Emergency Department Information System Research Articles

Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

BackgroundSevere overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days.MethodsBetween February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator.Results46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints.ConclusionsThis randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff.Trial registrationRegistered on clinicaltrials.gov as NCT03660215 on 4th September 2018.

The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study.

The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Impact of ambient temperature on respiratory disease: a case-crossover study in Seoul.

Respiratory diseases contribute to global morbidity and mortality, and temperature is a significant factor. We investigated the association between ambient temperature and emergency department (ED) visits for various respiratory diseases in Seoul, South Korea. Using data from the National Emergency Department Information System (2008-2017), we analysed 1,616,644 ED visits for respiratory diseases, categorised according to the Korean Standard Classification of Diseases 7th revision codes (J00-J99). Using a time-stratified case-crossover design and a distributed lag nonlinear model, we investigated the effect of temperature exposure on ED visits for respiratory diseases, calculating the relative risk (RR) for the maximum risk temperature (MaxRT) of both cold and hot extremes compared to the minimum risk temperature (MinRT). Cold temperatures (MaxRT: -9.0°C) resulted in a 2.68-fold increase (RR = 2.68, 95% CI = 2.26-3.14) in ED visits for total respiratory diseases, while hot temperatures (MaxRT: 29.4°C) led to a 1.26-fold increase (RR = 1.26, 95% CI = 1.11-1.42) compared to the MinRT (24.8°C). Cold temperatures increased the risk of most respiratory diseases, except interstitial lung disease, whereas hot temperatures increased ED visits for acute upper respiratory infections and influenza. Cold temperatures increased ED visits for all age groups, especially those aged 18-64 (RR = 3.54, 95% CI = 2.90-4.33), while hot temperatures significantly affected those < 18 (RR = 1.45, 95% CI = 1.27-1.66). The risk levels were similar in both males and females, regardless of hot and cold temperatures. Our findings underscore the significant impact of both cold and heat exposure on ED visits for respiratory diseases, with varying intensities and risk profiles across different population groups.

The pattern of emergency department utilization in pediatric patients who underwent interfacility transfers from the emergency department: a nationwide population-based study in South Korea, 2016-2018

Purpose: The shortage of pediatric emergency care has become a significant societal issue. This study investigated the usage pattern of emergency departments (EDs) by pediatric patients who underwent interfacility transfers (IFTs) in South Korea, focusing on cases involving single and double IFTs.Methods: This nationwide cross-sectional study included all pediatric patients (&lt; 19 years) who underwent IFTs at regional and local emergency medical centers from 2016 through 2018, using data from the National Emergency Department Information System. After excluding unidentified cases, clinical features and ED use patterns were compared between patients with single IFT, i.e., an IFT after the initial ED visit, and those with double IFT, i.e., a sequential transfer from one medical facility to another.Results: Among 20,888 pediatric cases of IFTs in the ED, 21.0% of disease cases (3,070/14,624) and 11.4% of injury cases (691/6,038) experienced double IFTs. The double-transfer group showed a lower proportion of high acuity than the single-transfer group (22.6% vs. 15.0%; P &lt; 0.001). However, median values of ED length of stay were longer in the double-transfer group, regardless of type of cases (disease: 163 minutes [single] vs. 218 minutes [double]; injury, 111 minutes vs. 172 minutes; all Ps &lt; 0.001). Guardian’s request was a substantial reason for double IFT (disease, 29.9% [919/3,070]; injury, 56.4% [390/691]).Conclusion: Double IFT is common in pediatric patients and strains medical resources, regardless of severity. The high occurrence of double IFT driven by guardians’ requests rather than medical emergencies underscores the need for improved awareness of the emergency medical system among pediatric patients’ caregivers.

Interrupting Effect of Social Distancing on Ischemic Heart Disease, Asthma, Stroke, and Suicide Attempt Patients by PM2.5 Exposure.

This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM2.5 exposure in eight Korean megacities from 2017 to 2020. The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM2.5 exposure. The SD level was added to the sensitivity analysis. The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences. While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.

Demographic characteristics of patients admitted to the emergency department for intoxication and a time series analysis during the COVID-19 period

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits.Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department.Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm.Conclusion: Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.

