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Freestanding emergency department

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https://www.readbyqxmd.com/read/28330970/variation-in-family-experience-of-pediatric-inpatient-care-as-measured-by-child-hcahps
#1
Sara L Toomey, Marc N Elliott, Alan M Zaslavsky, David J Klein, Sifon Ndon, Shannon Hardy, Melody Wu, Mark A Schuster
BACKGROUND: Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. The Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services commissioned development of the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey to address this gap. Using Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, we measured performance of hospitals in a national field test...
March 22, 2017: Pediatrics
https://www.readbyqxmd.com/read/28262320/comparing-utilization-and-costs-of-care-in-freestanding-emergency-departments-hospital-emergency-departments-and-urgent-care-centers
#2
Vivian Ho, Leanne Metcalfe, Cedric Dark, Lan Vu, Ellerie Weber, George Shelton, Howard R Underwood
STUDY OBJECTIVE: We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. METHODS: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type...
February 15, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28096296/a-critical-asthma-standardized-clinical-and-management-plan-reduces-duration-of-critical-asthma-therapy
#3
Jackson Wong, Michael S D Agus, Dionne A Graham, Elliot Melendez
BACKGROUND AND OBJECTIVE: Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. METHODS: This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies...
February 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/27929691/association-between-pediatric-home-management-plan-of-care-compliance-and-asthma-readmission
#4
Ronen Zipkin, Sheree M Schrager, Eugene Nguyen, Mary Rose Mamey, Ingrid Banuelos, Susan Wu
OBJECTIVES: In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect...
December 8, 2016: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/27890310/same-day-total-hip-arthroplasty-performed-at-an-ambulatory-surgical-center-90-day-complication-rate-on-549-patients
#5
Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
October 20, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27702960/state-regulation-of-freestanding-emergency-departments-varies-widely-affecting-location-growth-and-services-provided
#6
Catherine Gutierrez, Rachel A Lindor, Olesya Baker, David Cutler, Jeremiah D Schuur
Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them)...
October 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27664881/postoperative-acute-care-use-after-freestanding-ambulatory-surgery
#7
George Molina, Bridget A Neville, Stuart R Lipsitz, Lorri Gibbons, Ashley Kay Childers, Atul A Gawande, William R Berry, Alex B Haynes
BACKGROUND: Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting. MATERIALS AND METHODS: We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina...
October 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27607095/simulation-for-operational-readiness-in-a-new-freestanding-emergency-department-strategy-and-tactics
#8
Robert L Kerner, Kathleen Gallo, Michael Cassara, John DʼAngelo, Anthony Egan, John Galbraith Simmons
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together...
October 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/27595370/patient-insurance-profiles-a-tertiary-care-compared-to-three-freestanding-emergency-departments
#9
Erin L Simon, Gregory Griffin, Kseniya Orlik, Zhenyu Jia, Dave Hayslip, Daniel Kobe, Nicholas Jouriles
BACKGROUND: It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure. OBJECTIVE: We examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs...
October 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27421814/where-do-freestanding-emergency-departments-choose-to-locate-a-national-inventory-and-geographic-analysis-in-three-states
#10
Jeremiah D Schuur, Olesya Baker, Jaclyn Freshman, Michael Wilson, David M Cutler
STUDY OBJECTIVE: 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. METHODS: 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...
April 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27338533/factors-affecting-pediatric-patient-transfer-in-testicular-torsion
#11
Daniel L Lodwick, Jennifer N Cooper, Peter C Minneci, Katherine J Deans, Daryl McLeod
BACKGROUND: Testicular torsion is a surgical emergency, and interhospital transfer could delay care and increase the risk of orchiectomy. This study identifies factors associated with transfer for pediatric testicular torsion. METHODS: This retrospective cross-sectional study examined emergency department (ED) visits for testicular torsion by men aged 1-21 y in National Emergency Department Sample from 2006 to 2012. Freestanding children's hospitals were excluded...
June 1, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27329858/culture-pus-not-blood-decreasing-routine-laboratory-testing-in-patients-with-uncomplicated-skin-and-soft-tissue-infections
#12
Amy J Sloane, David M Pressel
BACKGROUND: Blood cultures and complete blood cell counts (CBCs) are commonly used in evaluating patients with skin and soft tissue infections (SSTIs). Published data have shown that these tests may not aid in patient management. The objective of this study was to decrease the collection of blood test specimens in children with uncomplicated SSTIs. METHODS: We designed a longitudinal preintervention/postintervention study that used modifications of well-known propaganda posters...
