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Unplanned return visit

Lynn S Borkenhagen, Rozalina G McCoy, Rachel D Havyer, Stephanie M Peterson, James M Naessens, Paul Y Takahashi
OBJECTIVES: To assess the degree to which self-reported symptoms predict unplanned readmission or emergency department (ED) care within 30 days of high-risk, elderly adults enrolled in a posthospitalization care transition program (CTP). DESIGN: Retrospective cohort study. SETTING: Posthospitalization CTP at Mayo Clinic, Rochester, Minnesota, from January 1, 2013, through March 3, 2015. PARTICIPANTS: Frail, elderly adults (N = 230; mean age 83...
December 12, 2017: Journal of the American Geriatrics Society
Teryl K Nuckols, Kathryn R Fingar, Marguerite L Barrett, Grant Martsolf, Claudia A Steiner, Carol Stocks, Pamela L Owens
BACKGROUND: Nationally, readmissions have declined for acute myocardial infarction (AMI) and heart failure (HF) and risen slightly for pneumonia, but less is known about returns to the hospital for observation stays and emergency department (ED) visits. OBJECTIVE: To describe trends in rates of 30-day, all-cause, unplanned returns to the hospital, including returns for observation stays and ED visits. DESIGN: By using Healthcare Cost and Utilization Project data, we compared 210,007 index hospitalizations in 2009 and 2010 with 212,833 matched hospitalizations in 2013 and 2014...
November 22, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Michael Stewart
BACKGROUND: Computed tomography of the kidneys, ureters and bladder is the recommended imaging modality for suspected urolithiasis. Early scanning is advised in guidelines, but there is limited published evidence to support this recommendation. PATIENTS AND METHODS: In a retrospective study, we reviewed patients managed according to a local guideline. Patients without high-risk features were either imaged during their initial visit (if in the daytime) or discharged for outpatient scans...
July 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
David Jaffe, Timothy Costales, Patrick Greenwell, Matthew Christian, Ralph Frank Henn
Surgical irrigation and debridement is the mainstay of treatment after the diagnosis of a septic knee. Arthroscopic treatment has been validated as a treatment option, but there is limited literature comparing it to an open arthrotomy regarding risk factors for failing single-stage surgical treatment. A retrospective review of surgically treated native adult septic knees at one urban tertiary care center was conducted to evaluate rates of unplanned return to the operating room (OR) following both arthroscopic and open treatment of an adult septic knee...
November 2017: Journal of Knee Surgery
Rose Galvin, Yannick Gilleit, Emma Wallace, Gráinne Cousins, Manon Bolmer, Timothy Rainer, Susan M Smith, Tom Fahey
Background: older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care. Objective: to perform a systematic review and meta-analysis of the Identification of Seniors At Risk (ISAR) screening tool, to determine its predictive value in identifying adults ≥65 years at risk of functional decline, unplanned emergency department (ED) readmission, emergency hospitalisation or death within 180 days after index ED visit/hospitalisation...
March 1, 2017: Age and Ageing
Matthew P Gray, Grant E Keeney, Michael J Grahl, Marc H Gorelick, Christopher D Spahr
BACKGROUND AND OBJECTIVE: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores. METHODS: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement...
November 2016: Pediatrics
Jennifer Calafati, Zia S Pradhan, Catherine M Birt
OBJECTIVE: To determine the frequency of patient visits in which an unplanned treatment modification was required in chronic patients attending a glaucoma clinic for routine follow-up and to identify the treatment interventions most commonly employed. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: A total of 630 previously stable patients attending a glaucoma clinic for routine follow-up. METHODS: This was a single-centre survey of all eligible patients returning to an academic glaucoma clinic...
December 2016: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Udai S Sibia, Abigail E Mandelblatt, Maura A Callanan, James H MacDonald, Paul J King
BACKGROUND: Unplanned hospital returns after total joint arthroplasty (TJA) reduce any cost savings in a bundled reimbursement model. We examine the incidence, risk factors, and costs for unplanned emergency department (ED) visits and readmissions within 30 days of index TJA. METHODS: We retrospectively reviewed a consecutive series of 655 TJAs (382 total knee arthroplasty and 273 total hip arthroplasty) performed between April 2014 and March 2015. Preoperative diagnosis was osteoarthritis of the hip or knee (97%) or avascular necrosis of the hip (3%)...
February 2017: Journal of Arthroplasty
Glenn V Ostir, Stephen M Schenkel, Ivonne M Berges, Teresa Kostelec, Laura Pimentel
OBJECTIVE: The objective was to examine associations between cognitive health and unplanned emergency department (ED) revisits 30, 60, and 90 days after the initial visit. METHODS: Sociodemographic, clinical, and cognitive measures were collected on 110 white and African American adults, 65 years and older, who sought care in an inner-city ED. The information was collected via face-to-face interviews and review of the electronic medical record. Returns to the study-site ED 30, 60, and 90 days later were identified through a search of the electronic medical record...
October 2016: American Journal of Emergency Medicine
Marie Yan, Marion Elligsen, Andrew E Simor, Nick Daneman
Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials...
