Emergency Department Facilities Research Articles

FAKTOR YANG BERHUBUNGAN DENGAN AKURASI LABEL TRIASE INTRARUMAH SAKIT DI INDONESIA: TINJAUAN LITERATUR

Emergency Department (ED) is the main gateway for patient care in hospitals. Health workers who meet the patient for the first time have the task of categorizing the patient's emergency condition known as triage. Triage has a different mechanism according to the conditions found. If the triage label given to the patient is not appropriate, it will result in a lack of optimal service in the ED. Health workers who perform triage should have knowledge in determining the accuracy of patient labelling. This study aims to summarize the factors related to the accuracy of triage labelling in Indonesia. This research is a literature review on several data bases including Science Direct, Proquest, and Google Scholar. Articles are searched with several keywords in Indonesian and English combined with Boolean. Article is selected according to the research objectives. The results showed a total of 1012 article from the three databases which were then selected 11 articles for analysis. Factors related to the accuracy of the triage label are classified into two, namely internal and external factors. Internal factors include characteristics (age, work experience, emergency training experience), knowledge, attitudes, skills and motivation of health workers. External factors include overcrowded ED conditions, facilities and infrastructure, human resources, the flow of patients entering the ED. Knowledge is the most frequently found factor related to the accuracy of the patient's triage label. Continuous training is needed to increase knowledge of triage label accuracy.

Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021

The health care system has undergone major changes in the past decade, and emergency department (ED) crowding has worsened over time; however, the most recent patterns in ED capacity and use in California have yet to be studied. To analyze patterns in ED capacity and utilization in California hospitals from 2011 to 2021. This retrospective cohort study used data from the California Department of Health Care Access and Information and the US Census Bureau to analyze ED facility characteristics from more than 400 general acute care hospitals with more than 320 EDs in California as well as patients who presented to those EDs between January 1, 2011, and December 31, 2021. Linear patterns (measured by percentage change) in total annual ED capacity (volume of hospital beds, EDs, ED treatment stations, and trauma centers) and ED use (ED visits by disposition and acuity) were assessed as primary outcomes. Patterns in ambulance diversion hours and the number of patients who left the ED without being seen were also examined as secondary outcomes. Visit acuity was categorized into 5 levels by increasing severity (minor, low to moderate, moderate, severe without threat, and severe with threat) based on California Department of Health Care Access and Information descriptions corresponding to Current Procedural Terminology codes. In the prepandemic period (2011-2019), the total population of California increased from 37 638 369 to 39 512 223 (5.0%; 95% CI, 4.1%-5.8%), then decreased to 39 237 836 in 2021 (0.7%; 95% CI, -3.9% to 2.5%). Over the entire study period (2011-2021), the total California population increased by 4.2% (95% CI, 3.3%-5.2%). From 2011 to 2019, the annual number of ED visits increased from 12 054 885 to 14 876 653 (23.4%; 95% CI, 20.0%-26.8%) before decreasing to 12 944 692 in 2021 (-13.0%; 95% CI, -33.1% to 7.1%); from 2011 to 2021, total ED visits increased by 7.4% (95% CI, 5.6%-9.1%). From 2011 to 2021, the total number of EDs decreased from 339 to 326 (-3.8%; 95% CI, -4.4% to -3.2%) and the total number of hospital beds decreased from 75 940 to 74 052 (-2.5%; 95% CI, -3.3% to -1.6%), while the number of ED treatment stations in these fewer EDs increased from 7159 to 8667 (21.1%; 95% CI, 19.7%-22.4%). The number of visits rated as severe with threat also increased, from 2 011 637 in 2011 to 3 375 539 in 2021 (67.8%; 95% CI, 59.7%-75.9%), while visits rated as minor decreased from 913 712 to 336 071 (-63.2%; 95% CI, -75.2% to -51.2%) over the same period. In this cohort study, multiple measures of ED capacity did not proportionally increase with the increasing demand for services; however, the COVID-19 pandemic appears to have substantially affected some of these patterns. These findings may be helpful to policy makers and health care stakeholders when planning resource allocation of limited health care resources.

