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Emergency department revisit

Frank X Scheuermeyer, Christopher DeWitt, Jim Christenson, Brian Grunau, Andrew Kestler, Eric Grafstein, Jane Buxton, David Barbic, Stefan Milanovic, Reza Torkjari, Indy Sahota, Grant Innes
STUDY OBJECTIVE: Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose. METHODS: At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality...
March 9, 2018: Annals of Emergency Medicine
Sangil Lee, Karisa K Harland, Morgan Bobb Swanson, Sara Lawson, Elijah Dahlstrom, Lance Clemson, Elaine Himadi
OBJECTIVES: Among emergency department (ED) mental health and substance abuse (MHSA) patients, we sought to compare mortality and healthcare utilization by ED discharge disposition and inpatient bed request status. METHODS: A retrospective cohort study of 492 patients was conducted at a single University ED. We reviewed three groups of MHSA patients including ED patients that were admitted, ED patients with a bed request that were discharged from the ED, and ED patients with no bed request that were discharged from the ED...
February 27, 2018: American Journal of Emergency Medicine
Brian W Patterson, Michael D Repplinger, Michael S Pulia, Robert J Batt, James E Svenson, Alex Trinh, Eneida A Mendonça, Maureen A Smith, Azita G Hamedani, Manish N Shah
OBJECTIVES: To evaluate the utility of routinely collected Hendrich II fall scores in predicting returns to the emergency department (ED) for falls within 6 months. DESIGN: Retrospective electronic record review. SETTING: Academic medical center ED. PARTICIPANTS: Individuals aged 65 and older seen in the ED from January 1, 2013, through September 30, 2015. MEASUREMENTS: We evaluated the utility of routinely collected Hendrich II fall risk scores in predicting ED visits for a fall within 6 months of an all-cause index ED visit...
March 6, 2018: Journal of the American Geriatrics Society
Nour Al Jalbout, Anna Jean Moreland
Splenic artery aneurysm (SAA) is a rare potentially fatal condition with an estimated prevalence in the general population ranging between 0.2 and 10.4%. Ruptured splenic artery aneurysm poses a great diagnostic challenge to emergency physicians due to non-specific and potentially fatal presentations. Dual (arterial and venous) phase imaging is very important for identifying the source of an active intraabdominal bleed when patients are stable enough to tolerate the exam. Here, we present a case of a 54-year-old female who presented with syncope to the emergency department, diagnosed with ruptured splenic artery aneurysm...
February 26, 2018: Clinical Imaging
Jelle de Gelder, Jacinta A Lucke, Bas de Groot, Anne J Fogteloo, Sander Anten, Christian Heringhaus, Olaf M Dekkers, Gerard J Blauw, Simon P Mooijaart
OBJECTIVES: To study predictors of emergency department (ED) revisits and the association between ED revisits and 90-day functional decline or mortality. DESIGN: Multicenter cohort study. SETTING: One academic and two regional Dutch hospitals. PARTICIPANTS: Older adults discharged from the ED (N=1,093). MEASUREMENTS: At baseline, data on demographic characteristics, illness severity, and geriatric parameters (cognition, functional capacity) were collected...
February 28, 2018: Journal of the American Geriatrics Society
Jane Kurtzman, Lihai Song, Michelle E Ross, Charles D Scales, David I Chu, Gregory E Tasian
PURPOSE: To determine the association between urology consultation and emergency department (ED) revisits for children with urinary stones. MATERIALS AND METHODS: This retrospective cohort study included patients ≤18 years-old who presented to an ED in South Carolina with a urinary stone from 1997-2015. The primary exposure was urology consultation during the index ED visit. The primary outcome was a stone-related ED revisit occurring within 180 days of discharge from an index ED visit...
February 20, 2018: Journal of Urology
Brian Farris, Courtney Shakowski, Scott W Mueller, Suzanne Phong, Tyree H Kiser, Gabrielle Jacknin
PURPOSE: Barriers to and clinical implications of patient nonadherence to filling discharge medication prescriptions from the emergency department (ED) were evaluated. METHODS: This was a retrospective, observational analysis of patients discharged from the ED from April 2013 through May 2015 with medication prescriptions. Patients age 18-89 years who were seen in the ED and did not retrieve discharge medication prescriptions from the onsite, 24-hour ED discharge pharmacy were included in this study...
March 1, 2018: American Journal of Health-system Pharmacy: AJHP
Miquel Sánchez, Montse Suárez, María Asenjo, Ernest Bragulat
Objective: To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design: A prospective interventional study. Setting: An ED of a tertiary care hospital. Participants: Triage acuity level-3 patients. Intervention(s): To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff...
February 13, 2018: International Journal for Quality in Health Care
Maame Yaa A B Yiadom, Henry Domenico, Daniel Byrne, Michele Marie Hasselblad, Cheryl L Gatto, Sunil Kripalani, Neesha Choma, Sarah Tucker, Li Wang, Monisha C Bhatia, Johnston Morrison, Frank E Harrell, Tina Hartert, Gordon Bernard
INTRODUCTION: Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge. METHODS AND ANALYSIS: This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions...
February 14, 2018: BMJ Open
Mollie Marr, Sarah M Horwitz, Ruth Gerson, Amy Storfer-Isser, Jennifer F Havens
OBJECTIVES: Pediatric mental health emergency department (ED) visits continue to rise with 19% to 62% of youth presenting to the ED ultimately returning for a mental health-related complaint. To better understand the needs of children returning to the ED, this study examines the clinical, demographic, and environmental factors associated with revisits to a dedicated child psychiatric ED. METHODS: Clinical factors, home environment, and mental health service utilization of 885 children presenting to a dedicated child psychiatric ED over a 1-year period were abstracted by retrospective chart review...
