Higher Acuity Levels Research Articles

Integrating Shapley Values into Machine Learning Techniques for Enhanced Predictions of Hospital Admissions

(1) Background: Predictive modeling is becoming increasingly relevant in healthcare, aiding in clinical decision making and improving patient outcomes. However, many of the most potent predictive models, such as deep learning algorithms, are inherently opaque, and their decisions are challenging to interpret. This study addresses this challenge by employing Shapley Additive Explanations (SHAP) to facilitate model interpretability while maintaining prediction accuracy. (2) Methods: We utilized Gradient Boosting Machines (GBMs) to predict patient outcomes in an emergency department setting, with a focus on model transparency to ensure actionable insights. (3) Results: Our analysis identifies “Acuity”, “Hours”, and “Age” as critical predictive features. We provide a detailed exploration of their intricate interactions and effects on the model’s predictions. The SHAP summary plots highlight that “Acuity” has the highest impact on predictions, followed by “Hours” and “Age”. Dependence plots further reveal that higher acuity levels and longer hours are associated with poorer patient outcomes, while age shows a non-linear relationship with outcomes. Additionally, SHAP interaction values uncover that the interaction between “Acuity” and “Hours” significantly influences predictions. (4) Conclusions: We employed force plots for individual-level interpretation, aligning with the current shift toward personalized medicine. This research highlights the potential of combining machine learning’s predictive power with interpretability, providing a promising route concerning a data-driven, evidence-based healthcare future.

Service Provider Perspectives on the Differences between Place‐Based and Scattered‐Site Permanent Supportive Housing in Los Angeles County after the Onset of the COVID‐19 Pandemic

Background. Permanent supportive housing (PSH) is an evidence‐based solution to chronic homelessness. There are two common PSH models: place‐based (PB) programs where clients live in one building with services provided onsite and scattered‐site (SS) programs, which use community apartments coupled with mobile case management and support. Understanding the relative strengths and weaknesses of PB and SS is important for PSH planning and service delivery. This paper explores homeless service provider perspectives on these two models after the onset of the COVID‐19 pandemic. Methods. Service providers (N = 37) from across 5 PSH agencies in Los Angeles that provided either PB or SS services during the pandemic participated in focus groups. Discussions were recorded, transcribed, and analyzed using template analysis, grounded theory, and inductive techniques. Results. Providers identified four major differences between PB and SS services: (1) challenges in finding placements; (2) managing relationships with landlords/property managers; (3) frequency of contact; and (4) community integration. Advantages of PB included ease of finding units, ease of managing relationships with landlords/property managers, greater ability to serve clients efficiently, more frequent client contact, and more community among residents. SS was seen to provide tenants with more opportunities to grow, live in healthier environments, and develop independence. During the pandemic, finding units for SS clients became more difficult, while differences between PB and SS related to frequency of contact and community integration became more attenuated. Conclusions. PB can be advantageous for clients with higher levels of acuity, whereas SS could be more appropriate for clients who are more stable and independent. PB programs are seen to have practical and logistical advantages, but some providers prefer SS services. Clients and providers should be matched to PSH configurations that best match their needs and preferences, and providers should be aware that public health emergencies may impact PB and SS settings differently.

Dynamics of the Physical Component in Athletes who Practice Rhythmic Gymnastics – A Longitudinal Study

The dimensions of competitive performance in the specific context of rhythmic gymnastics are found in components such as physical and biological condition, physiological factors, technical and physical aspects, and, above all, in the training process. In the long-term training process, the individual's consciousness is fully engaged at a high level of acuity, at the limit of possibilities, sports performance being multiply determined and conditioned. The purpose of this longitudinal study is to obtain confirmatory information regarding the level of development of the physical abilities of athletes who practice rhythmic performance gymnastics, starting from the smallest training category up to the last level, that of Seniors. Through the involvement of specialists at the national level, data were collected from 141 performance athletes, a fact that allowed the outline of a motor profile for all categories.

The NASEM Report: Are the Solutions Part of the Problem?

The NASEM Report: Are the Solutions Part of the Problem?

Modelling the impacts of COVID-19 on nurse workload and quality of care using process simulation.

