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Emergency department observation unit

David M Cline, Susan Silva, Caroline E Freiermuth, Victoria Thornton, Paula Tanabe
Introduction: Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC), such as a day hospital (DH) or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. Methods: In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD) VOC, we prospectively compared acute care encounters for utilization of 1) emergency department (ED); 2) ED observation unit; 3) DH, and 4) hospital admission, of two different patient cohorts with SCD presenting to our two study sites...
March 2018: Western Journal of Emergency Medicine
Marc L Martel, Lauren R Klein, Kurt A Hager, Diana B Cutts
Introduction: Food insecurity is a significant issue in the United States and is prevalent in emergency department (ED) patients. The purpose of this study was to report the novel use of an integrated electronic medical record (EMR) order for food resources, and to describe our initial institutional referral patterns after focused education and implementation of the order. Methods: This was a retrospective, observational study, describing food-bank referral patterns before and after the implementation of dedicated ED education on the novel EMR order for food resources...
March 2018: Western Journal of Emergency Medicine
Susann J Jarhult, Melissa L Howell, Isabelle Barnaure-Nachbar, Yuchiao Chang, Benjamin A White, Mary Amatangelo, David F Brown, Aneesh B Singhal, Lee H Schwamm, Scott B Silverman, Joshua N Goldstein
Introduction: Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). Methods: We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup...
March 2018: Western Journal of Emergency Medicine
Duygu Ferek Emir, Ibrahim Ulas Ozturan, Serkan Yilmaz
INTRODUCTION: Alpha lipoic acid (ALA) is a potent antioxidant used to treat a variety of disorders. Although ALA is considered a very safe supplement and intoxication is very rare, acute high-dose ingestions can cause mortality. In this report, we discuss a very rare case of ALA intoxication to increase awareness of this issue. CASE REPORT: A 22-year-old female was referred to our emergency department with ALA intoxication after ingesting a total of 18g of ALA with a suicidal intention...
March 13, 2018: American Journal of Emergency Medicine
J Hansen, L Zhang, A Eaton, R Baxter, C A Robertson, M D Decker, D P Greenberg, E Bassily, N P Klein
BACKGROUND: Menactra® vaccine (MenACWY-D) was licensed in the United States in 2005 for persons 11-55 years of age, in 2007 for children 2-10 years of age, and in 2011 for infants/toddlers 9-23 months of age. We conducted two studies at Kaiser Permanente Northern California (KPNC), an integrated health care organization, to assess the safety of MenACWY-D in 2-10-year-olds and 9-23-month-olds receiving the vaccine during routine clinical care. METHODS: We conducted observational, retrospective studies of MenACWY-D in 2-10-year-olds (October 2007-October 2010) and in 9-23-month-olds (June 2011-June 2014)...
March 14, 2018: Vaccine
Colin J Crilly, Amy J Allen, Teresa M Amato, Allison Tiberio, Rifka C Schulman, Robert A Silverman
OBJECTIVE: To determine whether hyperglycemic patients can be successfully managed in the Emergency Department Observation Unit (EDOU), as determined by the frequency of inpatient admission following their EDOU stay. METHODS: This was a retrospective chart review of patients≥18years presenting to an academic tertiary care ED between May 1, 2014 and May 31, 2016, found to have a glucose≥300mg/dL, and selected for EDOU admission. Patient demographic information, lab results including an HbA1c, disposition, and hospital revisits within 30days of discharge were recorded...
February 27, 2018: American Journal of Emergency Medicine
Kuo-Chen Huang, Yan-Ren Lin, Yuan-Jhen Syue, Chia-Te Kung, I-Min Chiu, Chao-Jui Li
BACKGROUND: There are fewer female emergency physicians (EPs) than male ones. This study attempted to analyze the differences in clinical practice between female and male EPs in the emergency department (ED). MATERIALS AND METHODS: A retrospective, 1-year cohort study was conducted across 4 EDs in the largest healthcare system in Taiwan. A total of 199,757 adult patients without trauma treated by 76 EPs (9 females and 67 males) were included in the study. The clinical practice of female and male EPs was compared...
March 2018: American Journal of the Medical Sciences
Sophia Y Wang, Mariam S Hamid, David C Musch, Maria A Woodward
Importance: Nearly 2 million patients visit emergency departments (EDs) because of eye concerns annually in the United States. How hospitals currently assign these patients to treatment is important for designing systems that equitably allocate resources for eye care in urgent settings. Objective: To investigate factors associated with ophthalmology consultation for eye-related adult ED encounters to assess possible disparities by sex, race/ethnicity, language preference, or residential distance from the medical center...
March 15, 2018: JAMA Ophthalmology
Craig I Coleman, Alexander G G Turpie, Thomas J Bunz, Jan Beyer-Westendorf
PURPOSE: Frailty predicts poorer outcomes in patients receiving anticoagulation. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin in frail patients experiencing venous thromboembolism in routine practice. METHODS: Using United States MarketScan claims data from 1/2012-12/2016, we identified frail patients (using the Johns Hopkins Claims-Based Frailty Indicator score) who had ≥1 primary hospitalization/emergency department visit discharge diagnosis code for venous thromboembolism (index event), received rivaroxaban or warfarin as their first outpatient oral anticoagulant (OAC) within 30-days of the index event and had ≥12-month of insurance coverage prior the index venous thromboembolism (baseline)...
