Characteristics Of Emergency Department Visits Research Articles

Visit Characteristics Associated With Opioids Administered or Prescribed During Emergency Department Visits for Ankle Sprain Between 2010 and 2015.

Recent research has demonstrated that patients with ankle sprain who are discharged from the emergency department (ED) are prescribed an opioid. Minimizing the exposure to opioids is important to help prevent future abuse and misuse of these medications. Identify ED visit characteristics for an ankle sprain that are associated with an opioid given in the ED, prescribed at discharge, or both. Retrospective analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Hospital. Isolated ankle sprain visits to a United States ED. The main outcome was an opioid given in the ED, prescribed at discharge, or both between 2010 and 2015. Explanatory variables included age, sex, race, attending physician or resident, and geographic location of the hospital. A multiple logistic regression was performed to assess the independent association between an opioid given in the ED, prescribed at discharge, or both, and all explanatory variables. The analysis accounted for the cluster, strata, and probability weights for each year of the NHAMCS. Ankle sprain visits for patients ≤17 years of age had a lower odds of an opioid being given in the ED, prescribed at discharge, or both, compared to visits for patients 18 to 24 years of age (adjusted odds ratio [aOR] = 0.26 [95% confidence interval (CI) = 0.1, 0.5]; P < .001). Visits in the West (aOR = 2.5 [95% CI = 1.2, 5.4]) or South (aOR = 2.9 [95% CI = 1.6, 5.4]; P = .010) had higher odds of an opioid being given in the ED, prescribed at discharge, or both, compared to visits in the Northeast. Ankle sprain visits for patients ≤17 years of age had a lower odds of an opioid compared to visits for patients 18 to 24 years of age. Ankle sprain visits in the South or West had a higher odds of an opioid compared to visits in the Northeast. These findings provide a direction for future work aimed at minimizing exposure to opioids after an ankle sprain.

Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System.

There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.

Economic Recession and Attendances in the Pediatric Emergency Department.

The economic recession has been shown to have a negative impact on health services worldwide. The purpose of this study was to examine whether the recent financial crisis in Greece that started in 2009 has affected the attendances in the pediatric emergency department of a University Hospital covering for a large geographical area in Greece. The study was based on a retrospective analysis of the cases presented to the paediatric emergency department and compared the attendances in 2008 (i.e., before the beginning of the economic crisis) with those in 2013 and 2017. Data on demographics and characteristics of emergency department visits, such as timing, reason, and outcome were recorded for each child. There were a total of 35.572 children seeking examination in those three years and data were collected for 5662 (17.36%) of them. Overall, the attendance rate has increased up to 20% without an increase to the hospital admission rates which remained stable throughout the study periods. Between 2008 and 2017, the percentage of febrile children attending the ED increased by 33.8% and of those with respiratory disorders by 63.1%. Our results indicate that the need for pediatric hospital services has changed following the economic crisis which could reflect gaps in the primary care setting and could well also result from financial constraints.

Characterizing Highly Frequent Users of a Large Canadian Urban Emergency Department.

IntroductionHighly frequent users (HFU) of the emergency department (ED) are a poorly defined population. This study describes patient and visit characteristics for Canadian ED HFU and patient subgroups with mental illness, substance misuse, or ≥ 30 yearly ED visits.MethodsWe reviewed health records from a random selection of adult patients whose visit frequency comprised the 99th percentile of yearly ED visits to The Ottawa Hospital. We excluded scheduled repeat ED assessments. We collected the following: 1) patient characteristics – age, sex, and comorbidities; and 2) ED visit characteristics – diagnosis category, length of stay, presentation time, consultation services, and final disposition. Two reviewers collected data, and we performed an inter-rater review to measure agreement.ResultsWe analyzed 3,164 ED visits for 261 patients in all subgroups overall. Within the HFU random selection, mean age was 53.4 ± 1.3, and 55.6% were female. Most patients had a fixed address (88.9%), and family physician (87.2%). Top ED diagnoses included musculoskeletal pain (9.6%), alcohol intoxication (8.5%), and abdominal pain (8.4%). Allied health (social work, geriatric emergency medicine, or community care access centre) was consulted for 5.9% of visits. In 52.7% of these cases, allied health services were not available at the time of presentation.ConclusionHFU are a complex population who represent a marked proportion of annual ED visits. Our data indicate that there are opportunities to improve the current approaches to care. Future work examining ED-based screening and multi-disciplinary approaches for HFU may help reduce frequent ED presentations, and better serve this vulnerable population.