February 12, 2018: Pediatric Emergency Care
M Malik, Z Moore, D Patton, T O'Connor, L E Nugent
BACKGROUND: Nursing assessment of elderly patients is imperative in Emergency Departments (ED) while providing interventions that increase independence facilitating discharge to primary healthcare. AIMS: To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS). METHODS: Search strategy used following databases; Cochrane, Medline, CINAHL, Embase, Scopus and Web of Knowledge; And terms; geriatric nurse assessment, nurse discharge planning, geriatric nurse specialist, nurse intervention, emergency department, accident and emergency, patient outcomes, discharge, admissions, readmissions, hospital utilization, hospitalization, length of stay/hospital stay...
February 8, 2018: International Emergency Nursing
Evelien de Vos-Kerkhof, Dorien H F Geurts, Ewout W Steyerberg, Monica Lakhanpaul, Henriette A Moll, Rianne Oostenbrink
In this study, we aimed to identify characteristics of (unscheduled) revisits and its optimal time frame after Emergency Department (ED) discharge. Children with fever, dyspnea, or vomiting/diarrhea (1 month-16 years) who attended the ED of Erasmus MC-Sophia, Rotterdam (2010-2013), the Netherlands, were prospectively included. Three days after ED discharge, we applied standardized telephonic questionnaires on disease course and revisits. Multivariable logistic regression analysis was used to identify independent characteristics of revisits...
February 3, 2018: European Journal of Pediatrics
Parth K Shah, Phyllis L Yan, Casey A Dauw, Brent K Hollenbeck, Khurshid R Ghani, Amy N Luckenbaugh, John M Hollingsworth
OBJECTIVE: To test whether duplicate imaging relates to a lack of information sharing among providers, we measured the association between emergency department (ED) switching during a kidney stone episode and receipt of a repeat computed tomography (CT) scan. METHODS: Using the MarketScan Commercial Claims and Encounters Database, we identified adults between the ages 18 and 64 with an ED visit for a diagnosis of kidney stones. Among patients who had an abdominal/pelvic CT scan at their initial encounter, we then determined the subset that made an ED revisit within 30 days of their first, distinguishing between those to the same versus a different ED...
January 22, 2018: Urology
John R Stephens, Carlton Moore, Kelly V Stepanek, James C Garbutt, Britta Starke, Allen Liles, Daniel E Jonas
BACKGROUND: Naltrexone trials have demonstrated improved outcomes for patients with alcohol use disorders. Hospital initiation of naltrexone has had limited study. OBJECTIVE: To describe the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal about naltrexone. DESIGN: A pre-post study analysis. SETTING: A tertiary academic center. PATIENTS: Patients hospitalized for alcohol withdrawal...
January 24, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Wen Zheng, Jiali Wang, Feng Xu, Jiaqi Zheng, He Zhang, Jingjing Ma, Guangmei Wang, Hao Wang, Derek P Chew, Yuguo Chen
INTRODUCTION: Acute chest pain represents a major healthcare burden in emergency departments (ED) throughout the world. Among these patients, rapidly determining whether an acute coronary syndrome (ACS) is evolving remains difficult. In China, there are limited data correlating the baseline characteristics, evaluation and management of ED patients with acute chest pain and ACS-related symptoms with clinical outcomes. Nor has there been an evaluation of outcomes at different levels of hospitals...
January 23, 2018: BMJ Open
Christopher J Russell, Mary R Mamey, Joyce Y Koh, Sheree M Schrager, Michael N Neely, Susan Wu
OBJECTIVES: To identify factors associated with longer length of stay (LOS) and higher 30-day hospital revisit rates for children hospitalized with bacterial tracheostomy-associated respiratory tract infections (bTARTIs). METHODS: This was a multicenter, retrospective cohort study using administrative data from the Pediatric Health Information System database between 2007 and 2014 of patients 30 days to 17 years old with a principal discharge diagnosis of bTARTI or a principal discharge diagnosis of bTARTI symptoms with a secondary diagnosis of bTARTI...
January 16, 2018: Hospital Pediatrics
Ula Hwang, Scott M Dresden, Mark S Rosenberg, Melissa M Garrido, George Loo, Jeremy Sze, Stephanie Gravenor, D Mark Courtney, Raymond Kang, Carolyn W Zhu, Carmen Vargas-Torres, Corita R Grudzen, Lynne D Richardson
OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period...
January 10, 2018: Journal of the American Geriatrics Society
Sophie Shay, Nina L Shapiro, Neil Bhattacharyya
OBJECTIVES: Children undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy. METHODS: Cross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010-11 were linked and examined for cases of pediatric tracheotomy (patients < 18...
January 2018: International Journal of Pediatric Otorhinolaryngology
Joyce J H Wachelder, Isabelle van Drunen, Patricia M Stassen, Steffie H A Brouns, Suze L E Lambooij, Mieke J Aarts, Harm R Haak
OBJECTIVES: Older adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes. DESIGN: A retrospective study. PARTICIPANTS: Older adults (≥65 years) visiting the ED, in the Netherlands...
December 26, 2017: BMJ Open
Dana R Sax, Dustin G Mark, Renee Y Hsia, Thida C Tan, Grace H Tabada, Alan S Go
BACKGROUND: Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. METHODS AND RESULTS: We examined adult members of a large integrated delivery system who visited an ED for acute heart failure and were discharged from January 1, 2013, through September 30, 2014. The primary outcome was a composite of repeat ED visit, hospital admission, or death within 7 days of discharge...
December 2017: Circulation. Heart Failure
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