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Emergency department observation unit

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https://www.readbyqxmd.com/read/29790166/physical-therapy-as-the-first-point-of-care-to-treat-low-back-pain-an-instrumental-variables-approach-to-estimate-impact-on-opioid-prescription-health-care-utilization-and-costs
#1
Bianca K Frogner, Kenneth Harwood, C Holly A Andrilla, Malaika Schwartz, Jesse M Pines
OBJECTIVE: To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. DATA SOURCES: Commercial health insurance claims data, 2009-2013. STUDY DESIGN: Retrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs...
May 23, 2018: Health Services Research
https://www.readbyqxmd.com/read/29789779/outcomes-in-cardiogenic-shock-patients-with-extracorporeal-membrane-oxygenation-use-a-matched-cohort-study-in-hospitals-across-the-united-states
#2
Rayan El Sibai, Rana Bachir, Mazen El Sayed
Background: ECMO is increasingly used for patients with critical illnesses. This study examines ECMO use in patients with cardiogenic shock in US hospitals and associated outcomes (mortality, hospital length of stay, and total hospital charges). Methods: A matched cohort retrospective study was conducted using the 2013 Nationwide Emergency Department Sample. Cardiogenic shock visits were matched (1 : 1) and compared based on ECMO use. Results: Patients with ECMO ( N = 802) were compared to patients without ECMO ( N = 805)...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29782079/the-dipep-diagnosis-of-pe-in-pregnancy-study-an-observational-study-of-the-diagnostic-accuracy-of-clinical-assessment-d-dimer-and-chest-x-ray-for-suspected-pulmonary-embolism-in-pregnancy-and-postpartum
#3
Steve Goodacre, Kimberley Horspool, Catherine Nelson-Piercy, Marian Knight, Neil Shephard, Fiona Lecky, Steven Thomas, Beverley J Hunt, Gordon Fuller
OBJECTIVE: To identify clinical features associated with PE diagnosis and determine the accuracy of decision rules and D-dimer for diagnosing suspected PE in pregnant/postpartum women. DESIGN: Observational cohort study augmented with additional cases. SETTING: Emergency departments and maternity units at eleven prospectively recruiting sites and maternity units in the United Kingdom Obstetric Surveillance System (UKOSS). POPULATION: 324 pregnant/postpartum women with suspected PE and 198 pregnant/postpartum women with diagnosed PE...
May 21, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29768698/financial-viability-of-emergency-department-observation-unit-billing-models
#4
Christopher W Baugh, Pawan Suri, Christopher G Caspers, Michael A Granovsky, Keith Neal, Michael A Ross
BACKGROUND: Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services...
May 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29764376/methicillin-resistant-staphylococcus-aureus-in-emergency-department-patients-in-the-united-arab-emirates
#5
Muna Al Jalaf, Hanan Fadali, Rasha Alanee, Firas Najjar, Zulfa Al Deesi, Rania M Seliem, Eric J Nilles
BACKGROUND: Since the 1990s, community-associated methicillin resistant staphylococcus aureus (CA-MRSA) has emerged as an important global cause of skin and soft tissue infections. Little is known about the epidemiology of this pathogen in the Middle East. METHODS: We conducted a prospective observational study in a single large teaching hospital in Dubai to identify the incidence of community-acquired methicillin resistant staphylococcus aureus (MRSA) among ambulatory patients presenting with purulent skin and soft tissue infections...
May 15, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29760857/retrospective-chart-review-of-synthetic-cannabinoid-intoxication-with-toxicologic-analysis
#6
Payal Sud, Miles Gordon, Laura Tortora, Matthew Stripp, Damon Borg, Adam Berman
Introduction: Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds. Methods: We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29760842/appropriateness-of-extremity-magnetic-resonance-imaging-examinations-in-an-academic-emergency-department-observation-unit
#7
McKinley Glover, Ravi V Gottumukkala, Yadiel Sanchez, Brian J Yun, Theodore I Benzer, Benjamin A White, Anand M Prabhakar, Ali S Raja
Introduction: Emergency departments (ED) and hospitals face increasing challenges related to capacity, throughput, and stewardship of limited resources while maintaining high quality. Appropriate utilization of extremity magnetic resonance imaging (MRI) examinations within the emergency setting is not well known. Therefore, this study aimed to determine indications for and appropriateness of MRI of the extremities for musculoskeletal conditions in the ED observation unit (EDOU). Methods: We conducted this institutional review board-approved, retrospective study in a large, quaternary care academic center and Level I trauma center...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29757891/spinal-epidural-abscess-in-an-infant-presenting-as-fever-and-respiratory-distress
#8
Katherine M Gupta, Khoon-Yen Tay
A 9-month-old healthy female presented during winter to the emergency department with a chief complaint of fever and prominent respiratory symptoms. She was discharged on oseltamivir with a presumptive diagnosis of influenza. She returned to the emergency department 2 days later with continued fever and more upper respiratory symptoms. She was admitted for intravenous hydration to the observation unit with a diagnosis of viral illness (with viral testing that returned positive for adenovirus) and dehydration...