Characteristics of Emergency Department Visits at King Abdulaziz University Hospital: A One Year Analysis

This study seeks to report the frequencies of the Emergency Department visits at King Abdulaziz University Hospital, as well as an analysis of its operational parameters. This is a retrospective analysis of all emergency visits over one year. In 2017, 69,522 patients were triaged, 62.55% adults, 20.12% pediatrics, and 17.33% OB/GYN. Ineligible patients (lower acuity stable non-Saudi patients who hold health insurance through their sponsors) were 12.84% of triaged patients, they were advised to go to another hospital. Females were 57.11%, and 40.92% were between 24 and 43 years, 18.49% younger than 14 years, and 9.22% older than 64 years. Saudi patients were 64.76%. Only 0.40% arrived by ambulance. Full management was provided for 73.83% of registered patients, whereas 26.17% left the waiting room after triage and initial evaluation by a physician without being treated due to bed unavailability; 97.22% were lower acuity and stable. Admission rates were 23.44%. The overall emergency department mortality rate was 0.52%, and death on arrival rate was 0.25%. Most registered patients (86.18%) were lower acuity and stable. All cases in which the patient needed resuscitation were treated immediately. Emergency department use by patients with low acuity conditions that are potentially treatable in other settings must be addressed.&#x0D;

Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003-2010.

IntroductionOne third of older adults fall each year, and falls are costly to both the patient in terms of morbidity and mortality and to the health system. Given that falls are a preventable cause of injury, our objective was to understand the characteristics and trends of emergency department (ED) fall-related visits among older adults. We hypothesize that falls among older adults are increasing and examine potential factors associated with this rise, such as race, ethnicity, gender, insurance and geography.MethodsWe conducted a secondary analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine fall trends over time by examining changes in ED visit rates for falls in the United States between 2003 and 2010, detailing differences by gender, sociodemographic characteristics and geographic region.ResultsBetween 2003 and 2010, the visit rate for falls and fall-related injuries among people age ≥ 65 increased from 60.4 (95% confidence interval [CI][51.9–68.8]) to 68.8 (95% CI [57.8–79.8]) per 1,000 population (p=0.03 for annual trend). Among subgroups, visits by patients aged 75–84 years increased from 56.2 to 82.1 per 1,000 (P <.01), visits by women increased from 67.4 to 81.3 (p = 0.04), visits by non-Hispanic Whites increased from 63.1 to 73.4 (p < 0.01), and visits in the South increased from 54.4 to 71.1 (p=0.03).ConclusionED visit rates for falls are increasing over time. There is a national movement to increase falls awareness and prevention. EDs are in a unique position to engage patients on future fall prevention and should consider ways they can also partake in such initiatives in a manner that is feasible and appropriate for the ED setting.

Distribution and predictors of emergency department charges: the case of a tertiary hospital in Lebanon.

