Excess Emergency Department Visits Research Articles

Trends in Substance Use Disorder-Related Emergency Department Visits in California: An Analysis of 46 Million Visits From 2006 to 2011.

To better understand the development of the growing opioid crisis in the early 21st century, the authors studied trends in substance use disorder among 46,132,211 emergency department (ED) visit discharges in California between 2006 and 2011. Utilizing the California State Emergency Department Database, the authors identified substance use based on International Classification of Diseases, Ninth Revision codes. Tabular and multivariable analysis methods were applied. ED visits were considered clustered at the level of patient. The authors observed a notable increase in substance use prevalence from 7.32 ± 6.07 to 12.21 ± 9.35 per 1000 ED visits. Nonopioid substance use was more prevalent among individuals aged ≤ 50 years old. Opioid use disorder (OUD) was associated with a higher mortality rate in the ED. In 2011, OUD was significantly higher among American Indians visiting the ED. A multivariable analysis revealed that OUD was an independent predictor for increased ED visits after controlling for demographic factors. Despite an overall decrease in mortality rate, opioid-related ED visits showed a higher mortality rate, underscoring the grave consequences of OUD. Nonopioid substance use was prevalent among younger age groups, suggesting a need for age-specific interventions. A major finding was the elevated OUD among American Indians, indicating persistent health disparities impacting this demographic. OUD was an independent risk factor for excess ED visits, which could strain health care systems. The authors suggest strategies like nonopioid pain management, community-level programs, and bridging ED with outpatient treatment facilities to mitigate the opioid crisis and ED overutilization. These findings advocate for tailored public health strategies, addressing the underlying disparities to combat the opioid epidemic effectively.

Impact of extreme weather events on healthcare utilization and mortality in the United States.

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

Excess emergency department visits for cardiovascular and respiratory diseases during the 2019–20 bushfire period in Australia: A two-stage interrupted time-series analysis

The health effects of the unprecedented bushfires in Australia in 2019–20 have not been fully examined. We aimed to examine the excess emergency department (ED) visits related to the 2019–20 bushfires in New South Wales (NSW). We obtained weekly data of ED visits for cardiovascular and respiratory diseases in all the 28 Statistical Area Level 4 (SA4) regions in NSW during the bushfire seasons from 2017 to 2020. A two-stage interrupted time-series analysis was applied to quantify the excess risk for ED visits in 2019–20. The total number of excess ED visits, excess percentages, and their empirical confidence intervals (eCIs) were calculated to estimate the impacts of the bushfire season. A total of 416,057 records of cardiorespiratory ED visits were included in our analysis. The bushfire season in 2019–20 was significantly associated with a 6.0% increase (95% eCI: 1.9, 10.3) in ED visits for respiratory diseases and a 10.0% increase (95% eCI: 5.0, 15.2) for cardiovascular diseases, corresponding to 6177 (95% eCI: 1989, 10,166) and 3120 (95% eCI: 1628, 4544) excess ED visits, respectively. The percentage of excess ED visits was higher in regions with lower SES and high fire density. In the context of climate change, more targeted strategies should be developed to prevent adverse bushfire effects and recover from such extreme environmental events.

P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM

Abstract Background and Aims The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system. Method Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP. Results Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits. Conclusion In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.

Heat-related morbidity and mortality in New England: Evidence for local policy

BackgroundHeat-related morbidity and mortality is a recognized public health concern. However, public health officials need to base policy decisions on local evidence, which is often lacking for smaller communities. ObjectivesTo evaluate the association between maximum daily heat index (HI) and morbidity and mortality in 15 New England communities (combined population: 2.7 million) in order to provide actionable evidence for local officials. MethodsWe applied overdispersed Poisson nonlinear distributed lag models to evaluate the association between HI and daily (May-September) emergency department (ED) admissions and deaths in each of 15 study sites in New Hampshire, Maine, and Rhode Island, controlling for time trends, day of week, and federal holidays. Site-specific estimates were meta-analyzed to provide regional estimates. ResultsAssociations (sometimes non-linear) were observed between HI and each health outcome. For example, a day with a HI of 95°F vs. 75°F was associated with a cumulative 7.5% (95% confidence interval [CI]: 6.5%, 8.5%) and 5.1% (95% CI: 0.2%, 10.3%) higher rate of all-cause ED visits and deaths, respectively, with some evidence of regional heterogeneity. We estimate that in the study area, days with a HI≥95°F were associated with an annual average of 784 (95% CI: 658, 908) excess ED visits and 22 (95% CI: 3, 39) excess deaths. ConclusionsOur results suggest the presence of adverse health impacts associated with HI below the current local guideline criteria of HI≥100°F used to issue heat advisories. We hypothesize that lowering this threshold may lead to substantially reduced heat-related morbidity and mortality in the study area.

Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults.

BackgroundHerpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age.MethodsIn this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population.ResultsPer HZ case, there was an average of 0.06 (95% CI 0.04–0.08) excess hospitalisations, 1.61 (95% CI 1.51–1.69) excess general practitioner visits, 1.96 (95% CI 1.86–2.15) excess prescriptions filled and 0.11 (95% CI 0.09–0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719–2767); GP visits was highest in those 60–69 years (N = 50567, 95%CI 39958–61105), prescriptions and ED visits were highest in 70–79 years (N = 50524, 95%CI 40634–60471 and N = 2891, 95%CI 2319–3449 respectively).ConclusionsThis study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted.

The Impact of a Student-Run Free Clinic on Reducing Excess Emergency Department Visits

Background: Access to primary care directly impacts inappropriate emergency department (ED) utilization. This relationship has been studied in free clinics, but little work has been done regarding the impact of student-run free clinics (SRFCs). This study investigates the effects of an SRFC in Nashville, Tennessee on reported ED utilization patterns, patient satisfaction with healthcare, and primary care access. Methods: The study population included all patients seen at the 12 South Community Clinic from April 2013 to January 2014. A 7-item paper questionnaire, including items on recent ED usage, satisfaction with current level of healthcare, and access to physicians, was distributed to new patients during their first clinic visit; returning patients received a 5-item follow-up questionnaire. New patient survey responses were compared with returning patient survey responses as aggregate data using unpaired t-tests, and descriptive statistics were used to calculate percentages. Results: The response rate was 94.9% (130/137) for new patients and 83.9% (115/137) for returning patients (N=274). The average reported number of ED visits in a three-month period was 0.47 in new patients and 0.24 in returning patients (p=0.0345). Access to the clinic significantly increased the overall level of healthcare satisfaction from 33.3% (35/105) of patients feeling very or completely satisfied prior to their first visit to the free clinic to 71.8% (79/110) of patients feeling very or completely satisfied on return visit (p&lt;0.0001). Since establishing care at the clinic, 98.2% (112/114) of returning patients reported easier access to a physician.Conclusions: The study design was limited by using data from a quality assurance project; identified, individual-level information was not used, and comparison of individual subject responses was not possible. It is unknown how many individuals may have participated in both or only one group or how many individuals may have repeated data points in the returning patient group. Despite these limitations, results suggest that given ongoing primary care access gaps, SRFCs may serve a role in impacting excess ED utilization, patient satisfaction, and access to care in medically underserved and underinsured populations.

Forecast-Based Interventions Can Reduce the Health and Economic Burden of Wildfires

We simulated public health forecast-based interventions during a wildfire smoke episode in rural North Carolina to show the potential for use of modeled smoke forecasts toward reducing the health burden and showed a significant economic benefit of reducing exposures. Daily and county wide intervention advisories were designed to occur when fine particulate matter (PM2.5) from smoke, forecasted 24 or 48 h in advance, was expected to exceed a predetermined threshold. Three different thresholds were considered in simulations, each with three different levels of adherence to the advisories. Interventions were simulated in the adult population susceptible to health exacerbations related to the chronic conditions of asthma and congestive heart failure. Associations between Emergency Department (ED) visits for these conditions and daily PM2.5 concentrations under each intervention were evaluated. Triggering interventions at lower PM2.5 thresholds (≤ 20 μg/m(3)) with good compliance yielded the greatest risk reduction. At the highest threshold levels (50 μg/m(3)) interventions were ineffective in reducing health risks at any level of compliance. The economic benefit of effective interventions exceeded $1 M in excess ED visits for asthma and heart failure, $2 M in loss of productivity, $100 K in respiratory conditions in children, and $42 million due to excess mortality.

Forecast-based interventions can reduce the health and economic burden of wildfires.

We simulated public health forecast-based interventions during a wildfire smoke episode in rural North Carolina to show the potential for use of modeled smoke forecasts toward reducing the health burden and showed a significant economic benefit of reducing exposures. Daily and county wide intervention advisories were designed to occur when fine particulate matter (PM2.5) from smoke, forecasted 24 or 48 h in advance, was expected to exceed a predetermined threshold. Three different thresholds were considered in simulations, each with three different levels of adherence to the advisories. Interventions were simulated in the adult population susceptible to health exacerbations related to the chronic conditions of asthma and congestive heart failure. Associations between Emergency Department (ED) visits for these conditions and daily PM2.5 concentrations under each intervention were evaluated. Triggering interventions at lower PM2.5 thresholds (≤ 20 μg/m(3)) with good compliance yielded the greatest risk reduction. At the highest threshold levels (50 μg/m(3)) interventions were ineffective in reducing health risks at any level of compliance. The economic benefit of effective interventions exceeded $1 M in excess ED visits for asthma and heart failure, $2 M in loss of productivity, $100 K in respiratory conditions in children, and $42 million due to excess mortality.

Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

BackgroundFrom January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED) and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave.MethodsED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects.ResultsDuring the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03), all-cause ambulance calls increased by 14% (95% CI 1.11-1.16), and all-cause mortality increased by 13% (95% CI 1.06-1.22). Those aged 75 years and older had the highest excess rates of all outcomes.ConclusionsThe 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

Automated monitoring of clusters of falls associated with severe winter weather using the BioSense system

ObjectivesTo identify and characterise clusters of emergency department (ED) visits for fall injuries during the 2007–2008 winter season.MethodsHospital ED chief complaints and diagnoses from hospitals reporting to the Centers for...

Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre–post intervention study

Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and manage somatization. We examined the effectiveness of this procedure for ED patients with MUS. We implemented a service that included staff education, timely access to consultation and gathering of outcome data. Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p< 0.001). In comparison revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) ( p< 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients. This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.

The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits

BackgroundClimate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity.ObjectivesIn this study we investigated whether any age or race/ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave.MethodsWe aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8–14 July and 12–22 August 2006).ResultsDuring the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67–7.01], especially in the Central Coast region, which includes San Francisco. Children (0–4 years of age) and the elderly (≥ 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79–13.43), acute renal failure, electrolyte imbalance, and nephritis.ConclusionsThe 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future.

Monitoring the Impact of Influenza by Age: Emergency Department Fever and Respiratory Complaint Surveillance in New York City

BackgroundThe importance of understanding age when estimating the impact of influenza on hospitalizations and deaths has been well described, yet existing surveillance systems have not made adequate use of age-specific data. Monitoring influenza-related morbidity using electronic health data may provide timely and detailed insight into the age-specific course, impact and epidemiology of seasonal drift and reassortment epidemic viruses. The purpose of this study was to evaluate the use of emergency department (ED) chief complaint data for measuring influenza-attributable morbidity by age and by predominant circulating virus.Methods and FindingsWe analyzed electronically reported ED fever and respiratory chief complaint and viral surveillance data in New York City (NYC) during the 2001–2002 through 2005–2006 influenza seasons, and inferred dominant circulating viruses from national surveillance reports. We estimated influenza-attributable impact as observed visits in excess of a model-predicted baseline during influenza periods, and epidemic timing by threshold and cross correlation. We found excess fever and respiratory ED visits occurred predominantly among school-aged children (8.5 excess ED visits per 1,000 children aged 5–17 y) with little or no impact on adults during the early-2002 B/Victoria-lineage epidemic; increased fever and respiratory ED visits among children younger than 5 y during respiratory syncytial virus-predominant periods preceding epidemic influenza; and excess ED visits across all ages during the 2003–2004 (9.2 excess visits per 1,000 population) and 2004–2005 (5.2 excess visits per 1,000 population) A/H3N2 Fujian-lineage epidemics, with the relative impact shifted within and between seasons from younger to older ages. During each influenza epidemic period in the study, ED visits were increased among school-aged children, and each epidemic peaked among school-aged children before other impacted age groups.ConclusionsInfluenza-related morbidity in NYC was highly age- and strain-specific. The impact of reemerging B/Victoria-lineage influenza was focused primarily on school-aged children born since the virus was last widespread in the US, while epidemic A/Fujian-lineage influenza affected all age groups, consistent with a novel antigenic variant. The correspondence between predominant circulating viruses and excess ED visits, hospitalizations, and deaths shows that excess fever and respiratory ED visits provide a reliable surrogate measure of incident influenza-attributable morbidity. The highly age-specific impact of influenza by subtype and strain suggests that greater age detail be incorporated into ongoing surveillance. Influenza morbidity surveillance using electronic data currently available in many jurisdictions can provide timely and representative information about the age-specific epidemiology of circulating influenza viruses.

Near-fatal heat stroke during the 1995 heat wave in Chicago.

In July 1995, Chicago sustained a heat wave that resulted in more than 600 excess deaths, 3300 excess emergency department visits, and a substantial number of intensive care unit admissions for near-fatal heat stroke. To describe the clinical features of patients admitted to an intensive care unit with near-fatal classic heat stroke. Patients were followed for 1 year to assess delayed functional outcome and mortality. Observational study. Intensive care units in the Chicago area. 58 patients admitted to the hospital from 12 July to 20 July 1995 who met the case definition of classic heat stroke. The data collection tool was designed to compile demographic and survival data and to permit analysis of organ system function by abstracting data on physical examination findings, electrocardiography and echocardiography results, fluid resuscitation, radiography results, and laboratory findings. Data on functional status at discharge and at 1 year were collected by using a modified Stanford Health Assessment Questionnaire. Patients experienced multiorgan dysfunction with neurologic impairment (100%), moderate to severe renal insufficiency (53%), disseminated intravascular coagulation (45%), and the acute respiratory distress syndrome (10%). Fifty-seven percent of patients had evidence of infection on admission. In-hospital mortality was 21%. Most survivors recovered near-normal renal, hematologic, and respiratory status, but disability persisted, resulting in moderate to severe functional impairment in 33% of patients at hospital discharge. At 1 year, no patient had improved functional status, and an additional 28% of patients had died. Near-fatal classic heat stroke is associated with multiorgan dysfunction. A high percentage of patients had infection at presentation. A high mortality rate was observed during acute hospitalization and at 1 year. In addition, substantial functional impairment at discharge persisted 1 year. The degree of functional disability correlated highly with survival at 1 year.