Emergency Department Disposition Of Patients Research Articles

Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: results from a registry

BackgroundTraumatic brain injuries (TBIs) are a common cause of emergency department (ED) visits and hospital admissions in Kampala, Uganda. The objective of this study was to assess determinants of ED...

251 Evaluation of Lung Ultrasound in Emergency Department Disposition of Patients with Endstage Renal Disease on Hemodialysis

251 Evaluation of Lung Ultrasound in Emergency Department Disposition of Patients with Endstage Renal Disease on Hemodialysis

288 Evaluation of Syncope in a Dedicated Observation Unit

The purpose of this study is to 1) determine the clinical background of patients evaluated for syncope in the emergency department (ED) observation unit (EDOU) and 2) determine which characteristics predict appropriateness of an EDOU level of care versus direct inpatient admission. This is a retrospective analysis of the 171 patients placed in the EDOU between March 2013 and July 2013 following evaluation in the ED for syncope. The study site is located in a diverse urban setting with a volume of 130,000 visits per year. The EDOU receives an average of 450 patients per month for a variety of chief complaints with an admission conversion rate of approximately 25%. Each patient file was reviewed by two trained evaluators to ensure accuracy. Patients were assigned to two different groups: those admitted during the EDOU evaluation (admitted group) and those discharged home from the EDOU (not admitted group). Descriptive statistics were computed for study variables to ensure that all data values were within expected ranges and to eliminate any data errors that may have occurred. SPSS version 21 was used to conduct the analysis. Chi-square and independent sample t-test were used to determine significant differences between groups. The sample consisted of 171 patients. The demographics of the patients evaluated are representative of the patient population of the study site. Of the 171 patients, 142 were discharged from the EDOU while 29 were converted to inpatient admissions from the EDOU. There were no significant differences between groups based on age (P=.756), sex (P=.449) or race/ethnicity (P=.310). There was no significant difference in the average number of past medical diagnoses for the admitted group and those discharged home (P=.796). However, admitted patients had significantly higher rates of reported medical history of syncope (27.6% versus 11.3%), P=.021, diabetes mellitus (DM) (37.9% versus 19.7%), P=.033, and an abnormal result in initial cardiac enzymes (20.7% versus 5.7%), P=.007. Of the 29 admitted patients, 15 (8.8% of the overall sample) developed unstable arrhythmias or non-ST elevation myocardial infarction (NSTEMI) with a median time to admission of 24 hours. With the exception of cardiac enzyme testing, no objective lab data, ECG finding, nor diagnostic testing, obtainable in the initial ED evaluation predicted the need for inpatient evaluation. The only statistically significant independent predictors of inpatient evaluation are a positive initial cardiac enzyme result, previous episode of syncope, and a past medical history that includes diabetes mellitus (DM). These factors may be used to create the inclusion and exclusion criteria for transfer to an EDOU. After initial evaluation, a finding of positive cardiac enzymes or a history of DM or previous syncope may be deemed grounds for exclusion from the EDOU. Using these exclusion criteria may help expedite evaluation and allocation of resources appropriately thereby positively impacting patient safety. This study was limited by the retrospective analysis of data. Future research will evaluate the differences between patients directly admitted for syncope versus those transferred to the EDOU first and then subsequently admitted. Applying the data learned from this study can help guide the appropriate care and ED disposition of patients thereby improving patient safety, patient flow, and hospital reimbursement.

Depression, Suicidal Ideation, and Suicidal Attempt Presenting to the Emergency Department: Differences Between These Cohorts

IntroductionThe World Health Organization estimates that one million people die by suicide every year. Few studies have looked at factors associated with disposition in patients with chief complaints of depression, suicidal ideation (SI) and suicidal attempts (SA) who present to the emergency department (ED). Our objective was to assess individual determinants associated with ED disposition of patients in depressed patients presenting to the ED.MethodsWe conducted a retrospective study using the National Hospital Ambulatory Medical Care Survey from 2006 to 2008. We used logistic regression to identify factors associated with discharge, in SI, SA and depression patients. Independent variables included socio-demographic information, vital signs, mode of arrival, insurance status, place of residence and concomitant psychiatric diagnosis.ResultsOf the 93,030 subjects, 2,314 met the inclusion criteria (1,362 depression, 353 SI and 599 SA). Patients who arrived by ambulance were less likely to be discharged (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43–0.92). Hispanic patients and patients age 15 to 29 were likely to be discharged (OR 1.61, 95% CI 1.16–2.24 and OR 1.55, 95% CI 1.15–2.10 respectively). Insurance status and housing status were not significantly associated patient was being discharge from EDs.ConclusionThe Hispanic population had higher discharge rates, but the reasons are yet to be explored. Patients with SA and SI are discharged less frequently than those with depression, regardless of insurance type or housing status.

Emergency Department Disposition of Patients Diagnosed With Rib Fracture

Emergency Department Disposition of Patients Diagnosed With Rib Fracture

Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited

Background Trauma systems use specific criteria based on physiologic, anatomic, and mechanistic factors for field triage. The purpose of this study was to evaluate the emergency department disposition of patients not meeting mandatory criteria (ie, physiologic or anatomic factors) for triage to a trauma center and the potential for over- or undertriage. Methods This was a retrospective review of trauma admissions from July 1999 to June 2001, to a level I trauma center. Triage criteria were classified as physiologic factors (n = 300), anatomic factors (n = 115), or mechanistic factors (n = 414), according to the criteria of the American College of Surgeons Committee on Trauma. Physiologic and anatomic factors were combined and compared with mechanistic factors. Results There were 1253 admissions during the study period. Sixty-six percent (n = 830) met study inclusion criteria. Fifty percent (n = 413) were admitted to the intensive care unit or operating room. Approximately 50% of each group (physiologic/anatomic, 52%; mechanistic, 47%; P = .08) were admitted directly to the operating room or to the intensive care unit. Conclusions Patients not meeting mandatory criteria for transfer to a trauma center often have serious injuries that require a higher level of care. The inclusion of all or select mechanistic criteria for evaluation at a trauma center is appropriate to achieve an acceptable rate of clinical undertriage, as well as resource undertriage and its subsequent complications.