BackgroundAs health care costs continue to increase worldwide, health care systems, and more specifically hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). The study aims to report on the distribution of ED resource use, as expressed in charges, and to determine predictors of/contributors to total ED charges at a major tertiary hospital in Lebanon.MethodsThe study used data extracted from the ED discharge database for visits between July 31, 2012 and July 31, 2014. Patient visit bills were reported under six major categories: solutions, pharmacy, laboratory, physicians, facility, and radiology. Characteristics of ED visits were summarized according to patient gender, age, acuity score, and disposition. Univariate and multivariate analyses were conducted with total charges as the dependent variable.ResultsFindings revealed that the professional fee (40.9 %) followed by facility fee (26.1 %) accounted for the majority of the ED charges. While greater than 80 % of visit charges went to physician and facility fee for low acuity cases, these contributed to only 52 and 54 % of the high acuity presentations where ancillary services and solutions’ contribution to the total charges increased. The total charges for males were $14 higher than females; age was a predictor of higher charges with total charges of patients greater than 60 years of age being around $113 higher than ages 0–18 after controlling for all other variables.ConclusionUnderstanding the components and determinants of ED charges is essential to developing cost-containment interventions. Institutional modeling of charging patterns can be used to offer price estimates to ED patients who request this information and ultimately help create market competition to drive down costs.

Characteristics of patients who accept and decline ED rapid HIV testing

PurposeUnderstanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing. Basic proceduresThis was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing. FindingsOf 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were “no perceived risk” and “tested in the last 3 months.” Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing. Principal conclusionsAcceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.

Expression of CYP4 and GSTr genes in R. philippinarum exposed to benzo(a)pyrene

Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing.This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing.Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were “no perceived risk” and “tested in the last 3 months.” Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing.Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.

756Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy (OPAT) Administered at Home

• Although administration of OPAT at home is now common practice, there is a paucity of data on the frequency of emergency department (ED) visits during such treatment. • The purpose of this study was to describe ED visits while on OPAT at home among patients discharged from a tertiary care hospital. Introduction • OPAT courses at Cleveland Clinic were identified from the institution’s OPAT registry which includes all patients discharged from hospital on parenteral antimicrobials. • All OPAT courses for patients discharged from hospital from January 1, 2013 to January 1, 2014, and treated at home, were selected. • For each treatment course ED visits that occurred while on OPAT were sought in the electronic medical record. Methods The majority of ED visits for patients on OPAT at home are unrelated to OPAT. About one in 20 patients receiving OPAT at home has at least one ED visit for an OPAT-related complication during the course of treatment, and about a fourth of these ED visits result in hospitalization. Conclusions • From January 1, 2013 to January 1, 2014, of 3161 OPAT courses at Cleveland Clinic, 1941 courses (61%) were administered at home for 1461 patients. • The total number of OPAT days for these 1941 courses was 43787. The baseline characteristics of the home OPAT courses are outlined in Table 1. • The distribution of reasons for ED visits is shown in Figure 1. • Of 297 ED visits, 115 (28%) were for OPAT-related complications (2.63 visits per 1000 OPAT days). Of the 115 OPAT-related ED visits, 17 (15%) were for antimicrobial adverse events (0.39 per 1000 OPAT days) and 98 (85%) for vascular access complications (2.24 per 1000 OPAT days). • 98 (5%) OPAT courses had at least one ED visit for an OPAT-related problem, with a median time to first visit of 9 days after hospital discharge. Results Baseline Characteristics Characteristic Age in years, mean ± SD Inpatient OPAT starts, n (% of OPATs) Vascular access device, n (% of OPATs) PICC Hohn catheter Tunneled central venous catheter Tunneled dialysis catheter Dialysis fistula or graft Indwelling port Midline Peripheral catheter Non-tunneled central venous catheter Active injection drug use Cleveland Clinic Home Infusion Pharmacy, n (%) Cleveland Clinic at Home Nursing, n (%) OPAT duration in days, mean (SD) Frequency 55 ± 15 1682 (87) 1508 (78) 152 (8) 142 (7) 18 (<1) 7 (<1) 95 (5) 15 (<1) 1 (<1) 3 (<1) 16 (0.8) 901 (46) 811 (42) 23 (17) 24% 4% 72% Antimicrobial Adverse Event Vascular Access Complication Unrelated to OPAT Figure 1. Reasons for ED Visits Table 1 Characteristic Vascular Access complication (n = 98) Admit to hospital, n (%) 20 (20) Days after OPAT start, median (Q1, Q3) 11 (5, 19) Antimicrobial Adverse Event (n = 17) 5 (29) 5 (3, 11) Unrelated to OPAT (n = 182) 84 (46) 8 (3, 14) Table 2. Characteristics of ED Visits by Reason for Visit ED Visits