Alcohol Use Disorder Visits and Suicide Ideation Diagnosis: Racial/Ethnic Differences at Emergency Departments

Nationally, suicide ideation prevalence is comparable among White, American Indian/Alaska Native, Black, and Hispanic adults experiencing alcohol use disorder. This study examines whether such comparability extends to the probability of receiving a suicide ideation diagnosis when presenting with alcohol use disorder at emergency departments. The probability of hospitalization following such diagnosis is examined as well. National Emergency Department Sample (2019) data were used. Logistic and multilevel logistic regression analyses were performed in 2022-2023 with suicide ideation diagnosis and subsequent hospitalization as the outcome variables. Control variables included demographics, payor, alcohol use disorder level, comorbidities, and emergency department facility. Adjusted probabilities were computed. Age-adjusted probabilities of suicide ideation diagnoses for American Indian/Alaska Native, Black, and Hispanic patients with alcohol use disorder were 5.4%, 6.7%, and 4.9% (95% CIs=3.7, 7.1; 6.0, 7.4; 4.4, 5.4), respectively; all less than that for White counterparts (8.7%; 95% CI=8.2, 9.2). Among patients with alcohol use disorder plus suicide ideation diagnoses, the age-adjusted probability of hospitalization for American Indians/Alaska Natives (32.4%; 95% CI=20.9, 44.0) was less than that for Whites, Blacks, and Hispanics (49.8%, 52.3%, and 49.9%; 95% CIs=46.7, 52.8; 47.1, 57.5; and 43.9, 55.8, respectively). In regressions with multiple control variables, the racial/ethnic differences remained statistically significant (p<0.05). Diagnosis of suicide ideation, a key step in emergency department suicide prevention care, occurred significantly less often for patients of color with alcohol use disorder than for White counterparts. American Indians/Alaska Natives, the racial/ethnic group known to have the nation's highest suicide rate, had the lowest probability of being hospitalized after a diagnosis of alcohol use disorder plus suicide ideation.

Hospital And Regional Characteristics Associated With Emergency Department Facility Fee Cash Pricing.

Self-pay patients are an understudied yet important and financially vulnerable population of emergency department (ED) users. As ED facility fees may be a key cost driver in patient ED bills, we leveraged newly available hospital pricing data to describe ED facility fees for self-pay patients (cash prices) and how they vary according to hospital and regional characteristics in a sample of 1,621 hospitals across the United States. The median cash price for ED facility fees ranged from $160.78 for a level 1 visit to $1,097.43 for a level 5 visit. Hospital for-profit status and a bed count of 251 or more beds were associated with higher cash prices for ED facility fees across all visit levels. Meanwhile, location in a county with a poverty rate of 16percent or more was correlated with lower facility fee cash prices for ED visit levels 2 and up. We hope that these findings can inform targeted policy efforts to better ensure affordable ED care for vulnerable patients.

How Should We Approach Syncope in the Emergency Department? Current Perspectives.

Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.

Do racial disparities exist at various time points during an emergency department visit for chest pain

IntroductionIt is well documented that disparities in patient care based on race and ethnicity are prevalent in the emergency medical care setting. In most cases these evaluations are patient focused and outcome based. The timeliness of patient treatment in the emergency department (ED) is correlated with patient outcomes. In this study, we sought to evaluate whether the timeliness of care for patients with chest pain across stages of care was impacted by patient race. MethodsThis was a retrospective evaluation of ED throughput times including adults who presented to one of seventeen EDs in a large healthcare system from January 1, 2019 to December 31, 2019 and met criteria for inclusion. The effect of race on different intervals of care were assessed. Generalized Linear Models were used to estimate the effect of race on different intervals of care while controlling for Charlson Comorbidity index, age, gender, insurance, ED facility type and emergency severity index acuity level. ResultsA total of 28,705 patients were included, with a mean age of 54 ± 18 years. The majority of patients were White (63%), female (56%) and had Medicare or Medicaid (56%). Black patients experienced significantly increased wait times for resident physician examination, advanced practice provider examination, attending physician examination, and ED disposition. There was no difference in time to triage between Black patients and White patients. ConclusionBlack patients have longer wait times for resident physician evaluation, advanced practice provider evaluation, attending physician evaluation, and ED disposition when presenting to the ED with chest pain.