March 8, 2018: American Journal of Medicine
Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Gail G Salvatierra, Bernice G Gulek, Baran Erdik, Deborah Bennett, Kenn B Daratha
BACKGROUND: More than a million people a year in the United States experience sepsis or sepsis-related complications, and sepsis remains the leading cause of in-hospital deaths. Unlike many other leading causes of in-hospital mortality, sepsis detection and treatment are not dependent on the presence of any technology or services that differ between tertiary and non-tertiary hospitals. OBJECTIVE: To compare sepsis mortality rates between tertiary and non-tertiary hospitals in Washington State...
March 6, 2018: Journal of Emergency Medicine
(no author information available yet)
BACKGROUND: Chronic idiopathic urticaria (CIU)/spontaneous urticaria (CSU) is defined by the presence of wheals,angioedema, or both for 6 weeks, with or without an identifiable trigger. Real-world health care data among children withCIU/CSU remain scarce. OBJECTIVES: To describe treatment patterns, health care resource utilization (HRU), and costs in pediatric patients with CIU/CSU (12 years old) and to compare these with pediatric patients without CIU/CSU. METHODS: A commercial administrative claims data base (September 2013 to June 2016) was used...
March 7, 2018: Allergy and Asthma Proceedings:
Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J McConnell, Neha Jakhete, James Crismale, Stefanie Porges, Vandana Khungar, Shivan J Mehta, David Goldberg, Zhiping Li, Thomas Schiano, Linda Regan, Clinton Orloski, Judy A Shea
Patients with cirrhosis have high admission and readmission rates, and it is estimated that a quarter are potentially preventable. Little data are available regarding nonmedical factors impacting triage decisions in this patient population. This study sought to explore such factors as well as to determine provider perspectives on low-acuity clinical presentations to the emergency department, including ascites and hepatic encephalopathy. A survey was distributed in four liver transplant centers to both emergency medicine and hepatology providers, who included attending physicians, house staff, and advanced practitioners; 196 surveys were returned (estimated response rate 50...
March 2018: Hepatology communications
Nivethitha Ilangkovan, Christian Backer Mogensen, Hans Mickley, Annmarie Touborg Lassen, Jess Lambrechtsen, Niels Peter Ronnow Sand, Rasmus Albiniussen, Jørgen Byg, Flemming Hald, Mette Hjortdal Grønhøj, Axel Diederichsen
OBJECTIVES: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. DESIGN: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up...
March 3, 2018: BMJ Open
Cassandra K Kisby, Michael R Polin, Anthony G Visco, Nazema Y Siddiqui
OBJECTIVE: The aim of the study was to compare unplanned postoperative encounters in women discharged same day versus later after robotic-assisted sacrocolpopexy (RA-SCP). METHODS: This is a retrospective cohort study of women who underwent RA-SCP at a tertiary care center January 2013 to September 2015. Women were divided into 2 cohorts based on their day of discharge: (1) same day or (2) postoperative day 1 (POD ≥ 1) or later. Our primary outcome was unplanned provider visits (clinic, urgent care, emergency department, or hospital readmission) during the 6 weeks after surgery...
February 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Julia Budde, Parul Agarwal, Madhu Mazumdar, Jonathan Yeo, Sidney S Braman
Studies on observation unit (OU) use to avoid a hospital admission from the emergency department (ED) have found variable effects on health care resource utilization, and these effects have not been studied in acute exacerbation of chronic obstruction pulmonary disease (AECOPD). We retrospectively collected data for all AECOPD-related ED visits (age > 40) to an urban, academic medical center between February 2013 and April 2017. We examined the total proportion of visits admitted to the hospital before and after availability of an OU and the proportion of visits discharged directly from the ED using segmented regression analysis...
February 27, 2018: Lung
L Rouch, F Farbos, C Cool, C McCambridge, C Hein, S Elmalem, Y Rolland, B Vellas, P Cestac
OBJECTIVES: To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. DESIGN: Observational prospective cohort study. SETTING: Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. PARTICIPANTS: 206 subjects with a mean age of 85 years...
2018: Journal of Nutrition, Health & Aging
Daniel A Waxman, Hemal K Kanzaria, David L Schriger
Importance: The Institute of Medicine described diagnostic error as the next frontier in patient safety and highlighted a critical need for better measurement tools. Objectives: To estimate the proportions of emergency department (ED) visits attributable to symptoms of imminent ruptured abdominal aortic aneurysm (AAA), acute myocardial infarction (AMI), stroke, aortic dissection, and subarachnoid hemorrhage (SAH) that end in discharge without diagnosis; to evaluate longitudinal trends; and to identify patient characteristics independently associated with missed diagnostic opportunities...
February 26, 2018: JAMA Internal Medicine
Melissa Chan, Garth Meckler, Quynh Doan
Background: General emergency department crowding negatively impacts patient care, and increases patient morbidity. Objectives: This study seeks to determine if markers of paediatric emergency department (PED) flow are independently associated with negative outcomes and increased health care utilization. Methods: We conducted a retrospective cohort study of PED visits from 2008 to 2012. Data were pulled from an electronic administrative database...
October 2017: Paediatrics & Child Health
Leora I Horwitz, Yongfei Wang, Faseeha K Altaf, Changqin Wang, Zhenqiu Lin, Shuling Liu, Jacqueline Grady, Susannah M Bernheim, Nihar R Desai, Arjun K Venkatesh, Jeph Herrin
BACKGROUND: Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. DESIGN: Cross-sectional analysis. SUBJECTS: Nonfederal United States acute care hospitals. MEASURES: Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges...
February 16, 2018: Medical Care
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