Emergency Department Characteristics Research Articles

Association of emergency department characteristics with presence of recommended pediatric-specific behavioral health policies.

In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC. Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.

Characteristics of emergency department visits among older adults with hearing difficultly during the COVID19 pandemic in the US

Hearing difficulty (HD) may be associated with an increased frequency of emergency department (ED) visits among older adults. The COVID-19 pandemic has adversely affected the health of older adults. However, less is known about the characteristics of ED visits by older adults with HD during the pandemic. This study examines the association between self-reported HD severity and ED visits during the pandemic. This population-based cross-sectional study used self-reported data on HD and the characteristics of respondents aged 65 years or older from three cycles of the National Health Interview Survey from 2020 to 2022. Data were analysed from February 23, 2023, to March 22, 2023. The primary outcome was self-reported ED visits in the past 12 months. This study employed generalised linear models to examine the relationship between ED visits (dependent variable) and HD in older adults, and the effect sizes were expressed as rate ratios. Key independent variables included the reasons for ED visit. Covariates such as demographic characteristics and socio-economic status were controlled for to account for potential confounding effects. During the pandemic, older adults with HD commonly visited the ED because of chronic pain (82.8%), frailty (77.9%), trouble falling/staying asleep (73.2%), hypertension (67.4%), and arthritis (60.1%), all of which were 1.5-times more likely in these adults than in those with normal hearing (chronic pain: adjusted rate ratio [ARR], 1.64 [95% CI 1.44–1.93]; frailty: ARR, 1.57 [95% CI 1.16–1.87]; trouble falling/staying asleep: ARR, 1.51 [95% CI 1.21–1.82]; hypertension: ARR, 1.01 [95% CI 0.92–1.23]; arthritis: ARR, 1.39 [95% CI 1.31–1.57]. Older adults with HD were more likely to visit the ED for chronic pain, frailty, trouble falling/staying asleep, hypertension, and arthritis than those with normal hearing during the COVID-19 pandemic. Our findings will be help for healthcare providers to be aware of these potential barriers and to implement strategies to ensure that patients with hearing difficulties can access necessary emergency care effectively.

Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey

The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BackgroundEmergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses’ health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.PurposeThe purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.MethodsThe study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.ResultsA total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.Conclusion and implications for practiceFuture strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

Characterizing emergency department and inpatient health care utilization after seizure-related hospitalization: A retrospective cohort study.

Seizure care is a significant driver of health care costs in both emergency department (ED) and inpatient settings, but the majority of studies have focused on inpatient admissions as the only metric of health care utilization. This study aims to better characterize ED and inpatient encounters among patients with seizure to inform care and policy. Using statewide administrative data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from Florida and New York, we identified patients with a seizure-related index hospitalization between January 1, 2016, and December 31, 2018. Among this cohort, we examined the incidence and characteristics of subsequent acute care visits in the ED and inpatient settings for 365 days after initial hospital discharge. A total of 54 456 patients had an eligible seizure-related hospitalization. Patients were 49% female, predominantly White (64%) and non-Hispanic (84%), and used a public primary payer (68%). There were 36 838 (68%) patients with at least one acute care visit in the year following discharge. Overall, patients had a median of 2 (interquartile [IQR] = 1-5) subsequent acute care visits and the median time to first acute care visit was 53 days (IQR = 15-138). Of the 154 369 subsequent acute care visits, 97 399 (63%) were ED-only visits, 56 970 (37%) were readmissions, and 37 176 (24%) were seizure-related. There were 18 786 patients (35%) with four or more acute care visits over 365 days of follow-up. Patients with four or more visits contributed 84% of acute care visits and 78% of costs after initial hospitalization. The majority of patients hospitalized for seizure return to the ED or hospital at least once in the year after discharge. A small portion of patients account for the majority of ED and inpatient visits as well as health care costs associated with this population, identifying a subgroup of patients who may benefit from improved inpatient and outpatient management.

