestive-heart-failure
#2
David Barbic, Chris DeWitt, Devin Harris, Robert Stenstrom, Eric Grafstein, Crane Wu, Cristian Vadeanu, Brett Heilbron, Jenelle Haaf, Stanley Tung, Dan Kalla, Julian Marsden, Jim Christenson, Frank Scheuermeyer
OBJECTIVES: An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation. METHODS: This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians...
November 9, 2017: CJEM
https://www.readbyqxmd.com/read/29094343/a-retrospective-nested-cohort-study-of-emergency-department-revisits-for-migraine-in-new-york-city
#3
Mia T Minen, Alexandra Boubour, Amanda Wahnich, Corita Grudzen, Benjamin W Friedman
OBJECTIVE: Migraine causes more than 1.2 million visits to US emergency departments (EDs) annually. Many of these visits are revisits among patients who had already been treated in an ED for migraine. The goal of this analysis was to determine the frequency of headache revisits among patients who present to an ED for management of migraine and sociodemographic factors associated with the revisit. METHODS: Using the New York City Department of Health and Mental Hygiene Syndromic Surveillance database, we conducted a retrospective nested cohort study...
November 2, 2017: Headache
https://www.readbyqxmd.com/read/29066022/variations-in-elderly-peoples-visits-to-the-emergency-departments-in-iceland-a-five-year-population-study
#4
Elisabet Gudmundsdottir, Helga Rosa Masdottir, Hlif Gudmundsdottir, Lovisa Agnes Jonsdottir, Ingibjörg Sigurthorsdottir, Sigrun Sunna Skuladottir, Sigrun Helga Lund, Thordis Thorsteinsdottir
INTRODUCTION: Elderly people visiting emergency departments (ED) are a non-homogenous group. Gender and other socio-demographic variations in emergency care might be present. However, gender-specific ED-data is scarce. METHODS: We retrieved retrospective data on all ED-visits, by 67years and older from 2008 to 2012, and calculated incidence of visits applying population registries. The relationship of age-categories, marital status, health and residence with outcomes were analyzed descriptively by Chi-square tests...
October 20, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/29029783/follow-up-trends-after-emergency-department-discharge-for-acutely-symptomatic-hernias
#5
Lara Spence, Eric Pillado, Dennis Kim, David Plurad
BACKGROUND: Patients frequently present to the Emergency Department (ED) with symptomatic hernias. This study evaluated the outcomes of patients presenting with symptomatic hernias without indication for immediate operation who are discharged for elective repair. METHODS: A three-year retrospective analysis of patients discharged from the ED with a symptomatic hernia was performed at a university affiliated county referral center. The incidences of ED revisits, clinic follow up and repairs occurring in the elective versus emergency setting were assessed...
September 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29018821/factors-affecting-unscheduled-return-visits-to-the-emergency-department-among-minor-head-injury-patients
#6
Kuo-Cheng Wang, Chung-Hsien Chaou, Peng-Huei Liu, Cheng-Yu Chien, Ching-Hsing Lee
STUDY OBJECTIVES: Differences between returning and non-returning minor head injury (MHI) emergency department (ED) patients, between the characteristics of the first visit and revisit, and between admitted and nonadmitted returning patients were investigated. METHODS: This was a retrospective study. All discharged ED patients with ICD-9 codes 850.0 to 850.9, 920, and 959.01 in 2013 were enrolled. Patients' demographic data, vital signs, Glasgow Coma Scale, ED diagnosis, length of stay, triage levels, ED examinations performed, and comorbidities were recorded for analysis...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28986161/screening-of-the-frail-patient-in-the-emergency-department-a-systematic-review
#7
Rasmus Jørgensen, Mikkel Brabrand
BACKGROUND: Several frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department. AIM: To assess the accuracy of the screening tools used in the emergency department to detect frailty in patients≥65years by their ability to identify the risk of adverse outcomes. METHODS: An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department...
October 3, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28976457/revisiting-the-appendiceal-diameter-via-ultrasound-for-the-diagnosis-of-acute-appendicitis
#8
Henry P Chicaiza, Laurie Malia, Christine H Mulvey, Sharon R Smith
OBJECTIVES: This study aims to investigate the optimal outer appendiceal diameter via ultrasound for the diagnosis of acute appendicitis. METHODS: A retrospective chart review was conducted on patients (ages, 2-18 years) presenting to an urban pediatric emergency department between January 1, 2009 and December 31, 2010 with suspected acute appendicitis. Children were considered as having "suspected acute appendicitis" if they (1) presented with acute abdominal pain and had either a surgical consult or an abdominal ultrasound, or (2) presented or transferred with the stated suspicion of acute appendicitis...
October 2, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28967514/bouncing-back-elsewhere-multilevel-analysis-of-return-visits-to-the-same-or-a-different-hospital-after-initial-emergency-department-presentation
#9
Bradley D Shy, George T Loo, Tina Lowry, Eugene Y Kim, Ula Hwang, Lynne D Richardson, Jason S Shapiro
STUDY OBJECTIVE: Analyses of 72-hour emergency department (ED) return visits are frequently used for quality assurance purposes and have been proposed as a means of measuring provider performance. These analyses have traditionally examined only patients returning to the same hospital as the initial visit. We use a health information exchange network to describe differences between ED visits resulting in 72-hour revisits to the same hospital and those resulting in revisits to a different site...
September 27, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28926508/racial-ethnic-variation-in-emergency-department-care-for-children-with-asthma
#10
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
#11
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
#12
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
#13
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
#14
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 from 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
#15
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
#16
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...
November 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28830636/the-relationship-between-emergency-department-volume-and-patient-complexity
#17
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
#18
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
#19
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
#20
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
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