Patterns Of Emergency Department Visits Research Articles

Impact of COVID-19 Lockdown on Emergency Department Visits, Hospital Admissions, and Mortality in Northern Jordan: An Interrupted Time Series Analysis

Background: The Jordanian healthcare system was significantly affected by the COVID19 pandemic, as lockdowns and infections strained the healthcare system. The impact of the ensuing national lockdown on emergency department visits, hospital admissions, and mortality is unclear. Purpose: To assess the impact of COVID-19 lockdown on the pattern of emergency department visits, hospital admissions, and mortality at a major hospital in northern Jordan. Methods: An electronic database belonging to King Abdullah University Hospital was used for a retrospective analysis, and the data was accessed in 2022. All patients who visited the emergency department before, during, and after the lockdown in 2020 and 2019 were analyzed using an interrupted time-series analysis. Descriptive statistics were calculated for categorical variables, followed by the Wilcoxon Signed-Ranks Test to detect mean differences. Results: ED visits decreased by 53.5% during the lockdown period and by 22% after the lockdown period compared to the same periods a year before. During lockdown, hospital admissions rose significantly from 11.8% in 2019 to 17.1% in 2020, with 23.96% critical care unit admissions. Post-lockdown, ED admissions increased from 11.3% in 2019 to 16.3% in 2020, with critical care admissions rising to 30.10%, and the mortality rate increased by 50%. Conclusion: The study concluded a decrease in hospital admissions and emergency visits during lockdown, but an increase in mortality rates. Future planning should focus on optimizing care for lifethreatening emergencies, improving national emergency preparedness, and developing Hospital Readiness Checklists for effective response to emergencies like COVID-19. Implications for Nursing: Nursing has faced challenges and changes due to the COVID19 lockdown. Patient admissions decreased after the 2020 lockdown, impacting nursing practice, mental health, and patient care. Nurses should be adapted to telehealth services, maintain care remotely, and address nurses’ mental health issues. Virtual tools should be utilized to connect with patients. Keywords: Jordan, COVID-19, Lockdown, Emergency department, Hospital admissions, Interrupted time series analysis.

Flow pattern of Emergency Department visits during Ramadan: A single-center experience for 3 years in Muslim-Majority Country

Flow pattern of Emergency Department visits during Ramadan: A single-center experience for 3 years in Muslim-Majority Country

Primary care services and emergency department visits in blended fee-for-service and blended capitation models: evidence from Ontario, Canada.

It is well-known that the way physicians are remunerated can affect delivery of health care services to the population. Fee-for-service (FFS) generally leads to oversupply of services, while capitation leads to undersupply of services. However, little evidence exists on the link between remuneration and emergency department (ED) visits. We fill this gap using two popular blended models introduced in Ontario, Canada: the Family Health Group (FHG), an enhanced/blended FFS model, and Family Health Organization (FHO), a blended capitation model. We compare primary care services and rates of emergency department ED visits between these two models. We also evaluate whether these outcomes vary by regular- and after-hours, and patient morbidity status. Physicians practicing in an FHG or FHO between April 2012 and March 2017 and their enrolled adult patients were included for analyses. The covariate-balancing propensity score weighting method was used to remove the influence of observable confounding and negative-binomial and linear regression models were used to evaluate the rates of primary care services, ED visits, and the dollar value of primary care services delivered between FHGs and FHOs. Visits were stratified as regular- and after-hours. Patients were stratified into three morbidity groups: non-morbid, single-morbid, and multimorbid (two or more chronic conditions). 6184 physicians and their patients were available for analysis. Compared to FHG physicians, FHO physicians delivered 14% (95% CI 13%, 15%) fewer primary care services per patient per year, with 27% fewer services during after-hours (95% CI 25%, 29%). Patients enrolled to FHO physicians made 27% more less-urgent (95% CI 23%, 31%) and 10% more urgent (95% CI 7%, 13%) ED visits per patient per year, with no difference in very-urgent ED visits. Differences in the pattern of ED visits were similar during regular- and after-hours. Although FHO physicians provided fewer services, multimorbid patients in FHOs made fewer very-urgent and urgent ED visits, with no difference in less-urgent ED visits. Primary care physicians practicing in Ontario's blended capitation model provide fewer primary care services compared to those practicing in a blended FFS model. Although the overall rate of ED visits was higher among patients enrolled to FHO physicians, multimorbid patients of FHO physicians make fewer urgent and very-urgent ED visits.