Changes in epidemiology of patients visiting emergency departments during the early COVID-19 pandemic period

Infectious disease outbreaks have a great influence on the use of emergency departments (EDs). The purpose of this study was to analyze the effect of the early coronavirus disease outbreak (COVID-19) on ED visits, to be able to more effectively use ED resources during infectious disease outbreaks. This was a retrospective observational study conducted in three tertiary EDs. We defined the COVID-19 period as 01 December 2019, to 30 April 2020, and the control periods were defined as the same period in 2018 and 2019. All patients who visited the EDs during the study period were included. We collected visitor data on the total number, demographics, clinical data, vital signs, acuity level, cause of visit, disposition, time of visit and diagnostic code. A total of 180,192 patients were enrolled in this study. During the COVID-19 period, the number of ED visits decreased significantly. This decline was significant since mid-February when the number of COVID-19 patients surged nationwide. The proportion of critical patients and admission rate increased while the proportion of non-emergency patients decreased significantly from February (p < 0.001). The proportion of night-time ED visits decreased significantly from March. During the COVID-19 period and pre-COVID-19 period, the top three diagnosis areas were “abdominal and pelvis pain” “fever of other and unknown origin” and “open wound in the head” and remained unchanged. “Influenza because of an identified seasonal influenza virus” decreased during the study period. The study showed the number and characteristics of ED visits changed during the COVID-19 period compared with those of pre-COVID-19 periods.

Emergency department visits among patients receiving systemic cancer treatment in the ambulatory setting

BackgroundMost patients receive systemic cancer treatment in the ambulatory setting. However, during their treatment journey, patients experience complications that necessitate emergency department (ED) visits. Few studies evaluated the burden of such visits and their characteristics. This study aimed to evaluate the incidence and characteristics of ED visits among adult cancer patients receiving systemic cancer treatment in the ambulatory setting.MethodsA retrospective observational study was conducted at a comprehensive cancer center in Jordan. Utilizing the medical records database, we identified all patients treated in the chemotherapy infusion units, between January and December 2021. Patients who received only supportive therapy were excluded. The proportion of patients who required ED visits, their characteristics, types of cancer treatments received, and reasons for ED visits were recorded.ResultsOver the study period, 4985 patients received 38,803 treatment cycles in the infusion units. Among those, 2773 (55.6%) patients had 10,061 ED visits. Patients who presented to the ED had a mean age of 53.7 ± 13.8 (SD) years and 1763 (63.6%) were females. The most common types of malignancies were breast (39.5%) and gastrointestinal (20%). The most common cancer treatments associated with ED visits were platinum-based (24.8%), immune-mediated/targeted therapy (15.3%), and hormonal (12.3%). The most common admission diagnoses were neuromuscular/skeletal symptoms (34.8%) and gastrointestinal symptoms (20.2%).ConclusionsIn a large cohort of cancer patients receiving cancer treatment in the ambulatory setting, over half of them required at least one ED visit. Most visits were for neuromuscular/skeletal and gastrointestinal symptoms. Future studies should identify measures to reduce ED visits to enhance the patients’ quality of life and outcomes and optimize resources.

Unplanned Emergency Department Visits Following Revision Total Joint Arthroplasty: Incidences, Risk Factors, and Mortalities

BackgroundThe incidence of unplanned emergency department (ED) visits following revision total joint arthroplasty is an indicator of the quality of postoperative care. The aim of this study was to investigate the incidences, timings, and characteristics of ED visits within 90 days after revision total joint arthroplasty. MethodsA retrospective review of 457 consecutive cases, including 254 revision total hip arthroplasty (rTHA) and 203 revision total knee arthroplasty (rTKA) cases, was conducted. Data regarding patient demographics, timings of the ED encounter, chief complaints, readmissions, and diagnoses indicating reoperation were analyzed. ResultsThe results showed that 41 patients who had rTHA (16.1%) and 14 patients who had rTKA (6.9%) returned to the ED within 90 days postoperatively. The incidence of ED visits was significantly higher in the rTHA group than in the rTKA group (P = .003). The most common surgery-related complications were dislocation among rTHA patients and wound conditions among rTKA patients. Apart from elevated calculated comorbidity scores, peptic ulcer in rTHA patients and cerebral vascular events and chronic obstructive pulmonary disease in rTKA patients might increase chances of unplanned ED visits. Patients who had ED visits showed significantly higher mortality rates than the others in both rTHA and rTKA cohorts (P = .050 and P = .008, respectively). ConclusionsThe ED visits within 90 days are more common after rTHA than after rTKA. Patients in both ED visit groups after rTHA and rTKA demonstrated worse survival. Efforts should be made to improve quality of care to prevent ED visits.