Facility Location Problem of Dynamic Optimal Location of Hospital Emergency Department in Palembang

The Emergency Department (ED) is one part of a hospital that provides initial treatment for patients who suffer from illness and injury, which can threaten their survival. The importance of integrated care in the ED is one of the keys to successfully treating patients at an advanced level. This becomes complex because the ED works in a team consisting of various multi-disciplinary sciences and limited human resources, facilities, and infrastructure. In the City of Palembang, 23 hospitals have emergency room facilities from 18 Sub-Districts, by using the TOPSIS (Technique for Others Reference by Similarity to Ideal Solution) method to vary the distance (radius) the optimal location of the emergency department is obtained according to the number of hospitals that have emergency room facilities, namely Ilir Timur I District, Ilir Barat I District, Sukarami District, and Plaju District. Based on the formulation of the p-median model and the completion of the TOPSIS method, the order of Districts that have optimal locations from 18 Sub-Districts that have emergency department facilities in the City of Palembang is obtained.

Changes and Inequities in Adult Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic in the US

The COVID-19 pandemic has negatively affected adult mental health (MH), with racial and ethnic minoritized groups disproportionately affected. To examine changes in adult MH-related emergency department (ED) visits into the Delta variant pandemic period and identify changes and inequities in these visits before and during COVID-19 case surges. This epidemiologic cross-sectional study used National Syndromic Surveillance Program data from US adults aged 18 to 64 years from 1970 to 2352 ED facilities from January 1, 2019, to August 14, 2021. All MH-related ED visits and visits related to 10 disorders (ie, anxiety, depressive, bipolar, schizophrenia spectrum, trauma- and stressor-related, attention-deficit/hyperactivity, disruptive behavioral and impulse, obsessive-compulsive, eating, and tic disorders) were identified. The following periods of MH-related ED visits were compared: (1) high Delta variant circulation (July 18-August 14, 2021) with a pre-Delta period (April 18-May 15, 2021), (2) after a COVID-19 case peak (February 14-March 13, 2021) with during a peak (December 27, 2020-January 23, 2021), and (3) the Delta period and the period after a COVID-19 case peak with the respective corresponding weeks during the prepandemic period. ED visits for 10 mental disorders and all MH-related visits. This cross-sectional study included 107 761 319 ED visits among adults aged 18 to 64 years (59 870 475 [56%] women) from January 1, 2019, to August 14, 2021. There was stability in most MH-related ED visit counts between the Delta and pre-Delta periods (percentage change, -1.4% to -7.5%), except for eating disorders (-11.9%) and tic disorders (-19.8%) and after a COVID-19 case peak compared with during a peak (0.6%-7.4%). Most MH-related ED visit counts declined in the Delta period relative to the prepandemic period (-6.4% to -30.7%); there were fluctuations by disorder when comparing after a COVID-19 case peak with the corresponding prepandemic period (-15.4% to 11.3%). Accounting for ED visit volume, MH-related ED visits were a smaller proportion of visits in the Delta period compared with the pre-Delta period (visit ratio, 0.86; 95% CI, 0.85-0.86) and prepandemic period (visit ratio, 0.80; 95% CI, 0.79-0.80). After a COVID-19 case peak, MH-related ED visits were a larger proportion of ED visits compared with during a peak (visit ratio, 1.04; 95% CI, 1.03-1.04) and the corresponding prepandemic period (visit ratio, 1.11; 95% CI, 1.11-1.12). Of the 2 510 744 ED visits included in the race and ethnicity analysis, 24 592 (1%) were American Indian or Alaska Native persons, 33 697 (1%) were Asian persons, 494 198 (20%) were Black persons, 389 740 (16%) were Hispanic persons, 5000 (0.2%) were Native Hawaiian or Other Pacific Islander persons, and 1 172 683 (47%) were White persons. There was between- and within-group variation in ED visits by race and ethnicity and increases in selected disorders after COVID-19 peaks for adults aged 18 to 24 years. Results of this cross-sectional study suggest that EDs may have increases in MH-related visits after COVID-19 surges, specifically for young adults and individual racial and ethnic minoritized subpopulations. Public health practitioners should consider subpopulation-specific messaging and programmatic strategies that address differences in MH needs, particularly for those historically marginalized.

ESI Triage Distribution in U.S. Emergency Departments.

