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Unplanned return visit

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...
December 17, 2016: 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%)...
August 12, 2016: 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
Jen-Wu Huang, Yi-Ying Lin, Nai-Yuan Wu, David Hung-Tsang Yen
The endoscopy-assisted technique has been demonstrated in harvesting muscle flaps; however, for pedicled freestyle fasciocutaneous flaps, few studies have applied this technique. We present a surgical procedure utilizing endoscopic-assisted method to identify the perforators of pedicled freestyle fasciocutaneous flaps for the reconstruction of soft tissue defects. From August to December 2012, 9 consecutive patients underwent endoscopic-assisted harvesting of fasciocutaneous flaps for the reconstruction of soft tissue defects...
February 2015: Medicine (Baltimore)
Dan Carai Maia Viola, Eduardo Cordioli, Carlos Henrique Sartorato Pedrotti, Mauro Iervolino, Antonio da Silva Bastos Neto, Luis Roberto Natel de Almeida, Henrique Sutton de Sousa Neves, Claudio Luiz Lottenberg
OBJECTIVE: To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. METHODS: We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time...
October 2014: Einstein
Romina Pace, Rachel Spevack, Claudia Menendez, Maria Kouriambalis, Laurence Green, Dev Jayaraman
OBJECTIVE: To evaluate the ability of nurse clinician discharge flow coordinators (DFCs) to identify medical patients at risk of unplanned return to the hospital emergency department within 30 days of discharge and whether a higher predicted risk of return was correlated with preventability. DESIGN: Prospective cohort study of patients discharged from medical wards at 2 hospital sites of the McGill University Health Center between September 1, 2011, and January 1, 2012...
December 2014: Hospital Practice (Minneapolis)
Jennifer J Frost, Adam Sonfield, Mia R Zolna, Lawrence B Finer
UNLABELLED: Policy Points: The US publicly supported family planning effort serves millions of women and men each year, and this analysis provides new estimates of its positive impact on a wide range of health outcomes and its net savings to the government. The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births...
December 2014: Milbank Quarterly
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