Patterns of emergency department visits preceding colorectal cancer diagnosis: a population-based study.

Aim: To assess the patterns of emergency department (ED) visits in the 3months preceding a diagnosis of colorectal cancer (CRC) in a real-world, population-based context. Materials & methods: Linked provincial registries in Alberta, Canada, were accessed and patients with CRC diagnosed between 2004 and 2018 were identified. The National Ambulatory Care reporting system was used to identify patients who visited an EDwithin 3months of a diagnosis of CRC. Multivariable logistic regression analysis was used to identify factors associated with any ED visits as well as frequent (≥3) ED visits. Results: A total of 25,310 patients with CRC were included in the current study. These include 10,126 patients (40%) who had at least one visit to the EDin the 3months before a diagnosis of CRC diagnosis and 613 patients (2.4%) who visited the EDmultiple (≥3) times. The following factors were associated with any visit to an ED: older age (odds ratio [OR]: 1.010; 95% CI: 1.008-1.012), female gender (OR: 1.23; 95% CI: 1.16-1.30), higher comorbidity index (OR: 1.38; 95% CI: 1.35-1.41), metastatic disease (OR: 2.37; 95% CI: 2.23-2.53), proximal tumors (OR: 1.59; 95% CI: 1.50-1.68)and North zone (OR vs south zone: 1.75; 95% CI: 1.55-1.98). Conclusion: It is not uncommon for CRC patients to visit the EDat least once in the 3months prior to havingsuch a diagnosis. Factors associated with frequent prediagnosis emergency visits included female gender, higher burden of comorbid disease, advanced stage, proximal tumorsand living in the North zone of Alberta (where there is limited access to specialist care).

Analysis of COVID-19 pandemic impact on the presenting complaints of the emergency department visits.

The impact of coronavirus disease 2019 (COVID-19) on economic and medical systems is significant, especially in the emergency department (ED). The patterns of ED visits have also changed significantly and may play a crucial role in rearranging medical resources to the most needed departments during the pandemic.This was a retrospective study conducted in hospitals of the Cathay Health System. All patients presented to the EDs between January 21, 2020 to April 30, 2020 (pandemic stage) and January 21, 2019 to April 30, 2019 (before the pandemic stage). Basic demographics, including visit characteristics, disposition, and chief complaints, of the patients visiting the ED between these 2 periods of time will be compared and analyzed.A total of 71,739 patients were included in the study. A reduction in ED visits was noted in 15.1% (32,950 ED visits) during the pandemic stage. ED visiting patients with the chief complaints of upper respiratory infection and social problems increased by 14.23% and 1.86%, respectively, during the pandemic period. Critical chief complaints such as cardiac arrest, chest pain and altered mental status decreased to less than the ED visits difference (−15.1%) between the pandemic and prepandemic stages, for 0%, −7.67%, and −13.8% respectively.Rearrangement of the ED pediatric staff to the COVID-19 special units and recruiting more social workers to the ED should be performed to respond to the COVID-19 pandemic.