The accurate triage of arriving emergency department (ED) patients is a key component of emergency nursing practice. Overtriage assignment of patients misallocates scarce resources in a time of department overcrowding, whereas patient undertriage can create risks for negative patient outcomes secondary to care delays. Limited evidence is available regarding ED triage accuracy. It is estimated that appropriate adherence to the Emergency Severity Index (ESI) triage tool and assigning triage categories could be as low as 60% (McFarlane, 2019a, 2019b). The purpose of this retrospective observational study was to examine the 2019 triage distribution of 954,847 ED encounters at 25 hospitals. Comparisons were then made with the spreads identified in the ESI Implementation Handbook (Gilboy, Tanabe, Travers, & Rosenau, 2020). Study results reflect the presence of wide variations in distribution when compared with the expected spread published by Gilboy et al. (2020). These variations illustrate the need for further facility-level evaluation. ESI Level 2 percentages varied from as little as 2.6% to as high as 69% of each facility's ED visit population. Examining an individual facility's annualized triage distribution may serve as a swift method in determining whether additional investigation into triage accuracy is warranted. EDs must implement and sustain an ongoing quality control program to achieve and maintain triage inter- and intrarater reliability. Further research is needed on the value of triage inaccuracy with real-time feedback on nurses' clinical decision-making and patient outcomes. It is also imperative that the expected and observed ESI triage distribution in U.S. EDs is updated when established accuracy quality control programs are present.

Security in Emergency Departments: Spatial Analysis of the Physical Environment

Emergency departments (EDs) are one of the most complex clinical areas in the healthcare system and one of the most dangerous workplaces. Evidence shows that healthcare professionals who work in EDs are more prone to violence from patients and visitors than those working in other healthcare settings. While many studies have highlighted organizational and operational policies to minimize the risk of violence against healthcare workers, very few studies have focused on the role of facility design. This research aimed to (1) gain an understanding of environmental design features in EDs that may impact the occurrence of violet events, and (2) propose potential environmental design scenarios for future examination of ED design through primary research. Peer-reviewed and gray literature on ED design were reviewed, and case examples of ED facility design projects were identified from online sources and were spatially analyzed. Findings from the literature suggested that entry zones of EDs, including entrance doors and vestibules for walk-in patients, reception areas/desks, and waiting areas are associated with the most security issues. Based on this finding, the spatial analysis was limited to the entry zones. The design examples were categorized based on their spatial patterns and visibility properties. This typology of entry layouts helped with developing three design scenarios with different levels of visibility. The design scenarios represent the most common layouts of entry design in ED facilities. A walk-through video of each scenario is developed for future research. A future study can identify the perceived security level of each scenario by presenting them to healthcare workers and security professionals working in EDs. This research highlights the importance of interior environmental design in improving security and reducing the risk of violent behavior against healthcare workers in EDs.

Management of asthma exacerbations in children

Asthma exacerbations are episodes of worsening asthma symptoms with shortness of breath, cough, wheeze and/or tight chest that require an increase in asthma treatment. A major change in the recommendations for managing mild asthma exacerbations is the move away from using inhaled short-acting beta-2 agonists (SABAs) as the sole reliever, toward a combination of a rapid-onset, long-acting beta-2 agonist, formoterol, in combination with an inhaled corticosteroid (ICS), or a SABA used together with an ICS in separate inhalers, in older children and adolescents. In children &lt;11 years of age who are adherent to daily ICS treatment, the ICS dose should not be increased short term. A written asthma plan should include instructions on how to self-manage asthma exacerbations, and when to present to a medical facility. Oxygen is an essential component of the management of asthma exacerbations at both primary care and emergency department facilities, together with inhaled SABAs via metered-dose inhaler and spacer, and oral corticosteroids.

Reader Response: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study.

Opioids are not the recommended treatment for migraine. In this study by Lipton et al.,1 which compared people with migraine who were opioid users vs nonusers, opioid users were less likely to have a self-reported physician-diagnosed migraine/chronic migraine diagnosis and had more visits to an emergency department (ED) or urgent care (UC) facility. This is similar to previous work, which showed that patients presenting to a headache center cited ED providers as being the first prescriber for their opioids (20.2%).2 There needs to be better training for ED and UC physicians in headache management.3,4

Identifying Constraints on Everyday Clinical Practice: Applying Work Domain Analysis to Emergency Department Care.

