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Freestanding emergency department

Jesse M Pines, Mark S Zocchi, Bernard S Black
OBJECTIVE: We compare case-mix, hospitalization rates, length of stay (LOS), and resource use in independent freestanding emergency departments (FSEDs) and hospital-based emergency departments (H-EDs). METHODS: Data from 74 FSEDs (2013-5) in Texas and Colorado, were compared to H-ED data from the 2013-14 National Hospital Ambulatory Medical Care Survey. In the unrestricted sample, large differences in visit characteristics (e.g. payer and case mix) were found between patients that use FSEDs compared to H-EDs...
January 30, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Erin L Simon, Cedric Dark, Mitch Kovacs, Sunita Shakya, Craig A Meek
BACKGROUND: Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. OBJECTIVE: We determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. METHODS: This was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015...
October 29, 2017: American Journal of Emergency Medicine
Aaron E Kornblith, Ashley A Foster, Christine S Cho, Ralph C Wang, David M Jaffe
OBJECTIVE: Adults presenting to pediatric emergency departments are transferred to general emergency departments in proportions between 20% and 60%. How illness severity is related to the decision to transfer is poorly understood. We compared the proportion of adults with emergent and nonemergent conditions with respect to their final disposition. We also determined characteristics associated with transfer. METHODS: We conducted a retrospective review of the electronic medical record and identified all patients 25 years and older presenting to a large urban freestanding pediatric emergency department from 2008 to 2013...
November 14, 2017: Pediatric Emergency Care
Rebecca J Hart, Michelle D Stevenson, Michael J Smith, A Scott LaJoie, Keith Cross
Importance: Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. Objective: To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients...
November 6, 2017: JAMA Pediatrics
Lindsey Korbel, Robert S Easterling, Nidhi Punja, John David Spencer
BACKGROUND: People with diabetes mellitus (DM) have increased infection risk. The healthcare utilization of pediatric and adolescent diabetic patients with infection is not well defined. This study evaluates the number of pediatric and adolescent patients with DM that seek medical treatment for infection management and assesses its socioeconomic impact. METHODS: A retrospective analysis was performed using the Pediatric Health Information System (PHIS) database on children and adolescents with DM who presented to the Emergency Department (ED) or were hospitalized for infection management from 2008 to 2014...
November 2, 2017: Pediatric Diabetes
Joshua M Sherman, Todd P Chang, Nurit Ziv, Alan L Nager
BACKGROUND: In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient...
October 9, 2017: Pediatric Emergency Care
Cedric Dark, Yingying Xu, Vivian Ho
Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes...
October 1, 2017: Health Affairs
Purvi L Shroff, Rebecca W Hayes, Pradeep Padmanabhan, Michelle D Stevenson
BACKGROUND: Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit. OBJECTIVE: The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child's illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED. METHODS: A 40-question interview was conducted with parents presenting to an ED within a freestanding children's hospital...
September 28, 2017: Interactive Journal of Medical Research
Michael L Callaham
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
Jeremiah D Schuur, Donald M Yealy, Michael L Callaham
No abstract text is available yet for this article.
December 2017: Annals of Emergency Medicine
Nitish Patidar, Robert Weech-Maldonado, Stephen J O'Connor, Bisakha Sen, Jerry M Trimm, Carlos A Camargo
The number of freestanding emergency departments (FSEDs) is growing rapidly in the United States. Proponents of FSEDs cite potential benefits of FSEDs including lower waiting time and reduced travel distance for needed emergency care. Others have suggested that increased access to emergency care may lead to an increase in the use of emergency departments for lower acuity patients, resulting in higher overall health care expenditures. We examined the relationship between the number of FSEDs in each county and total Medicare expenditures between 2003 and 2009...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Melissa D Aldridge, Andrew J Epstein, Abraham A Brody, Eric J Lee, R Sean Morrison, Elizabeth H Bradley
BACKGROUND: Care at the end of life is increasingly fragmented and is characterized by multiple hospitalizations, even among patients enrolled with hospice. OBJECTIVE: To determine whether hospice spending on direct patient care (including the cost of home visits, drugs, equipment, and counseling) is associated with hospital utilization and Medicare expenditures of hospice enrollees. DESIGN: Longitudinal, observational cohort study (2008-2010)...
August 17, 2017: Journal of Palliative Medicine
James Rachal, Wayne Sparks, Christine Zazzaro, Terri Blackwell
Carolinas HealthCare System is one of the largest freestanding psychiatric emergency departments in the country. It has grown from a small community mental health center in the 1930s, to one of the largest providers of emergency mental health services in the country. It offers services in person and via telepsychiatry to other emergency departments and primary care clinics. It decreased emergency room wait times and revolutionized where and how patients get their care. This has been the work of several groups from many disciplines...
September 2017: Psychiatric Clinics of North America
Rachel Root, Paul Krogh, Kristi Gullickson, Barbara Hintzen, Martha Christophersen, Steven Kastendieck, Matt Kresl
No abstract text is available yet for this article.
June 1, 2017: American Journal of Health-system Pharmacy: AJHP
Amanda M McIntosh, Suhong Tong, Sara J Deakyne, Jesse A Davidson, Halden F Scott
OBJECTIVES: To assess the validity of Vasoactive-Inotropic Score as a scoring system for cardiovascular support and surrogate outcome in pediatric sepsis. DESIGN: Secondary retrospective analysis of a single-center sepsis registry. SETTING: Freestanding children's hospital and tertiary referral center. PATIENTS: Children greater than 60 days and less than 18 years with sepsis identified in the emergency department between January 2012 and June 2015 treated with at least one vasoactive medication within 48 hours of admission to the PICU...
August 2017: Pediatric Critical Care Medicine
Rebeca M Tacy, Sherry Donaworth, Kathleen Ballman
Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project...
April 2017: Advanced Emergency Nursing Journal
Soumya Murag, Cristie Suzukawa, Todd P Chang
BACKGROUND: Child life specialists (CLS) work with children directly to minimize long-term psychological sequelae of traumatic or medical events such as intravenous cannulation. There has been little done to measure how CLS impact outcomes of medical procedures. The objective of this study is to determine the impact of interventions by CLS upon successful attainment of intravenous (IV) cannulation among pediatric patients in the emergency department setting. METHOD: This was an eight month retrospective review within an urban tertiary-care freestanding pediatric Emergency Department (ED), using nursing and CLS documentation of ED patients younger than 21years who underwent IV cannulation...
September 2017: Journal of Pediatric Nursing
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...
April 2017: Pediatrics
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...
December 2017: Annals of Emergency Medicine
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
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