Exploring Which Patients Use Their Closest Emergency Departments Using Geocoded Data

BackgroundEach year, roughly 20% of U.S. adults visit an emergency department (ED), but little is known about patients’ choice of ED. ObjectivesExamine the discretion patients have to choose among EDs, characteristics associated with ED choice, and relationship between ED choice and self-reported care experiences of ED patients. MethodsWe surveyed adult patients discharged to the community (DTC) in January–March 2018 from 16 geographically dispersed hospital-based EDs, geocoded patient and hospital-based ED addresses within 100 miles of patient addresses, and calculated travel distances. We examined the likelihood of visiting the closest ED based on patient and ED characteristics. Linear regression models examined the association of choosing the closest ED with seven measures of patient experience of care (scaled 0–100), adjusting for patient characteristics. Results43.6% of 4647 responding patients visited the ED nearest their home (on average, 5.7 miles away). Patients who chose a farther ED had more urgent conditions, were more educated, and were less likely to be non-Hispanic White. They were significantly more likely to have visited an ED in a higher-rated, metropolitan, network hospital with major teaching status, a cardiac intensive care unit, and a certified trauma center. Patients who chose a farther ED were more likely to recommend that ED, with “medium-to-large” differences in scores (+4.3% more selected “definitely yes”, p < 0.05). ConclusionsFewer than half of patients visited the closest ED. Patients who chose a farther ED tended to seek higher-rated hospitals and report more favorable experiences.

Correlates ofthe Veterans Visiting Emergency Departments inTaiwan: A Comparison Before andAfter the Coronavirus Disease 2019 Pandemic.

Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care-sensitive conditions.

The Changing Trend of Paediatric Emergency Department Visits in Malaysia Following the COVID-19 Pandemic.

Background The coronavirus disease 2019 (COVID-19) pandemic has impacted the emergency department (ED) due to the surge in medical demand and changes in the characteristics of paediatric visits. Additionally, the trend for paediatric ED visits has decreased globally, secondary to implementing lockdowns to stop the spread of COVID-19. We aim to study the trend and characteristics of paediatric ED visits following Malaysia's primary timeline of the COVID-19 pandemic. Methods and materials A five-year time series observational study of paediatric ED patients from two tertiary hospitals in Malaysia was conducted from March 17, 2017(week 11 2017) to March 17, 2022 (week 12 2022). Aggregated weekly data were analysed using R statistical software version 4.2.2 (R Foundation forStatistical Computing, Vienna, Austria) against significant events during the COVID-19 pandemic to detect influential changepoints in the trend. The data collected were the number of ED visits, triage severity, visit outcomes and ED discharge diagnosis. Results Overall, 175,737 paediatric ED visits were recorded with a median age of three years and predominantly males (56.8%). A 57.57% (p<0.00) reduction in the average weekly ED visits was observed during the Movement Control Order (MCO) period. Despite the increase in the proportion of urgent (odds ratio (OR): 1.23, p<0.00) and emergent or life-threatening (OR: 1.79, p<0.00) cases, the proportion of admissions decreased. Whilst the changepoints during the MCO indicated a rise in respiratory, feveror other infectious diseases, or gastrointestinal conditions, diagnosis of complications originating from the perinatal period declined from July 19, 2021 (week 29 2021). Conclusion The incongruent change in disease severity and hospital admission reflects the potential effects of the healthcare system reform and socioeconomic impact as the pandemic evolves. Future studies on parental motivation to seek emergency medical attention may provide insight into the timing and choice of healthcare service utilisation.

Racial Differences in Emergency Department Visit Characteristics and Management of Preadolescents at Risk of Suicide.