350 Patterns of End-of-Life Care as Measured by Emergency Department Visits among Cancer Patients in Puerto Rico

Community palliative care services are scarce in Puerto Rico (PR). Therefore, patients with advanced cancer commonly visit the emergency department (ED) at end of life. Identification of these patients and their palliative care needs can help in care coordination. Recognition of patients with limited life expectancies and palliative care needs may improve the end of life trajectory of these patients. Our objective was to characterize ED visits of advanced cancer patients at the end of life by examining, for the first time, the patterns of ED visits in PR using the PR Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). Data was obtained from the PRCCR-HILD, which links nearly 90% of cancer cases diagnosed in PR with insurance claims files. We included patients diagnosed between 2011 and 2016, aged ≥18 years with primary invasive cancer, that died between 2011 and 2017, with a recorded date of death, who died from cancer, and who had insurance claims during their last three months. End-of-life care indicators were ED visits, ED death, and hospice use. We used logistic regression models to examine factors associated with end-of-life care. The study cohort included 10,812 cancer patients. We found that 49% had at least one ED visit, 20% had ≥2 ED visits, and another 9.7% died in the ED. Only 9.4% of patients in the cohort were enrolled in hospice. Of those, 46% used hospice within 30 days of death and, 9% enrolled in hospice within three days of death. According to the bivariate analysis, there was an association between having ≥ 2 ED visits and the variables of age group, type of cancer, and stage at diagnosis (p-value<0.05). Likewise, there is an association with death in an ED and sex, age group, and type of cancer (p-value<0.05). In the adjusted model, patients ≥ 80 years were 44% less likely to have ≥ 2 ED visits (aOR: 0.56, 95% CI: 0.46-0.68) compared to patients aged <50 years. Patients with distant stage are more likely to have ≥2 ED visits (p-value<0.05). Also, results of the multiple logistic model showed that significant predictors of death at ED were: ages 65 to 79 (aOR, 0.71; 95% CI, 0.58 to 0.87) and ages ≥80 (aOR, 0.43; 95% CI, 0.33 to 0.56). Female patients were found to be significantly less likely to die in an ED setting. ED visits at end of life can be interpreted as a poor-quality cancer care. Awareness among ED staff of the potential of ED-initiated palliative care is needed. This study demonstrates the potential of the PRCCR-HILD as a resource to further investigate the quality of care among advanced cancer patients at the end of life. Further studies are warranted to improve the quality of care and to mitigate disparities at end-of-life care in PR. Stakeholders need to commit to palliative care as a public health priority in PR, implementing education, planning services, and mobilizing community resources.

Patterns of emergency department visits during Hajj period: Towards healthcare optimization in view of Saudi Arabia’s vision 2030

Objective:This study aimed to examine the pattern of emergency department (ED) visits by Hajj patients and determine the urgency of emergency visits at an advanced healthcare center.Methods:A retrospective review of medical records of Hajj patients visiting the ED at King Abdullah Medical City Makkah from September 1 to October 5, 2015 was conducted.Results:We considered 233 visits by 199 Hajj patients. Most diseases were cardiovascular related. Approximately half of the ED visits led to hospital admission, which were largely during the evening and nighttime. Potentially avoidable visits were significantly encountered during the daytime. Average bed occupation time in the ED was similar for both cases: those admitted to inpatient care and discharged from ED. Results from the Canadian Triage and Acuity Scale revealed that most patients were triaged with a score of III (48.4%) followed by a clinically better score of IV (32%); however, scores did not change significantly throughout the Hajj day.Conclusions:During Hajj, a significant proportion of patients who visited the ED at the ultimate healthcare facility were discharged within 24 hours, with a higher rate in the morning-afternoon period. Both admitted and discharged cases required equal levels of care. Therefore, an extension in working days at primary care centers and optimization of advanced healthcare facilities during Hajj is currently warranted.

Longitudinal Patterns of Emergency Department Visits: A Multistate Analysis of Medicaid Beneficiaries.

The objective of this study was to examine the longitudinal patterns of emergency department (ED) visits among adult fee-for-service Medicaid. Data were obtained from the Medicaid analytic eXtract files, Area Health Resource File, and County Health Rankings. A retrospective longitudinal study design, with four observations for each individual was used. The study population consisted of 33,393 Medicaid beneficiaries who met inclusion criteria. ED visits were time-lagged and time-varying patient-level factors were measured for each year. Time-invariant characteristics (gender and race/ethnicity) were measured in 2006. Multivariable hurdle models with logistic (ED use versus no ED use) and negative binomial regressions (ED visits among ED users) were used to analyze the ED visits over time. To account for correlation due to repeated observations, mixed effect models with robust standard errors were performed. In both unadjusted and adjusted analysis, the likelihood of ED use did not change from year to year (AOR=1.00, 95 percent CI: 0.99, 1.01). Among ED users, the estimated number of ED visits increased over time (IRR=1.01, 95 percent CI: 1.01, 1.03). Primary care resources should be a major focus to reduce the increased burden on the EDs.