Emergency departments (EDs) are complex socio-technical work systems that require staff to manage patients in an environment of fluctuating resources and demands. To better understand the purpose, and pressures and constraints for designing new ED facilities, we developed an abstraction hierarchy model as part of a work domain analysis (WDA) from the cognitive work analysis (CWA) framework. The abstraction hierarchy provides a model of the structure of the ED, encompassing the core objects, processes, and functions relating to key values and the ED's overall purpose. Reviews of relevant national and state policy, guidelines, and protocol documents applicable to care delivery in the ED were used to construct a WDA. The model was validated through focus groups with ED clinicians and subsequently validated using a series of WDA prompts. The model shows that the ED system exhibits extremely interconnected and complex features. Heavily connected functions introduce vulnerability into the system with function performance determined by resource availability and prioritization, leading to a trade-off between time and safety priorities. While system processes (e.g., triage, fast-track) support care delivery in ED, this delivery manifests in complex ways due to the personal and disease characteristics of patients and the dynamic state of the ED system. The model identifies system constraints that create tension in care delivery processes (e.g., electronic data entry, computer availability) potentially compromising patient safety. The model identified aspects of the ED system that could be leveraged to improve ED performance through innovative ED system design.

Response to the COVID-19 Outbreak in The Emergency Department Designed for Emerging Infectious Diseases in Korea.

BackgroundAccording to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities; second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic.Materials and MethodsThis research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards.ResultsA total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms. There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients.ConclusionImproving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Type of facility influences lengths of stay of children presenting to high volume emergency departments

BackgroundEmergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada.MethodsThis population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained.ResultsAbout half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals.ConclusionsPediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice

IntroductionDespite scaphoid fractures being relatively uncommon pro-active treatment of suspected fractures has been seen as a risk management strategy. The poor positive predictive value of X-rays has led to published guidelines advocating MRI as a first-line or early imaging tool. It is unclear whether UK hospitals have been able to introduce early scanning and this national survey sought to establish the current management strategies for patients with a suspected scaphoid fracture. MethodAn electronic survey of UK emergency departments (ED) was conducted to establish the initial and follow up strategies for patients with negative imaging. Comparison of first and second-line imaging modalities was undertaken together with review of the clinical speciality responsible for ongoing management. Results166 UK NHS Trusts were identified with emergency department facilities of which 66 (39.8%) responded. All sites perform an X-ray as the initial examination. For those with a negative examination ED follow up was the most common approach (54.6%), although many sites refer patients to other specialities including orthopaedics (39.4%) for follow up. The data demonstrated inconsistencies in the number of follow-up episodes and the different imaging investigations utilised. Frustration with the challenges presented by this patient cohort was evident. ConclusionThe suspected scaphoid fracture represents an ongoing challenge to the NHS with many resource intensive pathways reliant on access to complex imaging investigations. Implications for practiceOur study identified that UK Emergency Departments have limited early access to complex imaging for scanning of the scaphoid. A range of strategies are used for follow up of suspected scaphoid fractures and these are resource intensive. Overtreatment of patients with suspected scaphoid fracture is used as a risk management approach.

Emergency Department Wait Times in NYS Hospitals on Prevalence of Hospital-Acquired C. difficile Infection

<h3>Background</h3> C. difficile is the most common hospital-acquired infection, as it is resistant to many sterilization and disinfection measures and can persist in the environment for extended periods of time. Given the fast-paced, high-volume care environment of emergency departments (ED), higher levels of C. difficile contamination are often found in the ED, compared to other areas of the hospital. This study examined the relationship between average patient wait times in the ED before admission, and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals. <h3>Methods</h3> A time series (2013-2015), fixed-effects regression analysis was conducted comparing each facility's annual average ED wait time for admitted patients, to that facility's average (HA-CDI) rates, limited to patients entering through the ED. This model controlled for known clinical and non-clinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age. <h3>Results</h3> ED wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional .003 cases of HA-CDI/1,000 patient discharges with every additional minute patients spend in that facility's emergency department (P < .001), on average. Standardized coefficients were also calculated to indicate variable effect size in the model. ED wait times had the largest effect size (.310), indicating they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI. <h3>Conclusions</h3> The relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients, or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.