Higher acuity levels in COVID-19 patients and increased infection prevention and control routines have increased the work demands on nurses. To understand and quantify these changes, discrete event simulation (DES) was used to quantify the effects of varying the number of COVID-19 patient assignments on nurse workload and quality of care. Model testing was based on the usual nurse-patient ratio of 1:5 while varying the number of COVID-19 positive patients from 0 to 5. The model was validated by comparing outcomes to a step counter field study test with eight nurses. The DES model showed that nurse workload increased, and the quality of care deteriorated as nurses were assigned more COVID-19 positive patients. With five COVID-19 positive patients, the most demanding condition, the simulant-nurse donned and doffed personal protective equipment (PPE) 106 times a shift, totaling 6.1 hours. Direct care time was reduced to 3.4 hours (-64% change from baseline pre-pandemic case). In addition, nurses walked 10.5km (+46% increase from base pre-pandemic conditions) per shift while 75 care tasks (+242%), on average, were in the task queue. This contributed to 143 missed care tasks (+353% increase from base pre-pandemic conditions), equivalent to 9.6 hours (+311%) of missed care time and care task waiting time increased to 1.2 hours (+70%), in comparison to baseline (pre-pandemic) conditions. This process simulation approach may be used as potential decision support tools in the design and management of hospitals in-patient care settings, including pandemic planning scenarios.

Changing temporal trends in patient volumes in a pediatric emergency department during a COVID-19 pandemic lockdown: A retrospective cohort study.

ObjectiveEmergency department (ED) teams have had to adjust limited staffing resources to meet the fluctuating levels of patient volume and acuity during the COVID-19 pandemic. Historically, Mondays have had the highest reported ED volumes. We are unaware of any studies reporting on the change of this Monday effect during the COVID-19 pandemic.MethodsThis retrospective, observational study of a single pediatric ED compared a pandemic lockdown period (3/23/2020-11/1/2020) with a seasonally comparative period (3/25/2019-11/3/2019). We compared the mean number of patients who arrived on Monday versus any other specific weekday (Tuesday, Wednesday, Thursday, or Friday) and the aggregate of other weekdays (Tuesday to Friday) for both study periods. Secondary analyses investigated overall mean volumes, admission rates, and differences in triage acuity levels.ResultsThere were 31,377 and 18,098 patients in the comparative and pandemic periods. The mean number of ED visits on Mondays in the comparative period was significantly more than any other weekday and the aggregate of weekdays (latter p<0.001). In contrast, there were no significant differences in the mean number of ED visits on Mondays in the pandemic period relative to any other weekday and the aggregate of weekdays (all p>0.05). The pandemic period had significantly lower mean volumes, higher admission rates, and more patients with higher acuity levels.ConclusionThe previously experienced Monday effect of increased relative ED patient volumes was not seen during the pandemic period. This change has operational implications for scheduling ED staffing resources. Larger database studies are needed to determine the generalizability of these findings.

What Has Changed in Injury-Related Presentations During COVID-19 Pandemic? A Single-Center Experience from a Pediatric Emergency Department

Objective:The coronavirus disease 2019 pandemic affected the healthcare systems worldwide. In this study, we aimed to examine the impact of the coronavirus disease 2019 pandemic on injury-related visits.Materials and Methods:We conducted a retrospective analysis of 7648 injury-related pediatric emergency department visits between March 11 and June 30, 2018, 2019, and 2020, and compared the total number of visits, triage levels, distributions of injury mechanisms, and admission rates during the pandemic in 2020 to the same period in 2018 and 2019.Results:In the first 4 months of the pandemic, there was a 69.5% drop in all pediatric emergency department visits compared to the previous 2 years. Despite this decrease, the proportion of injury-related pediatric emergency department visits increased from 14% to 20.9% in 2020 (P < .001). There was a 3.8% increase in the frequencies of patients with high triage acuity levels (T1, T2, and T3) and a 3.8% decrease in patients with low triage acuity levels (P < .001). The domestic injury rate increased from 40% to 60% during the pandemic period (P < .001). Hospitalization rates increased from 6% to 11.5% and admission to intensive care units increased from 0.9% to 3.3%. The differences were statistically significant (P < .001). Visits due to burn increased from 2.7% to 5.2% (P < .001), poisoning from 3.4% to 5.5% (P < .001), bicycle accidents from 3.3% to 6.8% (P < .001), while injuries due to motor vehicle accidents decreased from 2.6% to 1.3% (P = .004) and sports injuries decreased from 8% to 2.1% (P < .001).Conclusion:This study revealed that despite the significant decrease in total pediatric emergency department visits, percentages of injury-related visits increased during the pandemic.