Suicide rates and frequency of pediatric emergency department (ED) visits for suicidal thoughts and behaviors have increased among Black preadolescents in the United States in recent years. This study examined whether characteristics of ED visits and treatment management of preadolescents with suicidal thoughts and behaviors differed by race. An electronic medical record query identified patients ages 8-12 (N=504) who visited a pediatric ED with a psychiatric-related chief complaint in 2019. The authors examined suicidal thoughts and behaviors that were reported with the Ask Suicide-Screening Questions tool, ED clinical impression, and ED disposition overall and by race. Compared with other racial groups, Black preadolescents were less likely to report suicidal thoughts, despite equivalent lifetime histories of suicide attempts, and were more likely to be brought to the ED by police and discharged (instead of being admitted to inpatient psychiatric care). Research to better understand racial disparities in suicide risk among preadolescents can inform prevention efforts.

Emergency Department Utilization by Patients With Eating Disorders: A National Population-Based Study.

BackgroundThere is a scarcity of national United States (U.S) data on emergency department (ED) utilization by patients with eating disorders. This study aims to determine the most common reasons for ED visits of patients with eating disorders, as well as baseline characteristics of patients who present due to eating disorders.MethodsWe obtained data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the United States. Each ED visit in NEDS 2018 can have only one "principal" diagnosis, which is the main reason for the visit and up to 34 "secondary" diagnoses. We abstracted data for all ED visits with "any" diagnosis of an eating disorder, using the ICD-10 code "F50". We highlighted the 10 most common "principal" diagnoses based on the organ system involved and the 10 most specific "principal" diagnoses for all ED visits by patients with any diagnosis of eating disorder. We then highlighted baseline characteristics of ED visits with a "principal" diagnosis of an eating disorder.ResultsThere were a total of 56,901 ED visits for patients with eating disorders in 2018. Among these, 7,979 had an eating disorder as the "principal" diagnosis. Patients who visited the ED principally for eating disorders were more likely to be young females and came from higher-income households; about a third were admitted with 22.1 million U.S. dollars in aggregate ED charges. Mental disorders, and injuries and poisoning were the most common principal diagnosis by organ system categories, while eating disorders, major depression disorder (MDD), hypokalemia, and dehydration are common specific reasons for ED visits among patients with eating disorders.ConclusionsEating disorders, and its medical complications and psychiatric comorbidities such as MDD are common reasons for ED visits among patients with eating disorders. Management of the underlying eating disorder and their psychiatric comorbidities through a multidisciplinary approach in the outpatient setting is invaluable in reducing ED utilization by these patients.

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy.

Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years. The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups. We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group. IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this.

Pediatric emergency care in New York City during the COVID-19 pandemic shutdown and reopening periods

ObjectiveNew York City (NYC) is home to the largest public healthcare system in the United States and was an early epicenter of coronavirus disease 2019 (COVID-19) infections. This system serves as the safety net for underserved and marginalized communities disproportionately affected by the pandemic. Prior studies reported substantial declines in pediatric emergency department (ED) volume during the initial pandemic surge, but few describe the ongoing impact of COVID-19 throughout the year. We evaluated the characteristics of pediatric ED visits to NYC public hospitals during the pandemic lockdown and reopening periods of 2020 compared to the prior year. MethodsRetrospective cross-sectional analysis of pediatric ED visits from 11 NYC public hospitals from January 2019–December 2020. Visit demographics, throughput times, and diagnosis information during the early (3/7/20–6/7/20) and late (6/8/20–12/31/20) pandemic periods coinciding with the New York State of emergency declaration (3/7/20) and the first reopening date (6/7/20) were compared to similar time periods in 2019. Findings were correlated with key pandemic shutdown and reopening events. ResultsThere was a 47% decrease in ED volume in 2020 compared to 2019 (125,649 versus 238,024 visits). After reopening orders began in June 2020, volumes increased but peaked at <60% of 2019 volumes. Admission rates, triage acuity, and risk of presenting with a serious medical illness were significantly higher in 2020 versus 2019 (P < 0.001). Time-to-provider times decreased however provider-to-disposition times increased during the pandemic (P < 0.001). Infectious and asthma diagnoses declined >70% during the pandemic in contrast to the year prior. After reopening periods began, penetrating traumatic injuries significantly increased compared to 2019 [+34%, Relative Risk: 3.2 (2.6, 3.8)]. ConclusionsNYC public hospitals experienced a sharp decrease in pediatric volume but an increase in patient acuity during both the initial pandemic surge and through the reopening periods. As COVID-19 variants emerge, the threat of the current pandemic expanding remains. Understanding its influence on pediatric ED utilization can optimize resource allocation and ensure equitable care for future surge events.

