Demand For Emergency Department Services Research Articles

Health Service Utilization and Poor Health Reporting in Asthma Patients.

The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are increasingly more likely to be characterized as frequent utilizers of both primary and emergency department care as the threshold for what constitutes frequent utilization increases. Investments in prevention and better management of the chronic condition may result in less demand for acute care services, especially among high frequency utilizers.

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

ObjectiveTo contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area.MethodsThis was a...

Demand for emergency department services in the elderly: an 11 year analysis of the Greater Sydney Area.

To describe trends in population-based rates of ED presentations in the Greater Sydney Area (GSA) and compare these between the elderly and non-elderly age groups. This was a retrospective study using ED presentation data from all public hospitals in the GSA and population data from the Australian Bureau of Statistics between 2001 and 2011. Age-specific ED presentation rates stratified by age group (<65 years, 65-79 years and ≥80 years of age) were presented and compared using negative binomial regression and generalised linear regression models. Over 11 million ED presentations were analysed. The annualised rate of increase in ED presentations per 1000 population was 1.8% per annum. The adjusted incidence rate ratio for patients aged 80 years and over was 3.6 times higher than patients younger than 65 years (95% CI 2.8, 4.7, P < 0.001) and 1.6 times higher for patients between 65 and 79 years of age (95% CI 1.4, 1.8, P < 0.001). There was an increase of 40 patients per 1000 population per year admitted to hospital from ED (β = 40, 95% CI 29, 52 P < 0.001) in patients aged 80 years or older compared with those aged less than 65 years of age. A disproportionate increase in ED presentation rates and in-patient admission rates in patients aged 80 years and over was demonstrated over 11 years in the GSA. ED models of care and system wide strategies to address these demographic changes are required.

Trends in the use of Emergency Examination Orders in Queensland since the implementation of the Mental Health Intervention Project

The Mental Health Intervention Project (MHIP) was established in Queensland in 2005 to improve interagency collaboration in the management of mental health crisis situations. The aim of this present study was to assess changes in the use of Emergency Examination Orders (EEOs) by police and ambulance officers since the commencement of the MHIP. Information concerning the use of EEOs was analysed to highlight changes that have occurred since the inception of the MHIP. The use of EEOs by police and ambulance officers increased by 262% since 2002. The proportion of EEOs completed by ambulance officers has increased from 14.5% in 2004 to 38% in 2010. Involuntary assessment was deemed necessary for less than half of the individuals presented by police and ambulance officers. Police continue to generate two-thirds of all EEOs completed. Police and ambulance officers may benefit from additional training in the use of EEOs. Providing alternative accommodation/treatment options for those under the influence of alcohol and other drugs may help to reduce the inappropriate use of EEOs and subsequent demand for Emergency Department services.

027 Paediatric emergency department attendances between 2000 and 2009: trends in a large UK Children's Hospital

Objectives and BackgroundThere has been an increase in UK demand for emergency department services. This may be attributed to changes in public behaviour or the availability of out of hours...

Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods

BackgroundEmergency departments are medical treatment facilities, designed to provide episodic care to patients suffering from acute injuries and illnesses as well as patients who are experiencing sporadic flare-ups of underlying chronic medical conditions which require immediate attention. Supply and demand for emergency department services varies across geographic regions and time. Some persons do not rely on the service at all whereas; others use the service on repeated occasions. Issues regarding increased wait times for services and crowding illustrate the need to investigate which factors are associated with increased frequency of emergency department utilization. The evidence from this study can help inform policy makers on the appropriate mix of supply and demand targeted health care policies necessary to ensure that patients receive appropriate health care delivery in an efficient and cost-effective manner. The purpose of this report is to assess those factors resulting in increased demand for emergency department services in Ontario. We assess how utilization rates vary according to the severity of patient presentation in the emergency department. We are specifically interested in the impact that access to primary care physicians has on the demand for emergency department services. Additionally, we wish to investigate these trends using a series of novel regression models for count outcomes which have yet to be employed in the domain of emergency medical research.MethodsData regarding the frequency of emergency department visits for the respondents of Canadian Community Health Survey (CCHS) during our study interval (2003-2005) are obtained from the National Ambulatory Care Reporting System (NACRS). Patients' emergency department utilizations were linked with information from the Canadian Community Health Survey (CCHS) which provides individual level medical, socio-demographic, psychological and behavioral information for investigating predictors of increased emergency department utilization. Six different multiple regression models for count data were fitted to assess the influence of predictors on demand for emergency department services, including: Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial. Comparison of competing models was assessed by the Vuong test statistic.ResultsThe CCHS cycle 2.1 respondents were a roughly equal mix of males (50.4%) and females (49.6%). The majority (86.2%) were young-middle aged adults between the ages of 20-64, living in predominantly urban environments (85.9%), with mid-high household incomes (92.2%) and well-educated, receiving at least a high-school diploma (84.1%). Many participants reported no chronic disease (51.9%), fell into a small number (0-5) of ambulatory diagnostic groups (62.3%), and perceived their health status as good/excellent (88.1%); however, were projected to have high Resource Utilization Band levels of health resource utilization (68.2%). These factors were largely stable for CCHS cycle 3.1 respondents. Factors influencing demand for emergency department services varied according to the severity of triage scores at initial presentation. For example, although a non-significant predictor of the odds of emergency department utilization in high severity cases, access to a primary care physician was a statistically significant predictor of the likelihood of emergency department utilization (OR: 0.69; 95% CI OR: 0.63-0.75) and the rate of emergency department utilization (RR: 0.57; 95% CI RR: 0.50-0.66) in low severity cases.ConclusionUsing a theoretically appropriate hurdle negative binomial regression model this unique study illustrates that access to a primary care physician is an important predictor of both the odds and rate of emergency department utilization in Ontario. Restructuring primary care services, with aims of increasing access to undersupplied populations may result in decreased emergency department utilization rates by approximately 43% for low severity triage level cases.

The Challenge of Predicting Demand for Emergency Department Services

The objective was to develop methodology for predicting demand for emergency department (ED) services by characterizing ED arrivals. One year of ED arrival data from an academic ED were merged with local climate data. ED arrival patterns were described; Poisson regression was selected to represent the count of hourly ED arrivals as a function of temporal, climatic, and patient factors. The authors evaluated the appropriateness of prediction models by whether the data met key Poisson assumptions, including variance proportional to the mean, positive skewness, and absence of autocorrelation among hours. Model accuracy was assessed by comparing predicted and observed histograms of arrival counts and by how frequently the observed hourly count fell within the 50 and 90% prediction intervals. Hourly ED arrivals were obtained for 8,760 study hours. Separate models were fit for high- versus low-acuity patients because of significant arrival pattern differences. The variance was approximately equal to the mean in the high- and low-acuity models. There was no residual autocorrelation (r = 0) present after controlling for temporal, climatic, and patient factors that influenced the arrival rate. The observed hourly count fell within the 50 and 90% prediction intervals 50 and 90% of the time, respectively. The observed histogram of arrival counts was nearly identical to the histogram predicted by a Poisson process. At this facility, demand for ED services was well approximated by a Poisson regression model. The expected arrival rate is characterized by a small number of factors and does not depend on recent numbers of arrivals.