Usability Evaluation of Emergency Department Information System: A Case of Discharge and Admission Sections of an Educational Hospital

Introduction: The emergency department is amongst the most important parts of the hospital, which has a great impact on the performance of other departments. In this regard, Emergency Department Information System (EDIS) plays a vital role in providing effective and appropriate healthcare services.Material and Methods: To evaluate the user-perceived usability of admission and discharge sections of the Emergency Department Information System of Shohada-e-Tajrish Educational Hospital, the study is carried out utilizing SUS and PSSUQ scales. Research participants include all users in the admission and discharge sections of the emergency department of the Hospital.Results: The mean score of the system usability based on the results of the SUS scale was 49.62±23.23, which is lower than the acceptable level (score above 68). The results generated by the PSSUQ tool revealed that the information quality (4.79), interface quality (4.91), and system usefulness (4.42) of admission and discharge sections of the EDIS do not have appropriate scores and need to be improved in this regard. .The worst usability score was related to system usefulness. There was no statistically significant correlation between the age of participants and usability scores. Moreover, there was no statistically significant difference between the user-perceived usability and the education level of participants (p&gt;0.05).Conclusion: The study revealed that users are not satisfied with system usability. In the event that the usability of the system is suboptimal, the user fails to effectively utilize the system, thereby impeding the attainment of the intended ultimate objective for which the system has been designed. Regarding the importance of admission and discharge sections in the EDIS, strides need to be made to improve the usability of the system which is used at the emergency department of Shohada-e-Tajrish educational hospital.

Ischaemic stroke in patients with diabetes requiring urgent procedures during the COVID-19 pandemic in South Korea: a retrospective, nationwide, population-based cohort study using data from the National Emergency Department Information System

ObjectivesThe COVID-19 pandemic resulted in suboptimal care for ischaemic stroke. Patients with diabetes mellitus (DM), a high-risk group for stroke, had compromised routine care during the pandemic, which increases the...

Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels.

Introduction Certain patient groups perceive specific barriers to accessing primary care, resulting in increased emergency department (ED) use for non-emergency conditions. There is evidence coming from other countries that homeless people are treated differently in accessing emergency services.Examination of ED wait time by demographic characteristics provides pertinent information to identify subgroups that are more subject to the consequences or causes of access block and delayed treatment. Methods We analyzed five years of Emergency Department Information System (EDIS) visit records of the largest tertiary care center in Atlantic Canada. The wait time from triage to seeing a physician was the outcome, housing status was the main exposure, and age and gender were the predictors. Quantile regressions were carried out to identify the influence of homeless visits in meeting the Canadian Association of Emergency Physicians (CAEP) wait time benchmarks for each Canadian Triage and Acuity Scale (CTAS) level. The classification and regression tree method was used to quantify and classify the demographic subgroups contributing to wait time disparities across CTAS levels. Results Homeless visit medianwait times that exceeded the three-hour CAEP benchmark were significantly longer for urgent (by 40 minutes, CI: 25-55), semi-urgent (by 31 minutes, CI: 17-45), and non-urgent (by 57 minutes, CI: 25-89) than acuity level-matched domiciled visitwait times. At the 50th percentile, one-hourbenchmark homeless triaged as semi-urgent waited (median=20 minutes, CI: 12-28) longer, and no other triage-level differences were found at this benchmark. Homeless emergent-level visits that exceeded the three-hour benchmark were 28 minutes, on average, shorter than domiciled patients of the same acuity level. Homeless females above 40 stayed the longest for non-urgent care (mean=173 minutes), 82 minutes longer (p=0.0001) than age-gender-acuity level-matched domiciled patients. Homelessness was the most prominent ED wait time classifier for non-urgent, ED visits.Overall, homeless patients triaged as CTAS-5 waited 30 minutes longer (p=0.0001) than domiciled patients triaged as CTAS-5.Homeless male 16-20-year-olds waited the shortest time of 72 minutes. Conclusion Homelessness-related wait time disparities exist in the low acuity non-urgent-level ED visits more than in the other levels, supporting the theory that lack of primary care access is a driver of ED use in this group. Our acuity level analysis supports that homeless people of a certain age (older) and gender groups (female) wait longer than their age-gender-matched domiciled patients to be seen by a physician in low acuity level presentations. Given the pattern of the homeless being seen earlier or statistically similar in emergent-level visits compared to matched domiciled patients and that 16-20-year-old homeless males were seen on average within 72 minutes (the shortest mean wait time reported for the triage level CTAS-5), we decline the notion of discrimination at the study site ED. If homeless patients' non-urgent needs were met elsewhere, pressure on the ED to meet benchmarks might be reduced.