2016: Canadian Journal of Infectious Diseases & Medical Microbiology
Guan Lin Goh, Peiqi Huang, Man Ching Patrick Kong, So-Phia Chew, Sashikumar Ganapathy
INTRODUCTION: Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits. METHODS: Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed...
June 2016: Singapore Medical Journal
Brandon A Ramo, Jeffrey E Martus, Naureen Tareen, Benjamin S Hooe, Mark C Snoddy, Chan-Hee Jo
BACKGROUND: Flexible intramedullary nailing (IMN) is a valuable tool in the treatment of femoral fractures in school-age children, whereas spica cast immobilization has been the standard of care for younger children. We compared these treatment modalities in a group of preschool-age children (four to five years of age). METHODS: A retrospective cohort of consecutive patients, four to five years of age, with an isolated, complete femoral shaft or subtrochanteric fracture treated with intramedullary nailing or early spica cast immobilization and followed until fracture-healing were identified from two centers...
February 17, 2016: Journal of Bone and Joint Surgery. American Volume
Judy Lowthian, Lahn D Straney, Caroline A Brand, Anna L Barker, P de Villiers Smit, Harvey Newnham, Peter Hunter, Cathie Smith, Peter A Cameron
BACKGROUND: an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. OBJECTIVES: to determine factors associated with early re-presentation. METHODS: prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood...
March 2016: Age and Ageing
Sarah Sunderland, Cynthia H Yarnold, Stephen J Head, Jill A Osborn, Andrew Purssell, John K Peel, Stephan K W Schwarz
BACKGROUND AND OBJECTIVES: The establishment at our center of a dedicated regional anesthesia service in 2008-2009 has resulted in a marked increase in single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery. Despite the documented benefits of regional over general anesthesia (GA), there has been a perceived increase among sBPB patients in postoperative return rates for pain at our institution. We conducted a retrospective quality improvement project to examine this...
January 2016: Regional Anesthesia and Pain Medicine
Gabrielle Hester, Adam L Hersh, Michael Mundorff, Kent Korgenski, Jacob Wilkes, Gregory Stoddard, Carrie L Byington, Rajendu Srivastava
BACKGROUND AND OBJECTIVES: Skin and soft tissue infections (SSTIs) are an increasingly common cause of pediatric hospital visits among infants. The optimal evaluation strategy for younger infants with SSTI is unknown because there is little information about outcomes including risks of concomitant bacterial infections and treatment failure. This study was designed to determine rates of concomitant invasive bacterial infection and hospital revisits for treatment failure as well as factors associated with treatment failure in infants presenting with SSTI...
November 2015: Hospital Pediatrics
G Ade, M Gninafon, L Tawo, N Aït-Khaled, D A Enarson, C-Y Chiang
SETTING: An asthma pilot project in Benin. OBJECTIVE: To assess the implementation of standard case management of asthma at three referral centres and three primary care centres. METHODS: The project began with local adaptation of international asthma guidelines, followed by situation analysis, pre-intervention, training and intervention. The initial dosage of inhaled beclometasone was determined by asthma severity. Outcome of treatment was assessed annually, starting from one year after enrolment...
March 21, 2013: Public Health Action
Soo Hoon Lee, Kyuseok Kim, Hooyoung Kim, Jin Hee Jeong, Changwoo Kang, Joong Eui Rhee, Young Im Byeon, Yeon Sook Im, Chanjong Park, Joonghee Kim, Seung Sik Hwang
OBJECTIVE: The objective of the present study is to develop new multifaceted interventions to reduce return visits (RVs) based on identified risk factors related to RVs in the ED and to compare the RV rate before and after the implementation of the intervention. METHODS: The present study was a controlled before and after study that was conducted in the ED of a 900-bed tertiary hospital in an urban area. The primary outcome was the rate of unplanned RVs to the ED and hospital admission after RV...
October 2015: Emergency Medicine Australasia: EMA
Melanie Duval, Jacob Wilkes, Kent Korgenski, Rajendu Srivastava, Jeremy Meier
OBJECTIVE: To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). METHODS: Review of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits...
October 2015: International Journal of Pediatric Otorhinolaryngology
Daniel I McIsaac, Gregory L Bryson, Carl van Walraven
PURPOSE: Ambulatory surgery is generally considered safe; however, as many as 3% of patients require unplanned acute postoperative care. The purpose of this study was to measure the impact of the day of the week of surgery on the outcomes of ambulatory surgery. METHODS: Using population-based health administrative data, we conducted a historical cohort analysis by identifying patients who underwent ambulatory surgery from 2002-2012. Multivariable regression was used to measure the association between the day of the week of surgery and the primary outcomes of 30-day emergency department (ED) visit or hospital readmission after successful discharge on the day of surgery...
August 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Maria Trent, Carol Thompson, Kathy Tomaszewski
PURPOSE: To evaluate the feasibility, acceptability, and preliminary effectiveness of DepoText, a text messaging reminder system designed to improve moderately long-acting reversible contraception appointment attendance among young urban adolescent girls and young adult women using Depo-Provera. METHODS: Female patients aged 13-21 years willing to be randomized, using Depo-Provera, and owning a cell phone with text messaging were recruited from an urban academic practice in a community with high rates of unplanned pregnancy for this institutional review board-approved randomized controlled pilot trial...
July 2015: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
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