May 2, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29736640/general-dependencies-and-causality-analysis-of-road-traffic-fatalities-in-oecd-countries
#9
Muhammad Rizwan Yaseen, Qamar Ali, Muhammad Tariq Iqbal Khan
The road traffic accidents were responsible for material and human loss which was equal to 2.8 to 5% of gross national product (GNP). However, literature does not explore the elasticity coefficients and nexus of road traffic fatalities with foreign direct investment, health expenditures, trade openness, mobile subscriptions, the number of researchers in R&D department, and environmental particulate matter. This study filled this research gap by exploring the nexus between road traffic fatalities, foreign direct investment, health expenditures, trade openness, mobile subscriptions, the number of researchers, and environmental particulate matter in Organization for Economic Cooperation and Development (OECD) countries by using panel data from 1995 to 2015...
May 7, 2018: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/29735290/incidence-timing-and-risk-factors-for-secondary-revision-after-primary-revision-of-traumatic-digit-amputations
#10
Andrew P Harris, Avi D Goodman, Joseph A Gil, Andrew D Sobel, Neill Y Li, Jeremy E Raducha, Grayson L Baird, Julia A Katarincic
PURPOSE: Primary revision amputation is the most common treatment method for traumatic digit amputations in the United States. Few studies have reported secondary revision rates after primary revision amputation. The primary aim of our study was to identify risk factors for secondary revision within 1 year of the index procedure. Secondarily, we describe the incidence and timing of complications requiring secondary revision. METHODS: Our institution's emergency department (ED) database was reviewed for traumatic digit amputations over a 6-year period...
May 5, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29722043/a-taxonomy-and-cultural-analysis-of-intra-hospital-patient-transfers
#11
Alana Rosenberg, Meredith Campbell Britton, Shelli Feder, Karl Minges, Beth Hodshon, Sarwat I Chaudhry, Grace Y Jenq, Beth L Emerson
Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015...
May 2, 2018: Research in Nursing & Health
https://www.readbyqxmd.com/read/29721320/accuracy-of-the-first-interpretation-of-early-brain-ct-images-for-predicting-the-prognosis-of-post-cardiac-arrest-syndrome-patients-at-the-emergency-department
#12
Mitsuaki Nishikimi, Takayuki Ogura, Kota Matsui, Kunihiko Takahashi, Kenji Fukaya, Keibun Liu, Hideo Morita, Mitsunobu Nakamura, Shigeyuki Matsui, Naoyuki Matsuda
Background: Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). Methods: This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29720051/analysis-of-rothman-index-data-to-predict-postdischarge-adverse-events-in-a-medical-intensive-care-unit
#13
Deepa Bangalore Gotur, Faisal Masud, Jaya Paranilam, Janice L Zimmerman
OBJECTIVE: Currently, there are no objective metrics included in the intensive care unit (ICU) discharge decision making process. In this study, we evaluate Rothman Index(RI) data for a possible metric as part of a quality improvement project. Our objectives were to determine whether RI could predict adverse events occurring within 72 hours of ICU discharge decision, the optimal clinical cutoff value for this metric, and to determine whether there is a relation between the RI warning alert 24 hours prior to discharge and adverse events postdischarge...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29719324/increased-burden-on-metropolitan-urological-services-the-era-of-the-australian-national-emergency-access-targets-neat-or-the-4-h-target
#14
Marlon L Perera, Neiraja Gnaneswaran, Matthew J Roberts, Nathan Lawrentschuk, Peter Ritchie, Steven T F Chan
Background: The National Emergency Access Targets (NEAT) was introduced in Australia in 2011 and guides the clearance of presentations within 4-h of initial presentation from the Emergency Department (ED). We aim to assess the impact of the introduction of NEAT on acute urological services at a large metropolitan center. Methods: A retrospective cohort study was performed and data were collected from electronic patient management systems. The control group was represented by ED presentations between June and September 2011, 1 year prior to the introduction of NEAT...