Имплантация факичной интраокулярной линзы пациенту с индуцированной гиперметропией после радиальной кератотомии (клинический случай)

The article describes a clinical case of the first experience of implantation of a phakic intraocular lens (PIOL) model IPCL V2.0 in a patient with induced hyperopia after radial keratotomy (RKT). The procedure for performing the operation and the course of the postoperative period are written. PIOL implantation in a patient with induced hyperopia that occurred in the long term after RKT allowed to achieve a high level of uncorrected visual acuity both for distance and near. This technique has a number of advantages: fast visual rehabilitation of patients, preservation of accommodation and reversibility of the intervention. Keywords: radial keratotomy, induced hypermetropia, phakic intraocular lens, VERION.

Assessing the Impact of the COVID-19 Pandemic on Emergency Department Use for Patients Undergoing Cancer-Directed Surgeries.

Emergency department (ED) use is a concern for surgery patients, physicians and health administrators particularly during a pandemic. The objective of this study was to assess the impact of the pandemic on ED use following cancer-directed surgeries. This is a retrospective cohort study of patients undergoing cancer-directed surgeries comparing ED use from 7 January 2018 to 14 March 2020 (pre-pandemic) and 15 March 2020 to 27 June 2020 (pandemic) in Ontario, Canada. Logistic regression models were used to (1) determine the association between pandemic vs. pre-pandemic periods and the odds of an ED visit within 30 days after discharge from hospital for surgery and (2) to assess the odds of an ED visit being of high acuity (level 1 and 2 as per the Canadian Triage and Acuity Scale). Of our cohort of 499,008 cancer-directed surgeries, 468,879 occurred during the pre-pandemic period and 30,129 occurred during the pandemic period. Even though there was a substantial decrease in the general population ED rates, after covariate adjustment, there was no significant decrease in ED use among surgical patients (OR 1.002, 95% CI 0.957–1.048). However, the adjusted odds of an ED visit being of high acuity was 23% higher among surgeries occurring during the pandemic (OR 1.23, 95% CI 1.14–1.33). Although ED visits in the general population decreased substantially during the pandemic, the rate of ED visits did not decrease among those receiving cancer-directed surgery. Moreover, those presenting in the ED post-operatively during the pandemic had significantly higher levels of acuity.

Assessing the Impact of Specialized Oral Nutrition Supplementation Use on Wound Healing

Research Objectives Assess utilization and impact of a specialized oral nutrition supplement (ONS) containing arginine, glutamine, and hydroxymethylbutyrate (HMB) on wound healing. Design Retrospective analysis comparing treatment group (51 patients, 161 wounds) receiving standard care plus a specialized ONS for ≥14 days and comparison group (136 patients, 263 wounds) receiving standard care. Between group differences evaluated using t-tests and mixed models with inverse probability weighting. Setting Inpatient rehabilitation hospital. Participants 187 adult patients admitted between 1/2018-12/2019 with ≥1 measured wound and ≥2 wound care nurse assessments. Interventions Specialized oral nutrition supplement administered for 14 days. Main Outcome Measures Wound healing was measured in weekly intervals by decrease in wound surface area (superficial) or volume (non-superficial) in past 1 week. Results While no age differences were reported between groups (50.9 vs 51.0 years, p=1.0), the treatment group had a higher percentage of male patients (90.2% vs 69.9%, p<0.01). Treatment group patients had more wounds (3.3 vs 2.0, p<0.01), lower functional independence measure scores (35.7 vs 40.3, p=0.082), and a higher case mix index (2.3 vs. 2.0, p=0.008) at baseline. Average inpatient stay (44. 8 vs 39.9 days, p=0.36) and wound area at baseline (22.0 vs 13.1 cm2, p=0.18) were higher, but not statistically different, in the treatment group. Treatment group wounds significantly decreased in area (61.0% vs 34.6%, p=0.01) compared to comparison group wounds. The odds of a decrease in wound size were higher in the treatment versus comparison group (OR = 24.1, p<0.01). Conclusions Patients receiving specialized ONS had more wounds and higher acuity level than those in the comparison group but had a significant reduction in wound size. There are several limitations in this retrospective study, including baseline functional and wound size differences. However, these findings support the benefits of specialized ONS in improving wound healing for patients with pre-existing wounds. Author(s) Disclosures KW Kerr, S Sulo and JL Nelson are Abbott employees and stockholders. Study financially supported by Abbott. Assess utilization and impact of a specialized oral nutrition supplement (ONS) containing arginine, glutamine, and hydroxymethylbutyrate (HMB) on wound healing. Retrospective analysis comparing treatment group (51 patients, 161 wounds) receiving standard care plus a specialized ONS for ≥14 days and comparison group (136 patients, 263 wounds) receiving standard care. Between group differences evaluated using t-tests and mixed models with inverse probability weighting. Inpatient rehabilitation hospital. 187 adult patients admitted between 1/2018-12/2019 with ≥1 measured wound and ≥2 wound care nurse assessments. Specialized oral nutrition supplement administered for 14 days. Wound healing was measured in weekly intervals by decrease in wound surface area (superficial) or volume (non-superficial) in past 1 week. While no age differences were reported between groups (50.9 vs 51.0 years, p=1.0), the treatment group had a higher percentage of male patients (90.2% vs 69.9%, p<0.01). Treatment group patients had more wounds (3.3 vs 2.0, p<0.01), lower functional independence measure scores (35.7 vs 40.3, p=0.082), and a higher case mix index (2.3 vs. 2.0, p=0.008) at baseline. Average inpatient stay (44. 8 vs 39.9 days, p=0.36) and wound area at baseline (22.0 vs 13.1 cm2, p=0.18) were higher, but not statistically different, in the treatment group. Treatment group wounds significantly decreased in area (61.0% vs 34.6%, p=0.01) compared to comparison group wounds. The odds of a decrease in wound size were higher in the treatment versus comparison group (OR = 24.1, p<0.01). Patients receiving specialized ONS had more wounds and higher acuity level than those in the comparison group but had a significant reduction in wound size. There are several limitations in this retrospective study, including baseline functional and wound size differences. However, these findings support the benefits of specialized ONS in improving wound healing for patients with pre-existing wounds.