Absolute Temperature Mean Changes and Emergency Department Visits for Asthma in Seoul, Korea: A Case-Crossover Study

Background Although weather changes are known to cause asthma symptoms, there were not many studies how absolute daily temperature change affect on asthma and their impact on asthma-related health-care utilization is poorly understood. Aims The objective of the present study was to determine the associations between absolute temperature mean changes (ATMC) and asthma-related emergency department (ED) visits among all ages in Seoul, Korea in 2007-2010. Methods Descriptive analyses of patient and ED visit characteristics were performed. A case-crossover study utilizing time-stratified controls was conducted to determine the impact of ATMC which is absolute temperature change between the day of event and 1 to 7 days prior to the asthma ED visits. We defined ATMC07 as average of absolute daily mean temperature change between ED visit day through 7 days prior of the event. Multivariable conditional logistic regression demonstrated the relation between ED visits and ATMC after controlling for other weather, pollutant measures, and week of influenza. Results The case-crossover study showed a statistically significant relation between asthma-related ED visits and ATMC in winter while there was no significant relation with daily temperature and the rest of seasons. The results showed the effect size respectively after adjustment for daily mean air pressure, daily mean relative humidity, daily maximum of sulfur dioxide, nitrogen dioxide, and PM10 ; ATMC01 (odds ratio = 1.020, 95%CI 1.001-1.040), ATMC02 (odds ratio= 1.033, 95%CI 1.005-1.062), ATMC03, (odds ratio=1.041, 95%CI 1.008-1.075) , ATMC04 (odds ratio=1.051, 95%CI 1.012-1.091) , ATMC05 (odds ratio=1.060, 95%CI 1.017-1.105) , ATMC06 (odds ratio=1.052, 95%CI 1.007-1.098) , ATMC07 (odds ratio=1.048, 95%CI 1.000-1.098). Conclusions We found that the association between asthma-related ED visits and the absolute temperature mean change is significantly strong in winter and larger ATMC causes more frequent asthma-related ED visits.

Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States

We compared the characteristics of emergency department (ED) visits of older versus younger homeless adults. We analyzed 2005-2009 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of visits to hospitals and EDs, and used sampling weights, strata, and clustering variables to obtain nationally representative estimates. The ED visits of homeless adults aged 50 years and older accounted for 36% of annual visits by homeless patients. Although demographic characteristics of ED visits were similar in older and younger homeless adults, clinical and health services characteristics differed. Older homeless adults had fewer discharge diagnoses related to psychiatric conditions (10% vs 20%; P = .002) and drug abuse (7% vs 15%; P = .003) but more diagnoses related to alcohol abuse (31% vs 23%; P = .03) and were more likely to arrive by ambulance (48% vs 36%; P = .02) and to be admitted to the hospital (20% vs 11%; P = .003). Conclusions. Older homeless adults' patterns of ED care differ from those of younger homeless adults. Health care systems need to account for these differences to meet the needs of the aging homeless population.

Short-term Outdoor Temperature Change and Emergency Department Visits for Asthma Among Children: A Case-Crossover Study