Frequency and Pattern of Emergency Department Visits by Long‐Term Care Residents—A Population‐Based Study

To obtain population-based estimates of emergency department (ED) visits by long-term care (LTC) residents. Retrospective cohort study using administrative data. All LTC facilities in Ontario, Canada. All LTC residents who visited an ED at least once during a 6-month period. All ED visits were described using the National Ambulatory Care Reporting System. Two distinct visit types were defined. Potentially preventable visits were defined as those for any ambulatory care sensitive condition; these are conditions for which exacerbations that result in hospital use suggest lack of access to adequate primary care. Low-acuity visits were defined as those triaged as non-urgent at ED registration and ended with return to the LTC facility without hospital admission. Nearly one-quarter of LTC residents visited the ED at least once in 6 months. Of all visits, 24.6% were for a potentially preventable reason, most commonly pneumonia, urinary tract infection, and congestive heart failure. These visits had a high frequency of ambulance transport (90.4%), emergent triage (35.3%), hospital admission (62.4%), and death within 30 days (23.6%). Of all visits, 11.0% were low acuity. Fall-related injury was the most common cause. Low-acuity visits were the shortest (mean length 4.5 +/- 4.0 hours) and had the lowest frequency of death within 30 days (4.3%). LTC residents made frequent visits to the ED. The visit types showed distinct patterns that suggest a need for better access to medical care for common conditions and a greater emphasis on fall prevention in LTC.

Effect of Gender, Age, and Severity of Asthma Attack on Patterns of Emergency Department Visits due to Asthma by Month and Day of the Week

To examine the pattern and strength of seasonal fluctuations in emergency department (ED) visits due to asthma, by month and day of the week, by the patient's age, gender, and severity of asthma attack. Time series analysis of ED visits was conducted among patients with asthma aged from 18 to 55 years who visited Ontario EDs between April 1, 2001 and March 31, 2004. Autoregressive regression models with months and days of the week as predictors were fitted for (1) all patients; (2) females and males separately; (3) each combination of gender and age group, and (4) each combination of gender and level of severity. The strength of seasonality in each group of patients was estimated from the R2-statistic derived from autoregression models. For all patient groups, the highest number of ED visits occurred in October and December, and on Sundays and Mondays. Month of January and Fridays were associated with a decreased number of visits. The strength of seasonality was similar in men and women (R2 = 0.52), was the highest in young patients and decreased with age, in men more rapidly than in women. Severe cases of asthma attacks exhibited weaker seasonality (R2 = 0.30) compared to mild (R2 = 0.45) or moderate (R2 = 0.53) cases. The strength of seasonal patterns of asthma ED visits is influenced by age and the severity of attack, and to a lesser extent, gender. Understanding the significance of seasonal precipitants of asthma in different patients subgroups could lead to better management strategies.

268-S: Effect of Gender, Age and Severity of Asthma Attack on Patterns of Emergency Department Visits Due to Asthma by Month and Day of the Week

268-S: Effect of Gender, Age and Severity of Asthma Attack on Patterns of Emergency Department Visits Due to Asthma by Month and Day of the Week

Patterns of emergency department visits for disorders of the eye and ocular adnexa.

To characterize the magnitude and patterns of visits to the emergency department (ED) for problems related to the eye and ocular adnexa. The National Hospital Ambulatory Medical Care Survey was used to obtain information on ED visits in the United States for conditions of the eye and ocular adnexa in 1993. Patients were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes. National projections were based on a staged probability design. There were 2.32 million projected ED visits for problems of the eye and ocular adnexa in 1993. Forty-nine percent of visits were for injuries, two thirds of which occurred in males. Thirty-five percent of injuries occurred in the home and 18% occurred in the workplace. Only 3% of patients required hospitalization. Most patients had private insurance, but substantial variations in coverage existed for patients who used the ED for injury- vs non-injury-related care. Emergency departments in the United States provide a large amount of eye care, much of which is for conditions other than trauma. Differences in insurance coverage for injury- and non-injury-related eye care indicate that factors other than medical urgency are involved in the decision to use ED services. Further studies are needed to determine the cost-effectiveness and quality of ocular-related ED visits.