Keynote Address: Closing the Research-to-practice Gap in Emergency Medicine

Emergency medicine in the United States is facing tremendous challenges due to recent public health emergencies, continuing threats of bioterrorism, and an increasing and unprecedented demand for emergency department services. These challenges include overcrowding; long waiting times; “boarding” of patients; ambulance diversion; a need for better, more reliable tools for triaging patients; and medical errors and other patient safety concerns. These challenges and concerns were brought to the forefront several years ago by the Institute of Medicine in several landmark reports that call for closing the research-to-practice gap in emergency medicine. The Agency for Healthcare Research and Quality is funding a number of projects that address many of the concerns raised in the reports, including the use of an advanced access appointment scheduling system to improve access to care; the use of an electronic medical record system to reduce waiting times and errors and improve patient and provider satisfaction; and the refinement of the Emergency Severity Index, a five-level triage scale to get patients to the right resources at the right time. The agency's Healthcare Cost and Utilization Project is gathering data that will allow researchers to examine a broad range of issues affecting the use, quality, and cost of emergency services. Although progress has been made over the past few years in closing the research-to-practice gap in emergency medicine, many challenges remain. The Agency for Healthcare Research and Quality has supported and will continue to support a broad portfolio of research to address the many challenges confronting emergency medicine, including ways to improve emergency care through the application of research findings.

Keynote Address: Closing the Research-to-practice Gap in Emergency Medicine

Emergency medicine in the United States is facing tremendous challenges due to recent public health emergencies, continuing threats of bioterrorism, and an increasing and unprecedented demand for emergency department services. These challenges include overcrowding; long waiting times; "boarding" of patients; ambulance diversion; a need for better, more reliable tools for triaging patients; and medical errors and other patient safety concerns. These challenges and concerns were brought to the forefront several years ago by the Institute of Medicine in several landmark reports that call for closing the research-to-practice gap in emergency medicine. The Agency for Healthcare Research and Quality is funding a number of projects that address many of the concerns raised in the reports, including the use of an advanced access appointment scheduling system to improve access to care; the use of an electronic medical record system to reduce waiting times and errors and improve patient and provider satisfaction; and the refinement of the Emergency Severity Index, a five-level triage scale to get patients to the right resources at the right time. The agency's Healthcare Cost and Utilization Project is gathering data that will allow researchers to examine a broad range of issues affecting the use, quality, and cost of emergency services. Although progress has been made over the past few years in closing the research-to-practice gap in emergency medicine, many challenges remain. The Agency for Healthcare Research and Quality has supported and will continue to support a broad portfolio of research to address the many challenges confronting emergency medicine, including ways to improve emergency care through the application of research findings.

The Measurement of Daily Surge and Its Relevance to Disaster Preparedness

This article reviews what is known about daily emergency department (ED) surge and ED surge capacity and illustrates its potential relevance during a catastrophic event. Daily ED surge is a sudden increase in the demand for ED services. There is no well-accepted, objective measure of daily ED surge. The authors propose that daily and catastrophic ED surge can be measured by the magnitude of the surge, as well as by the nature and severity of the illnesses and injuries that patients present with during the surge. The magnitude of an ED surge can be measured by the patient arrival rate per hour. The nature and severity of the surge can be measured by the type (e.g., trauma vs. infection vs. biohazard) and acuity (e.g., triage level) of the surge. Surge capacity is defined as the extent to which a system can respond to a rapid and sizeable increase in the demand for resources. ED surge capacity includes multiple dimensions, such as systems, space, staffing, and supplies. A multidimensional measure is needed that reflects both the core components and their relative contribution to ED surge capacity. Although many types of factors may influence ED surge capacity, relatively little formal research has been conducted in this area. A better understanding of daily ED surge capacity and influencing factors will improve our ability to simulate the potential impact that different types of catastrophic events may have on the surge capacity of hospital EDs nationwide.

Patients Leaving Emergency Departments Without Being Seen by a Physician-Reply

In Reply. —We agree with Dr Hass that emergency department overcrowding is a sign of the inadequate provision of ambulatory care. Increasing the availability of primary care by improving the incentives for providing those services should decrease the demand for emergency department services. However, the distribution of that care will remain inequitable as long as a significant proportion of the population does not have an adequate way to pay for these services. While charity care might bridge some gaps, recent history suggests that it is far from sufficient to guarantee universal access. Dr Kunst suggests that universal access to care and cost containment are mutually exclusive. To be sure, expanding coverage by simply building on the inefficient health system that currently exists in the United States invites aggravation of the cost predicament. However, the US General Accounting Office and others have demonstrated the potential for administrative savings from national health