Examining the Mental Health Presentations of Treatment-Seeking Transgender and Gender Nonconforming (TGNC) Youth

Recent research suggests that transgender and/or gender nonconforming (TGNC) youth present with heightened levels of mental health problems compared to peers. This study seeks to examine the mental health needs of a large sample of treatment-seeking TGNC youth by comparing them to cisgender males and females. Participants were 94,804 children and youth ages 4–18 years (M = 12.1, SD = 3.72) who completed the interRAI Child and Youth Mental Health Instrument (ChYMH) or Screener (ChYMH-S) at participating mental health agencies in the Ontario, Canada. Overall, the mental health presentations of TGNC youth were similar to cisgender females but at higher acuity levels. TGNC youth showed significantly higher levels of anxiety, depression, social disengagement, positive symptoms, risk of suicide/self-harm, and were more likely to report experiencing emotional abuse, past suicide attempts, and a less strong, supportive family relationship than cisgender females and males. Clinical implications of these findings are discussed.

9.2 Children's Mental Healthcare Needs in Primary Care: Results From a Statewide Needs Assessment for Primary Care Physicians in Vermont

The objectives of this presentation are to: 1) provide a qualitative and quantitative description of the experience of a cohort of pediatric primary care providers (PCPs) across the State of Vermont with the treatment and referral of mental health conditions including use of a phone and email consultation service; and 2) describe the barriers that these PCPs report to recommending psychotherapy, medication, wellness strategies, and connecting their patients to care in the community. Individual PCPs engaged around this issue were identified. Online and paper surveys were sent, and 32 responses collected in May-June 2019. Seventy-four percent of respondents were seeing 6 or more children per week with mental health–related complaints. Sixty-two percent reported at least one-quarter of patient encounters involving mental health issues. Nearly all were comfortable with managing mild-moderate ADHD, depression, and anxiety, and reported using rating scales/screening tools to assess for these conditions. Seventy-eight percent had moderate-to-severe complexity patients they were treating without specialty input, with a mean of 4 active cases. The PCPs felt that with these cases, they were operating outside of their scope of practice and comfort. The vast majority were referring cases to child and adolescent psychiatry when there was diagnostic or medication complexity or a high level of acuity. Forty-eight percent reported access to a consultation phone/email service, which was used mostly sporadically, with cited barriers including time and feeling that patients needed to be seen in person to be effective. Diagnostic uncertainty was the most commonly cited barrier to medication prescribing. Barriers to nonmedication treatment included lack of interest or follow through from families, not knowing which particular therapy to recommend or where to refer, and difficulty accessing treatment. Quality concerns and frequent clinician turnover were also mentioned. This selected sampling of pediatric PCPs reported seeing significant numbers of children with mental health issues. For several conditions, they felt comfortable managing mild-to-moderate–level acuity. Many had moderate-to-severe cases they were managing without specialty input. PCPs would welcome increased communication between providers, improved quality measures, databases of community providers and their area of expertise, and consideration of expanded consultative services.