Disparities in Emergency Department Visits for Opioid and Stimulant Overdoses in Florida During COVID-19.

Emergency department (ED) visits for drug overdoses increased nationally during COVID-19 despite declines in all-cause ED visits. The study purpose was to compare characteristics of ED visits for opioid and stimulant overdoses before and during COVID-19 in Florida. This study tested for disparities in ED visits for opioid and stimulant overdoses by race/ethnicity, age, and insurance status. The study identified ED visits for opioid and stimulant overdose in Florida during quarters two and three of 2019 and compared them with quarters two and three of 2020. Overall, there was an increase in the number of opioid and stimulant overdoses during COVID-19. Combined with the decline in the number of all-cause ED visits, drug overdoses represented a larger share of ED visits during COVID-19 compared with before COVID-19. The study did not find evidence of disparities by race/ethnicity, as each group experienced similar increases in the likelihood of ED visits involving drug overdoses during COVID-19. Differences emerged according to age and insurance status. ED visits involving those under age 18 were more likely to involve opioid or stimulant overdose, and ED visits among those over age 65 were less likely to involve opioid overdose during COVID-19. ED visits among those with vulnerable insurance status were more likely to involve opioid overdose during COVID-19. Patterns of behavior change during periods of restricted activity due to a pandemic. These changes in behavior change the mix of risks that people face, suggesting the need for a reallocation of population health management resources during pandemics.

Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020.

The French syndromic surveillance (SyS) system, SurSaUD®, was one of the systems used to monitor the COVID-19 outbreak. This study described the epidemiological characteristics of COVID-19-related visits to both emergency departments (EDs) and the network of emergency general practitioners known as SOS Médecins (SOSMed) in France from 17 February to 28 June 2020. Data on all visits to 634 EDs and 60 SOSMed associations were collected daily. COVID-19-related visits were identified using ICD-10 codes after coding recommendations were sent to all ED and SOSMed doctors. The time course of COVID-19-related visits was described by age group and region. During the lockdown period, the characteristics of ED and SOSMed visits and hospitalisations after visits were described by age group and gender. The most frequent diagnoses associated with COVID-19-related visits were analysed. COVID-19 SyS was implemented on 29 February and 4 March for EDs and SOSMed, respectively. A total of 170,113 ED and 59,087 SOSMed visits relating to COVID-19 were recorded, representing 4.0% and 5.6% of the overall coded activity with a peak in late March representing 22.5% and 25% of all ED and SOSMed visits, respectively. COVID-19-related visits were most frequently reported for women and those aged 15-64 years, although patients who were subsequently hospitalised were more often men and persons aged 65 years and older. SyS allowed for population health monitoring of the COVID-19 epidemic in France. As SyS has more than 15 years of historical data with high quality and reliability, it was considered sufficiently robust to contribute to defining the post-lockdown strategy.

Association of Emergency Department Payer Mix with ED Receipt of Telehealth Services: An Observational Analysis.

IntroductionTelehealth is commonly used to connect emergency department (ED) patients with specialists or resources required for their care. Its infrastructure requires substantial upfront and ongoing investment from an ED or hospital and may be more difficult to implement in lower-resourced settings. Our aim was to examine for an association between ED payer mix and receipt of telehealth services.MethodsUsing data from the National Emergency Department Inventory (NEDI)-USA 2016 survey, we categorized EDs based on receipt of telehealth services (yes/no). The NEDI-USA data for EDs in New York state was linked with data from state ED datasets (SEDD) and state inpatient data (SID) to determine EDs’ payer mix (percent self-pay or Medicaid). Other ED characteristics of interest were rural location, academic status, and annual ED visit volume. We compared EDs with and without telehealth receipt, and used a logistic regression model to examine the relationship between ED payer mix and telehealth receipt after accounting for other ED characteristics.ResultsOf the 162 New York EDs in the SEDD-SID dataset, 160 (99%) were linked to the NEDI-USA dataset and 133 of those responded (83%) to the survey. Telehealth receipt was reported by 48 EDs (36%, 95% confidence interval [CI], 28–44%). Emergency departments with and without telehealth receipt were similar (all P >0.40) with respect to rurality (6% vs 9%, respectively), academic status (13% vs 8%), and annual volume (median 36,728 vs 43,000). By contrast, median percent of Medicaid or self-pay patients was lower in telehealth EDs (36%) vs non-telehealth EDs (45%, P = 0.02). In adjusted analysis, increasing proportion of Medicaid and self-pay patients was associated with decreased odds of telehealth receipt (odds ratio 0.87 per 5% increase; 95% CI, 0.77–0.99). Rural location, academic status, and ED volume were not significantly associated with odds of ED telehealth receipt in the adjusted model.ConclusionAmong EDs in the state of New York, increasing proportion of self-pay and Medicaid patients was associated with decreased odds of ED telehealth receipt, even after accounting for rural location, academic status, and ED volume. The findings support the need for additional infrastructural investment in EDs serving a greater proportion of disadvantaged patients to ensure equitable access.

