Percent Of Emergency Department Visits Research Articles

Assessing preventable emergency department visits and hospitalizations following implementation of a high-touch program at an academic cancer center.

415 Background: Patients with cancer undergoing treatment are high utilizers of emergency department (ED) services and are at increased risk of hospitalization. A “high-touch” (HT) model of identifying and increasing communication with cancer patients at elevated risk of ED visits was implemented. The goal was to assess whether patients in the HT cohort had a reduced rate of unplanned ED visits and hospitalizations when compared to patients prior to implementation of the model. Methods: In this retrospective study (1/1/2018-4/1/2021), 51 patients on primarily palliative-intent treatment for their cancer were prospectively included in the HT group based on providers’ assessment of their risk of ED visits and malignancy-related complications. This group was compared to a similar cohort (n= 71) pre-implementation of the HT model. Data on baseline characteristics, malignancy type, reason for unplanned ED visits, and patient interaction with the oncology clinic immediately prior to ED visits were obtained, along with end-of-life outcomes including palliative measures. Each ED visit was also categorized as a potentially preventable or non-preventable visit, based on established criteria from Centers for Medicare and Medicaid Services (CMS). Results: While implementation of a HT program did not significantly decrease utilization, the percent of ED visits (p < 0.001) and hospitalizations (p = 0.002) for CMS-preventable reasons was notably higher in the HT cohort. Patients in the HT cohort also reached out to clinic providers significantly more frequently before visiting the ED (p < 0.001). Over half of patients in the HT cohort were seen by a palliative care physician in the inpatient setting within the last 6 months of life. Patients in both groups had similar high rates of dying at home or inpatient hospice versus dying in a hospital setting. Conclusions: Incorporation of a HT model of care in an oncology clinic may promote closer patient interaction with oncology providers prior to emergency department visits, but may come at the cost of increased medical utilization for otherwise CMS-preventable hospitalizations.[Table: see text]

Reasons for Calling EMS

Background: Frequent callers of emergency medical services comprise a disproportionate percentage of emergency department visits. This study aims to describe reasons for calling 911 and healthcare services among frequent callers in Ontario.
 Methods: Cross-sectional research design. A mailed self-administered survey was conducted. Participants were residents of an urban City in Canada, 18 years or older, and had called 911 at least 5 times in the past year. Dillman’s Total Design Method was used to implement the survey. Data was summarized using frequency distribution. Subgroup analyses were performed to assess for factors associated with reasons for calling in the past, reasons for calling in the future, and health services utilized.
 Results: Among the 67 participants, 47.8% were over 65, 50.70% were female, 85.1% were unemployed, and 38.8% lived alone. Most frequently reported reasons for having called 911 were inability to get up after a fall (41.8%), exacerbation of chronic medical conditions (37.3%), inability to get to the hospital (34.3%), experiencing severe pain (34.3%), and anxiety attacks (23.9%). Subgroup analysis showed significant associations: unemployment was associated with calling due to an alcohol or drug overdose (OR=6.50; CI: 1.16, 36.26); age over 65 had a lower odds of calling in the future for alcohol or drug overdose (OR=0.06; CI: 0.01, 0.51), for serious allergic response (OR=0.22; CI:0.081, 0.740) or for severe pain (OR=0.18; CI: 0.064, 0.518); age over 65 (OR=4.46CI=1.24-17.41) had higher odds of using Community Care Access Centers; and male participants had lower odds of using telehealth (OR=0.19; CI:0.038, 0.97).
 Conclusions: Policy makers should review these reasons for frequently calling 911 and implement a system to help frequent callers use more appropriate health care services including a non-ambulance response to calls related to falls, transport to medical care facilities, or anxiety attacks. This might free up ambulance services for more urgent calls.

QuickStats: Percentage of Emergency Department Visits* with Medicaid as the Primary Expected Source of Payment Among Persons Aged

QuickStats: Percentage of Emergency Department Visits* with Medicaid as the Primary Expected Source of Payment Among Persons Aged <65 Years, by Race and Ethnicity† - National Hospital Ambulatory Medical Care Survey, United States, 2011-2021.

QuickStats: Percentage of Emergency Department Visits for Pain* at Which Opioids† Were Given or Prescribed, by Patient Age and Year - National Hospital Ambulatory Medical Care Survey, United States, 2010-2020.

QuickStats: Percentage of Emergency Department Visits for Pain* at Which Opioids† Were Given or Prescribed, by Patient Age and Year - National Hospital Ambulatory Medical Care Survey, United States, 2010-2020.