Predicting the risk of VISIT emergency department (ED) in lung cancer patients using machine learning.

2042 Background: Lung cancer patients commonly need unplanned visits to ED. Many of these visits could be potentially avoidable if it were possible to identify patients at risk when the previous scheduled visit takes place. At that moment, it would be possible to perform elective actions to manage patients at risk to consult the ED in the near future. Methods: Unplanned visits of patients in active cancer therapy (i.e. chemo or immunotherapy) are attended in our own ED facilities. Our Electronic Health Record (EHR) includes specific modules for first visit, scheduled visits and unplanned visits. Lung cancer patients with at least two visits were eligible. The event of interest was patient visit to ED within 21 or 28 days (d) from previous visit. Free text data collected in the three modules were obtained from EHR in order to generate a feature vector composed of the word frequencies for each visit. We evaluate five different machine learning algorithms to predict the event of interest. Area under the ROC curve (AUC), F1 (harmonic mean of precision and recall), True Positive Rate (TPR) and True Negative Rate (TNR) were assessed using 10-fold cross validation. Results: 2,682 lung cancer patients treated between March 2009 and October 2019 were included from which 819 patients were attended at ED. There were 2,237 first visits, 47,465 scheduled visits (per patient: range 1-174; median 12) and 2,125 unplanned visits (per patient: range 1-20; median 2). Mean age at diagnosis was 64 years. The majority of patients had late stage disease (34.24 % III, 51.56 % IV). The Adaptive Boosting Model yields the best results for both 21 d or 28 d prediction. Conclusions: Using unstructured data from real-world EHR enables the possibility to build an accurate predictive model of unplanned visit to an ED within the 21 or 28 following d after a scheduled visit. Such utility would be very useful in order to prevent ED visits related with cancer symptoms and to improve patients care. [Table: see text]

Containing COVID-19 in the Emergency Department: The Role of Improved Case Detection and Segregation of Suspect Cases.

ObjectivesPatients with COVID‐19 may present with respiratory syndromes indistinguishable from common viruses. This poses a challenge for early detection during triage in the emergency department (ED). Over a 3‐month period, our ED aimed to minimize nosocomial transmission by using broader suspect case criteria for better detection and using appropriate personal protective equipment (PPE) for health care workers (HCWs).MethodsAll ED admissions with respiratory syndromes over a 3‐month period were tested for COVID‐19. The sensitivity and specificity of screening criteria in detecting COVID‐19 were assessed. A risk‐stratified approach was adopted for PPE usage in the ED, based on high‐risk “fever areas” and lower‐risk zones. When a case of COVID‐19 was confirmed, surveillance was conducted for potentially exposed patients and HCWs.ResultsA total of 1,841 cases presenting with respiratory syndromes required admission over the study period. Among these, 70 cases of COVID‐19 were subsequently confirmed. The majority (84.2%, 59/70) were detected at ED triage because they fulfilled suspect case criteria. Of these, 34 met the official screening criteria; an additional 25 were detected by the broader internal screening criteria. Over the 12‐week period, the cumulative sensitivity of internal screening criteria was 84.3% (95% confidence interval [CI] = 73.6% to 91.9%), whereas the sensitivity of the official screening criteria was 48.6% (95% CI = 36.4% to 60.8%). Given the broadened internal criteria, the preexisting ED “fever area” was insufficient and had to be expanded. However, there were no cases of nosocomial transmission from intra‐ED exposure, despite extensive surveillance.ConclusionFrontline physicians need to be given leeway to decide on the disposition of cases based on clinical suspicion during an ongoing outbreak of COVID‐19. If a broader criterion is used at ED triage, ED facilities and isolation facilities need to be readied to accommodate a surge of suspect cases. Usage of appropriate PPE is essential in minimizing nosocomial transmission.

Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients

BackgroundMigrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients.MethodsThis is a retrospective, hospital-based study. The study was done at the University Children’s Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients.All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes.The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score.ResultsA total of 75′199 hospital visits were included, of which 63′405 were emergency department visits and 11′794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients’ admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297).ConclusionsAdmissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.