Changes in Emergency Department Performance during Strike of Junior Physicians in Korea.

Objective A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods This retrospective observational study evaluated ED flow and performance during the junior doctors' strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors' strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors' strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period (P < 0.001). The doctors' strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion During the junior doctors' strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.

Quality improvement in remote prescribing

Quality improvement in remote prescribing

Acuity level of care as a predictor of case fatality and prolonged hospital stay in patients with COVID-19: a hospital-based observational follow-up study from Pakistan

ObjectivesTo determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.DesignA hospital-based observational follow-up...

Identifying Acuity Level-Based Adult Emergency Department Use Time Trends Across Demographic Characteristics.

IntroductionCanadian emergency departments (EDs) are struggling under the weight of increased use by a growing population of elderly patients; those who lack proper housing; and those who lack family physicians to provide primary care. The Canadian Foundation for Healthcare Improvement projected a possible ED service utilization increase in Canada at a rate of 40% over three decades. This calls for local-level information on the time trends to understand demographic and temporal variations in the different geographical locations in the country. This study sought to identify and quantify acuity level-based per capita ED visit annual time trends for the 10-year period of 2006-2015 (by age, gender, and housing status). The aim is to provide detailed information on the time trends for demographically targeted ED planning locally. The lengthy record of data allows examining the changing directions in different time segments.Material and methodsAdministrative data from the largest emergency department in Halifax (Nova Scotia, Canada) was analyzed. Per capita adult ED visit rates (EDVR) based on Canadian Triage Acuity Scale (CTAS), age, gender, and housing status were analyzed. Trends in the age-gender-based standardized rates using 2011 census city population data were also estimated in order to account for the population increase in the city. ResultsNo study in Canada has documented the possibility of flattening the escalating ED visit trend by maintaining an annual declining trend in low-acuity-level visits or documented a threshold rate of decline to be maintained. This study observed that the annual linear per capita non-homeless EDVR increment trend (328/year, CI:245-411, per 100,000) for all-acuity-level visits - noted for a ten-year period - would become stable when low-acuity-level CTAS4-5 visit declining trends (427/year, CI:350-503 and 121/year, CI:79-163, per 100,000) - noted for the period of 2012-2015 - were maintained at the same magnitude and direction. Alarming annual emergent (high acuity level of CTAS2) EDVR increase equivalent to 335/year (CI:280-391, per 100,000) was noted for all combined visits, from all age, gender, and housing groups visits. The highest incremental rate noted among above-50-year-olds (521/year, per 100,000, 95% CI:433-608) was neither driven by overall increasing population census numbers nor by increasing aging population numbers. We found statistically similar age-gender standardized rates (294/year, CI: 207-382) for all ED visits and (316/year, CI:261-372) for CTAS2 level visits, when adjusted for annual population increase. Homeless ED visits did not contribute to the overall ED visit incremental trend. The highest annual homeless increment rate was shown for <30-year-old group high acuity CTAS-2 level visits (219/year, CI:193-246, per 100,000). ConclusionNeither the city population increase nor increased homeless visits contributed to ED visit annual per capita incremental trends in the city of Halifax. The increasing trend was chiefly driven by high-acuity-level visits by >50-year-old patients. Our findings suggest one way to make this escalating ED visit rates stable in the future is by maintaining the declining semi-urgent and non-urgent visit trends at the same rates estimated within the years 2012-2015. These findings highlight the potential directions for ED services planning to keep up with the growing demand for high-acuity-level ED services by the aging population.

Recurrent Pneumothoraces in a Patient with Emery Dreifuss Syndrome: A Case Report and Review of the Literature.

Emery Dreifuss Muscular Dystrophy (EDMD) is an inherited disorder which leads to progressive worsening of muscular function. In this report, we present a case of a 29 years old woman with EDMD who presented with sudden left anterior chest pain and was diagnosed with recurrent pneumothoraces. We will highlight how a patient with EDMD-related pneumothoraces can develop rapidly worsening ventilatory function resulting in acute hypercapnic respiratory failure. Patients with muscular dystrophies require a high level of acuity on part of the physician to predict. Physician should be on high alert when treating patients with EDMD and pneumothorax given the potential for rapid respiratory deterioration and the requirements of immediate ventilation support. Having the ability to predict the severity of respiratory involvement in patients with EDMD is a key for favorable outcomes, besides prognostication, it also allows physicians to develop an earlier interventional plan for management of potential respiratory failure. In this report, we also provide in-depth review regarding the approach to the assessment of respiratory function in patients with EDMD and the current literature on the management of respiratory complications seen in patients with EDMD, a highly vulnerable population.