Out‐of‐Network “Surprise Billing” in Massachusetts: Estimating the Prevalence and Financial Impact

Research ObjectiveTo examine the type of services that are prone to “surprise billing” and the potential increased spending for patients and payers.Study DesignOut‐of‐network billing occurs when patients receive services from providers that do not have a negotiated rate with the patient's insurer. While patients sometimes choose such providers knowingly (e.g., a preferred out‐of‐network mental health provider), out‐of‐network billing often occurs in scenarios outside of patients' control ‐ e.g., an out‐of‐network anesthesiologist participating in a surgery at an in‐network facility without patient knowledge ‐known as “surprise billing.” [Organization blinded] investigated “surprise billing” trends using the state's all‐payer claims database.Population StudiedPatients insured by three large commercial payers in Massachusetts from 2015 to 2017 that had out‐of‐network indicators in their claims. These members represent over 15% of the state's commercially‐insured lives.Principal FindingsAmong 657,140 commercially insured patients in 2017, we identified 68,342 distinct “surprise” claims, representing 30,332 Massachusetts residents (4.6%) during 44,689 healthcare encounters, in which patients most likely received care from out‐of‐network providers that they did not choose. Among these encounters, 10,590 (23.7%) were ambulance services, and 34,099 (76.3%) were professional services, primarily from ERAP providers (emergency, radiology, anesthesiology, or pathology). Among “surprise” professional services, 29.3% of encounters occurred within the emergency department (ED). Among the payers examined, 7.2 percent of ED visits in 2017 resulted in at least one “surprise” claim. The hospital outpatient department was the setting where most “surprise” professional encounters occurred, accounting for 82.6% of non‐ED out‐of‐network radiology claims, 71.2% of such pathology claims, and 65.5% of such anesthesiology claims.While claims data cannot substantiate whether a patient received a “balance bill” for any given encounter (when a patient is billed for the difference between the insurer's payment and the provider's charges on an out‐of‐network bill), we observed the potential for balance billing in more than 90% of “surprise” professional services claims. The average balance potentially billed to patients for these claims was $167 per claim but varied widely, ranging from $5 at the 5th percentile to $749 at the 95th percentile.Across a range of “surprise” procedures and ambulance services, average spending on out‐of‐network claims far exceeded average spending on in‐network claims. In addition, charges and payer‐paid amounts appeared to rise substantially over time. For example, for a moderate severity ED evaluation and monitoring (E&amp;M) visit, the out‐of‐network charge grew 11% from $294 in 2015 to $325 in 2017.ConclusionsOut‐of‐network claims for ambulance and ERAP services continue to occur in the Massachusetts commercial market, potentially leading to higher premiums and burdening patients with unforeseen and large balance bills.Implications for Policy or PracticeWith recent federal and state legislative action to limit the practice of “surprise billing,” it is crucial to understand the practice's implications on payers, patients, and overall market functioning.

Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010–2015

Background: Exacerbation of asthma symptoms increases the likelihood of emergency department (ED) visits and hospitalizations. Because the ED is an important healthcare resource for immediate asthma care with acute exacerbations, we identify those populations most likely to seek ED treatment for asthma and describe the asthma burden for post-ED visit hospitalizations and critical care units.Methods: We examined the characteristics of asthma-related ED visits and hospital admissions and assessed the association between them using multivariable logistic regression models by analyzing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010–2015.Results: Of all ED visits, 1.32% were asthma-related; of all ED visits that resulted in hospitalization, 1.12% were asthma-related and, of all ED visits that resulted in admission to a critical care unit, 1.20% were asthma related. The percentages of asthma-related ED visits and post-ED hospitalizations (H) were greater among children (adjusted prevalence ratio: ED: 2.28 [1.96.29–2.65]; H: 8.75 [5.93–12.92]) than among adults and greater for blacks (ED: (2.26 [1.97–2.60]; H: 3.25 [2.07–5.12]) and Hispanics (ED: (1.74 [1.47–2.08]; H: 2.424 [1.46–4.00]) than for whites. The percentage of ED visits was also greater for those covered by Medicaid or the Children’s Health Insurance Program (CHIP) than by private insurance.Conclusions: Both asthma-related ED visits and post-ED hospitalizations were greater for children, blacks, and Hispanics. ED visits were also greater for Medicaid/CHIP. These findings might help prompt future studies on identifying additional potential risk factors for frequent ED visits among disproportionally affected subpopulations.

QuickStats: Percentage of Emergency Department Visits for Pain* at Which Opioids† Were Given or Prescribed, by Geographic Region§ of the Hospital - United States, 2005-2017.

QuickStats: Percentage of Emergency Department Visits for Pain* at Which Opioids† Were Given or Prescribed, by Geographic Region§ of the Hospital - United States, 2005-2017.

Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers

ABSTRACTWhile the frequency of children’s behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011–2012) for children age 0–18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.