Sociodemographic changes in emergency department visits due to alcohol during COVID-19

IntroductionLittle detailed sociodemographic information is available about how alcohol use and associated health care visits have changed during COVID-19. Therefore, we assessed how rates of emergency department (ED) visits due to alcohol have changed during COVID-19 by age and sex and for individuals living in urban and rural settings and low and high-income neighborhoods. MethodsOur cohort included 13,660,516 unique Ontario residents between the ages of 10−105. We compared rates and characteristics of ED visits due to alcohol, identified using ICD-10 codes, from March 11-August 31 2020 to the same period in the prior 3 years. We used negative binomial regressions to examine to examine changes is visits during COVID-19 after accounting for temporal and seasonal trends. ResultsDuring COVID-19, the average monthly rate of ED visits due to alcohol decreased by 17.2 % (95 % CI -22.7, -11.3) from 50.5–40.9 visits per 100,000 individuals. In contrast, the proportion of all-cause ED visits due to alcohol increased by 11.4 % (95 % CI 7.7, 15.3) from 15.0 visits to 16.3 visits per 1000 all cause ED visits. Changes in ED visits due to alcohol were similar for men in women. Decreases in visits were larger for younger adults compared to older adults and pre-COVID-19 disparities in rates of ED visits due to alcohol between urban and rural settings and low and high-income neighborhoods widened. ED visits related to harms from acute intoxication showed the largest declines during COVID-19, particularly in younger adults and urban and high-income neighborhoods. ConclusionED visits due to alcohol decreased during the first six months of COVID-19, but to a lesser extent than decreases in all-cause ED visits. Our data suggest a widening of geographic and income-based disparities in alcohol harms in Ontario during COVID-19 which may require immediate and long-term interventions to mitigate.

Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates.

Agitation and restraint among pediatric psychiatric patients are a frequent, yet little studied, source of morbidity and, rarely, mortality in the emergency department (ED). This study examined agitation and restraint among youth patients in a specialized pediatric psychiatric ED, considering clinical and sociodemographic characteristics of those who required restraint to determine the clinical correlates of agitation and restraint in this population. This descriptive study was a 6-year retrospective chart review of all patients restrained for acute agitation. Demographics, clinical characteristics, diagnoses, and reasons for restraint were collected. Relationships between sociodemographic and clinical variables to types of restraints used were examined, along with change over the study period in rate of and mean time in restraint. The average restraint rate was 1.94%, which remained fairly consistent throughout study period, although average time in restraint decreased significantly. Restraints were more common in males. Adolescents were overrepresented in the ED population, and after controlling for this, restraint rates were similar in adolescents and younger children. Physical aggression was the most frequent precipitant, although among adolescents verbal aggression was also a precipitant (more so than in younger children). Disruptive behavior disorder diagnoses were most frequently associated with restraint. A lower rate of restraint is reported here than has been seen in programs where youths are treated in medical or adult psychiatric EDs. Hospitals without specialized pediatric psychiatric emergency programs should invest in staff training in deescalation techniques and in access to pediatric psychiatric treatment. The finding that, of youth restrained, a significant proportion were under 12 years old and/or carried diagnoses not typically associated with aggressive behavior, indicates that crisis prevention, management, and treatment should include younger populations and diverse diagnostic groups, rather than focusing narrowly on older patients with psychotic or substance use disorders.