April 2018: Urology Annals
https://www.readbyqxmd.com/read/29717706/impact-of-specific-training-in-anaphylaxis-of-the-triage-nursing-staff-in-a-tertiary-hospital-s-paediatric-emergency-department
#15
E Arroabarren, J Alvarez-García, M Anda, M de Prada, C Ponce, M J Alvarez-Puebla
BACKGROUND: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the Emergency Departments (ED) for control or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Paediatrics Emergency Unit (PEU), delaying their treatment. In conjunction with our PEU staff we designed a basic educational intervention (BEI) to try to solve this problem...
May 2, 2018: Journal of Investigational Allergology & Clinical Immunology
https://www.readbyqxmd.com/read/29716787/management-of-acute-retinal-ischemia-follow-the-guidelines
#16
REVIEW
Valérie Biousse, Fadi Nahab, Nancy J Newman
Acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Guidelines recommend the combination of urgent brain magnetic resonance imaging with diffusion-weighted imaging, vascular imaging, and clinical assessment to identify TMVL, BRAO, and CRAO patients at highest risk for recurrent stroke, facilitating early preventive treatments to reduce the risk of subsequent stroke and cardiovascular events...
April 28, 2018: Ophthalmology
https://www.readbyqxmd.com/read/29702265/cost-of-managing-meningitis-and-encephalitis-among-adult-patients-in-the-united-states
#17
J M Balada-Llasat, Ning Rosenthal, Rodrigo Hasbun, Louise Zimmer, Christine C Ginocchio, Steven Duff, Jessica Chung, Samuel Bozzette
OBJECTIVES: To determine the associated cost related to diagnosis and treatment of meningoencephalitis (ME) in adult patients in the United States. METHODS: A retrospective observational study design was used to assess the use and costs of diagnostic tests, antimicrobial treatment and total hospitalization for adult patients with suspected ME who received a lumbar puncture (LP) procedure during an emergency department visit or during the first two service days of an inpatient stay...
April 24, 2018: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/29701496/evaluation-of-hospital-length-of-stay-and-revenues-as-a-function-of-admission-mode-clinical-pathways-including-observation-unit-stay-and-hospitalization-characteristics
#18
Enrique Casalino, Anne Perozziello, Christophe Choquet, Sonia Curac, Christophe Leroy, Romain Hellmann
Objectives Hospital length of stay (days) and revenues per day (euros) could be different depending on admission mode. To determine the impact of admission mode as a function of clinical pathway, we conducted the present study. DATA SOURCES: We included 159,206 admissions to three academic hospitals during a four-year period. Data were obtained from the electronic system of the hospital trust. Study design A case (through-emergency department)-control (elective (EA)) study was conducted (77,052), matched by age, stay severity and type, disease-related group, and discharge mode...
January 1, 2018: Health Services Management Research
https://www.readbyqxmd.com/read/29698542/point-prevalence-of-healthcare-associated-infections-and-antibiotic-use-in-three-large-swiss-acute-care-hospitals
#19
Aliki Metsini, Miriam Vazquez, Rami Sommerstein, Jonas Marschall, Cathy Voide, Nicolas Troillet, Céline Gardiol, Didier Pittet, Walter Zingg, The Swissnoso Network
BACKGROUND: The overall burden of healthcare-associated infections (HAIs) remains high, even in high-income countries. However, the current burden of HAI in Switzerland is unknown. Prevalence surveys have a long tradition in the field of infection prevention and control for measuring both HAI and antimicrobial use. The objective of this survey was to test the point prevalence survey (PPS) methodology of the European Centre for Disease Prevention and Control (ECDC) in acute-care hospitals in Switzerland...
April 26, 2018: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29698343/the-effect-of-an-observation-unit-on-pediatric-minor-head-injury
#20
Yusuke Hagiwara, Nobuaki Inoue
OBJECTIVE: The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma. METHODS: This study was a retrospective before-and-after study of pediatric patients 18 years or younger with minor blunt head trauma. Patients with a Glasgow Coma Scale score of 14 or 15 who presented to the emergency department were included in the analysis. The rates of head CT use in the period before and after the institution of the OU were compared...
April 24, 2018: Pediatric Emergency Care
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