A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010\u20132014

BackgroundPrevious reports on anaphylaxis in Asia are limited to relatively small-scale studies. We performed this study to identify the nationwide prevalence of anaphylaxis and epinephrine prescription rates by age groups.MethodsThe total number of patients, yearly and overall prevalence, percentage of emergency department visits, and epinephrine prescription rates were calculated for patients diagnosed with anaphylaxis based on the Korean National Health Insurance database from 2010 to 2014.ResultsThe mean prevalence of anaphylaxis in Korea was 26.23 (95% confidence interval, CI 25.78–26.68) per 100,000 person-years during the 5 years. It increased from 20.55 (95% CI 20.15–20.10) in 2010 to 35.33 (95% CI 34.81–35.85) per 100,000 person-years in 2014. The average prevalence was > 35 per 100,000 person-years among 50–69 year-olds, and the mean crude prevalence in children was 22.3 (0–2 years), 17.3 (3–6 years), 12.1 (7–12 years), and 14.9 (13–17 years) per 100,000 person-years, respectively. The overall prevalence increased 1.7-fold, with the highest rate of increase in 0–2 years of age. The overall percentage of emergent anaphylaxis patients was 88.4%, and the prevalence of emergent anaphylaxis increased from 18.63 (95% CI 18.25–19.01) to 31.28 (95% CI 30.79–31.77) per 100,000 person-years. In-hospital epinephrine prescription rate increased from 31.5 to 39.7%.ConclusionsThe mean prevalence of anaphylaxis in Korea was 26.2 per 100,000 person-years during the study period. The total number of anaphylaxis patients increased 1.7-fold from 2010 to 2014, with the most noticeable increment being in young children.

QuickStats: Percentage of Emergency Department Visits That Had an Opioid* Ordered or Prescribed, by Age Group — National Hospital Ambulatory Medical Care Survey, United States, 2006–2015

<i>QuickStats</i>: Percentage of Emergency Department Visits That Had an Opioid* Ordered or Prescribed, by Age Group — National Hospital Ambulatory Medical Care Survey, United States, 2006–2015<sup />

Temporal association of implementation of the Arizona Health Care Cost Containment System (AHCCCS) with changes in dental-related emergency department visits in Maricopa County from 2006 to 2012.

To evaluate changes in emergency department (ED) dental-related visits in Maricopa County before and after the elimination of dental benefits for adult Medicaid-insured patients as of October 2010. Hospital visits extracted from a hospital discharge dataset were used to calculate a yearly rate ratio of dental-related versus non-dental-related ED visits (as a comparison group) for adults, children, and payer types. Changes in ED visits over time were evaluated from 2006 to 2012. Overall, 1.3 percent of all ED visits (8,030,767) were for dental-related purposes. Medicaid-insured patients accounted for 41.9 percent and 44.3 percent of all dental-related ED visits in 2006 and 2012, respectively. The rate ratio for the percentage of dental-related versus non-dental-related ED visits in each age category and payer type showed little fluctuation over time indicating no evidence of change in the dental-related ED visits as a proportion of the overall number of visits due to the cuts in the dental benefits for adult Medicaid-insured patients. We found no evidence that cuts in dental benefits for adult Medicaid-insured patients resulted in increased dental-related ED visits in Maricopa County during the study period. Rather, we found evidence of a shift in payer type after the 2010 policy change where dental-related ED visits by self-paid patients increased as dental-related ED visits by Medicaid-insured patients decreased. Such payer shifts will result in high uncompensated care burdens for providers and, ultimately, governmental payers.

Clinical profile of acute abdomen cases at a tertiary care hospital

Background: Abdominal pain is a common presentation in the outpatient setting and is challenging to diagnose. Abdominal pain is the presenting complaint in 1.5 percent of office-based visits1 and in 5 percent of emergency department visits. Methods: All patients with who present with acute abdomen including blunt trauma to abdomen and post-operative cases are included for study and those who give consent for study. A total of 50 cases were studied during the period. Results: Out of 50 cases 37 were due to non-traumatic abdominal pathology and 13 cases were caused by traumatic factor. Conclusions: Abdominal pain is a common presenting complaint in the Emergency Department and clinicians must consider multiple diagnoses, especially in those cases that require immediate intervention in order to limit morbidity and mortality.

Cervical Spine Trauma in Children and Adults: Perioperative Considerations

A wide spectrum of cervical spine injuries, including stable and unstable injuries with and without neurologic compromise, account for a large percentage of emergency department visits. Effective treatment of the polytrauma patient with cervical spine injury requires knowledge of cervical spine anatomy and the pathophysiology of spinal cord injury, as well as techniques for cervical spine stabilization, intraoperative positioning, and airway management. The orthopaedic surgeon must oversee patient care and coordinate treatment with emergency department physicians and anesthesia services in both the acute and subacute settings. Children are particularly susceptible to substantial destabilizing cervical injuries and must be treated with a high degree of caution. The surgeon must understand the unique anatomic and biomechanical properties associated with the pediatric cervical spine as well as injury patterns and stabilization techniques specific to this patient population.

DISEASES OF THE FORESKIN, PENIS, AND URETHRA

Diseases of the foreskin, penis, and urethra are uncommon conditions that constitute a small percentage of emergency department visits. However, it is important that the emergency physician recognize and treat these conditions and understand which conditions require urologic consultation. Rapid and proper treatment in the emergency department can alleviate patient discomfort, increase patient satisfaction, and prevent future morbidity.