Association of Display of Patient Photographs in the Electronic Health Record With Wrong-Patient Order Entry Errors

Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). Previous research shows that interruptive solutions, such as electronic patient verification forms or alerts, can reduce these types of errors but may be time-consuming and cause alert fatigue. To evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors. In this cohort study, data collected as part of care for patients visiting the ED of a large tertiary academic urban hospital in Boston, Massachusetts, between July 1, 2017, and June 31, 2019, were analyzed. In a quality improvement initiative, the ED staff encouraged patients to have their photographs taken by informing them of the intended safety impact. The rate of WPOE errors (measured using the retract-and-reorder method) for orders placed when the patient's photograph was displayed in the banner of the EHR vs the rate for patients without a photograph displayed. The primary analysis focused on orders placed in the ED; a secondary analysis included orders placed in any care setting. A total of 2 558 746 orders were placed for 71 851 unique patients (mean [SD] age, 49.2 [19.1] years; 42 677 (59.4%) female; 55 109 (76.7%) non-Hispanic). The risk of WPOE errors was significantly lower when the patient's photograph was displayed in the EHR (odds ratio, 0.72; 95% CI, 0.57-0.89). After this risk was adjusted for potential confounders using multivariable logistic regression, the effect size remained essentially the same (odds ratio, 0.57; 95% CI, 0.52-0.61). Risk of error was significantly lower in patients with higher acuity levels and among patients whose race was documented as White. This cohort study suggests that displaying patient photographs in the EHR provides decision support functionality for enhancing patient identification and reducing WPOE errors while being noninterruptive with minimal risk of alert fatigue. Successful implementation of such a program in an ED setting involves a modest financial investment and requires appropriate engagement of patients and staff.

Predicting Pain-Related 30-Day Emergency Department Return Visits in Middle-Aged and Older Adults.

The objective of this study was to determine predictive factors for pain-related emergency department returns in middle-aged and older adults. Design, Setting, and Subjects. This was a subanalysis of patients > 55 years of age enrolled in a prospective observational study of adult patients presenting within 30 days of an index visit to a large, urban, academic center. Demographic and clinical data were collected and compared to determine significant differences between patients who returned for pain and those who did not. Multiple logistic regressions were used to determine significant predictive variables for return visits. The majority of the 130 enrolled patients > 55 years of age returned for pain (57%), were African American (78%), were younger (55-64 years old, 67%), had a high emergency department acuity level (level 1 or 2) at their index visit (56%), had low health literacy (Rapid Estimate of Adult Literacy in Medicine [REALM] score, 62%), lived in an area of extreme deprivation (69%), and were admitted (61%) during their index visit. Age (odds ratio [OR] = 0.9, 95% CI = 0.8-0.9, P = 0.047), health literacy (REALM scores; OR = 3.1, 95% CI = 1.3-7.5, P = 0.011), and index visit pain scores (OR = 1.1, 95% CI = 1.0-1.2, P = 0.004) were predictive of emergency department returns for pain in middle-aged and older adults. The likelihood of emergency department return visits for pain in middle-aged and older adults decreased with older age, increased with higher health literacy (REALM scores), and increased with increase in pain scores.

Patient experience in a pediatric emergency department during COVID-19

The COVID-19 pandemic has changed many dynamics in healthcare in the United States. This study explores an increase in patient experience (PE) scores in a pediatric emergency department. Visits were analyzed before and after March 8, 2020, corresponding with the first local case of COVID-19. Changes in the patient population and characteristics of survey responders were analyzed. Overall, the number of daily visits decreased (113 vs 36/day) and survey response rate decreased (3.7 vs 2.8%, p = 0.03), but PE scores increased (87.21 to 93.73, p = 0.002). Comparatively, an increase in patients with higher acuity levels by Emergency Severity Index (ESI), white/Caucasian race, and non-Hispanic ethnicity were observed in the population. Similarly, responders were comprised of higher ESI and a similar racial shift. No correlations, however, were identified between these factors and PE score. Overall, while the data suggest some changes in demographics and acuity, they do not adequately account for the increase in PE score. Further evaluation of the patient/provider relationship during a global pandemic is justified.