Although weather changes are known to cause asthma symptoms, their impact on asthma-related health-care utilization is poorly understood. The objective of the present study was to determine the association between short-term outdoor temperature change and asthma-related emergency department (ED) visits among children 3-18 years of age in Detroit, Michigan, in 2000-2001. Descriptive analyses of patient and ED visit characteristics were performed. A case-crossover study utilizing time-stratified controls was conducted to determine the impact of maximum temperature change and change rate measured during 4-, 8-, 12-, and 24-hour periods. Multivariable conditional logistic regression demonstrated the relation between ED visits and temperature change after controlling for other weather and pollutant measures. There were 4,804 asthma-related ED visits during the study period, and they occurred most frequently in the fall and during morning hours. The case-crossover study showed a statistically significant inverse relation between ED visits and maximum 24-hour temperature change after adjustment for climatic factors (for temperature change, odds ratio = 0.992, P = 0.04; for temperature change rate, odds ratio 0.972, P = 0.01). The association persisted after air pollutant measures were added to the model, although the association was not significant. Despite the finding that a greater 24-hour temperature change decreased the risk of asthma-related ED visits, the overall results suggested a negligible association with short-term temperature change.

Why do cancer patients die in the emergency department (ED)? Analysis of 283 deaths in North Carolina EDs in 2008.

6119 Background: Emergency departments (ED) in the US are utilized by cancer patients for symptom management, treatment side effects, oncologic emergencies, and/or end of life care. EDs have become a place where acute care needs are addressed and there are discussions about end of life care. The purpose of this study was to describe characteristics of cancer patients who died in the ED, highlighting lung cancer patients and their ED visit characteristics. Methods: A secondary data analysis of ED visit data fromthe North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a population database of 110 of the 112 EDs in NC in 2008. This was a descriptive, retrospective analysis providing descriptive statistics of patient demographics including: sex, age at death, insurance, cancer type, and visit categories (hour, day, month). Free text chief complaints, as recorded by the health care provider, were cleaned and categorized. Results: There were37,760 ED visits by 27,644 patients associated with cancer; 283 (1%) of these visits resulted in death in the ED. The most common chief complaints of those who died were respiratory distress (17.3%), neurological changes (13.4%), and pain (5.7%). Of all cancer deaths, 63% were male with a mean age of 66 (SD 14.2). Over a third (N= 104, 36.7%) of cancer ED visits resulting in death had a code for lung cancer listed. Medicare was the insurance provided for almost half (47.3%) of these patients. Majority of deaths occurred on a patient’s first ED visit (70.9%). Although a third (34.7%) of deaths occurred during weekends, over a third (37.5%) occurred during weekday clinic hours. Conclusions: Even though deaths in the ED were infrequent, this study provides insight into reasons patients visit the ED. Some patients were enrolled in Hospice and/or had a DNR documented. This study can inform future research associated with precipitating factors leading up to the ED visit (e.g. worsening shortness of breath, location of care prior to ED visit). This study illustrates the importance of research on discussion of end of life care needs (advanced directives, code status, use of Hospice services) with cancer patients and their family before they reach the final stage of their disease.

Trends in the Duration of Emergency Department Visits, 2001-2006

Trends in the Duration of Emergency Department Visits, 2001-2006

Adverse drug events leading to emergency department visits in elderly: the role of inappropriate prescription.

Adverse drug reactions are more incident among the elderly and are frequently associated to inappropriate prescription for this group. The objective of the current study was to investigate the incidence and the characteristics of emergency department visits, related to inappropriate prescription, at the Hospital Israelita Albert Einstein. Patients aged 60 years or older, admitted to the emergency department at Unidade Avançada Ibirapuera of Hospital Israelita Albert Einstein, were included in the study. Potentially inappropriate medication for the elderly was evaluated using updated 2003 Beers criteria. Over a period of 6 months, 214 individuals were included in the study, being 53.7% male. The mean age was 70.8 years (60-107). A total of 48 registries of inappropriate prescription were recorded in 42 patients (19.6% of sample). An emergency visit related to adverse drug event was verified in 27 individuals (12.5% of the sample). From these patients, 34.5% were admitted to the emergency department because of an adverse event caused by an inappropriate medication. Inappropriate prescription is frequent among elderly patients admitted to emergency department. A surveillance system and a program to educate physicians on the most recent criteria of appropriate prescription may help reducing emergency visits and adverse drug events in the elderly population.