July 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27309191/contextual-factors-associated-with-hospitals-decision-to-operate-freestanding-emergency-departments
#13
Nitish Patidar, Robert Weech-Maldonado, Stephen J O'Connor, Bisakha Sen, J M Mickey Trimm, Carlos A Camargo
BACKGROUND: Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. PURPOSE: The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. METHODOLOGY: All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011...
June 15, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27174171/freestanding-emergency-critical-care-during-the-aftermath-of-hurricane-sandy-implications-for-disaster-preparedness-and-response
#14
Silas W Smith, Catherine T Jamin, Sidrah Malik, Liliya Abrukin, Keegan M Tupchong, Ian Portelli, Glenn Asaeda, David J Prezant, Binhuan Wang, Ming Hu, Lewis R Goldfrank, Chad M Meyers
OBJECTIVE: To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy. METHODS: We retrospectively reviewed records of all patients in Bellevue's EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated...
June 2016: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/27098330/the-safety-of-hand-and-upper-extremity-surgical-procedures-at-a-freestanding-ambulatory-surgery-center-a-review-of-28-737-cases
#15
REVIEW
Kanu S Goyal, Sameer Jain, Glenn A Buterbaugh, Joseph E Imbriglia
BACKGROUND: More procedures are being completed on an outpatient basis at freestanding ambulatory surgery centers. The purpose of our study was to determine the safety and rate of adverse events in outpatient hand and upper-extremity surgical procedures. METHODS: A retrospective review of cases at a single, freestanding ambulatory surgery center over an eleven-year period was performed. In our analysis, 28,737 cases were performed and were included. Adverse events were defined as serious complications causing harm to a patient or leading to additional treatment...
April 20, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27079966/emergency-department-visits-and-readmissions-among-children-after-gastrostomy-tube-placement
#16
Adam B Goldin, Kurt F Heiss, Matt Hall, David H Rothstein, Peter C Minneci, Martin L Blakely, Marybeth Browne, Mehul V Raval, Samir S Shah, Shawn J Rangel, Charles L Snyder, Charles D Vinocur, Loren Berman, Jennifer N Cooper, Marjorie J Arca
OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression...
July 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/26924805/factors-associated-with-30-day-unplanned-pediatric-surgical-readmission
#17
Morgan K Richards, David Yanez, Adam B Goldin, Tim Grieb, Whitney M Murphy, George T Drugas
BACKGROUND: Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission. METHODS: All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge...
September 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/26686934/the-impact-of-a-freestanding-ed-on-a-regional-emergency-medical-services-system
#18
Benjamin J Lawner, Jon Mark Hirshon, Angela C Comer, Jose V Nable, Jeffrey Kelly, Richard L Alcorta, Laura Pimentel, Christina L Tupe, Mary Alice Vanhoy, Brian J Browne
OBJECTIVE: The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times. METHODS: This study is based on data from the county's computer-aided dispatch center, the FED, and the Maryland Health Services Cost Review Commission. The analysis involved a pre/post design, with a 6-month washout period...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26520697/preventable-transfers-in-pediatric-trauma-a-10-year-experience-at-a-level-i-pediatric-trauma-center
#19
Stephen J Fenton, Justin H Lee, Austin M Stevens, Kyle C Kimbal, Chong Zhang, Angela P Presson, Ryan R Metzger, Eric R Scaife
BACKGROUND: Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center. METHODS: Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36hours of arrival without surgical intervention or advanced imaging studies...
April 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26484036/role-of-interventional-nephrology-in-the-multidisciplinary-approach-to-hemodialysis-vascular-access-care
#20
REVIEW
Gerald A Beathard
Dialysis vascular access planning, creation, and management is of critical importance to the dialysis patient population. It requires a multidisciplinary approach involving patients and their families, dialysis facility staff, the nephrologist, the surgeon, and the interventionalist. With the emergence of interventional nephrology as a subspecialty of nephrology, the nephrologist is increasingly providing both the nephrology and interventional aspects of care, and in some areas, the surgical functions as well...
September 2015: Kidney Research and Clinical Practice
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