Epidemiology of suicide attempts and self-harm in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Epidemiology of suicide attempts and self-harm in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Characteristics of pediatric emergency department visits before and during the COVID-19 pandemic: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

: As of 2018, approximately 1.2 million pediatric patients visited emergency departments (EDs) in Korea, showing a steady increase. Given the distinct differences between children and adults, it is vital to examine the epidemiological characteristics of pediatric patients visiting the ED. : This study retrospectively analyzed the ED use patterns of pediatric patients <18 years old in Korea from January 1, 2018, to December 31, 2022, using data from the National Emergency Department Information System (NEDIS). : Most pediatric ED patients were boys, with an average age of 6.6±5.3 years. Patients younger than 1 year and those in critical condition had longer ED stays and more frequently required hospital admission and used the 119-ambulance service. The primary symptom was fever, and the most common discharge diagnosis was gastroenteritis. Following the declaration of the COVID-19 pandemic in 2020, ED visits decreased by 49%. Meanwhile, there was an increase in in-hospital mortality rate/age- and sex-standardized mortality rate per 100,000 ED visits, Admission and transfer rates remained similar between before and after the start of the pandemic. : Through this analysis, we identified the characteristics of pediatric patients visiting EDs in Korea. We observed a sharp decline in ED visits after the start of the COVID-19 pandemic. From there, ED visits slowly increased but remained below prepandemic levels for 3 years. This research will serve as a foundational resource for appropriately allocating and preparing pediatric ED resources.

Recent status of sudden cardiac arrests in emergency medical facilities: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Recent status of sudden cardiac arrests in emergency medical facilities: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

: This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.

Trends in traumatic brain injury-related emergency department visits in Korea: a report from the National Emergency Department Information System (NEDIS) 2018-2022.

Trends in traumatic brain injury-related emergency department visits in Korea: a report from the National Emergency Department Information System (NEDIS) 2018-2022.

Emergency department utilization in elderly patients: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

: With general aging of the population, emergency department (ED) utilization by elderly patients is increasing. In this study, we analyzed data on ED visits of patients aged 65 years and older in Korea. : The study is a retrospective analysis of National Emergency Department Information System (NEDIS) data from 2018-2022, focusing on patients aged 65 years and older who visited EDs across Korea. ED utilization data were analyzed using Korean Triage and Acuity Scale (KTAS) scores. The patients were divided into three age groups, and common chief complaints and diagnoses were identified. Age- and sex-standardized ED visits per 100,000 population and outcomes were also analyzed. : During the study period, there was a total of 9,803,065 elderly patient ED visits. The mean patient age was 76.4±7.6 years, and 47.6% were men. The ED mortality rate and in-hospital mortality rate were 1.8% and 4.6%, respectively. The KTAS scores 1-2 group accounted for 11.0% of patients, KTAS score 3 group for 42.5%, KTAS scores 4-5 group for 37.2%, and KTAS score unknown group for 9.4%. When patients were categorized into three age groups, the oldest group exhibited the highest rates of KTAS score 1, severe illness diagnoses, and mortality. The most frequently reported chief complaint was abdominal pain, and the most common diagnosis was light headedness. When analyzing the data by year, the COVID-19 outbreak had a discernible impact on ED visits and clinical outcomes. : Over the past 5 years, ED visits for elderly patients have averaged 26,050 per 100,000 population per year, with a temporary decline during the COVID-19 pandemic and a subsequent upward trend.

Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Epidemiology of stroke in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022.

Incidence of overtriage and undertriage and associated factors: A cross-sectional study using a secondary data analysis.

Improving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study. To identify incidence and risk factors of mistriage, such as overtriage and undertriage. This is a cross-sectional study. The data came from the National Emergency Department Information System database in 2016-2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease-related signs and triage-related factors were independent variables. Expected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%-0.7%) and undertriage (2.4%-3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40-64 age group, female), disease-related signs (known disease, direct visit) and triage-related factors (regional emergency medical centre). Risk factors to undertriage were disease-related signs (systolic/diastolic blood pressure and pulse rates within normal range). While the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease-related signs and triage-related factors and risk factors to undertriage were disease-related signs. No patient or public contribution. Nurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

Trends for syndromic surveillance of norovirus in emergency department data based on chief complaints.

This study compared the trends in norovirus cases to determine whether chief complaint-based emergency department (ED) visits data could reflect trends of norovirus in Korea. The ED visits from the National Emergency Department Information System (NEDIS) database and the weekly reported number of noroviruses from the sentinel surveillance system were collected between August 2017 and December 2020. The correlation between weekly norovirus cases and weekly ED visits considering the chief complaint and discharge diagnosis code was estimated using a three-week moving average. In total, 6,399,774 patients with chief complaints of digestive system disease visited ED. A higher correlation between reported norovirus cases and ED visit with chief complaint of vomiting and discharge diagnosis code of gastroenteritis and colitis of unspecified origin or other and unspecified gastroenteritis and colitis of infectious origin was observed (R=0.88, p<.0001). The correlation was highest for the 0-4-years age group (R=0.89, p<.0001). However, no correlation was observed between the reported norovirus cases and the number of emergency department visits with norovirus identified as a discharge diagnosis code. ED visit data considering a combination of chief complaints and discharged diagnosis code would be available for early detection of infectious disease trends.