Percentage Of Emergency Department Research Articles

COVID-19 Stats: COVID-19* and Influenza† Discharge Diagnoses as a Percentage of Emergency Department (ED) Visits,§ by Year - United States, June 2018-March 2021.

COVID-19 Stats: COVID-19* and Influenza† Discharge Diagnoses as a Percentage of Emergency Department (ED) Visits,§ by Year - United States, June 2018-March 2021.

Implementing the Regulation of the Minister of Health by Polish Emergency Departments In 2020

Aim: The inadequate system of triage in Emergency Departments leads to the situation in which the personnel is not always able to provide care on time. A regulation determining the conditions of performing triage in Emergency Departments (paragraph 1, section 2) was issued on 27 June 2019. In order to present the level of the fulfilment of rules from the regulation and to determine the level of organization in the Polish health care, the percentage of Emergency Departments which provided the required information on their websites, was examined. Material and methods: The study was conducted in April 2020. 236 websites of hospitals with Emergency Departments were analyzed. The criteria of data retrieval were as follows: 1. The presence of the information concerning the rules of redirecting patients to Primary Health Care/After Hours Medical Centers. 2. The presence of information concerning the time an Emergency Department doctor has to inform the patient about the admission or about refusal to admit a patient. The collected data were statistically analyzed. Each Emergency Department was given the following statuses: “yes”, “no”, or “incomplete”. Results: Information concerning the 1st criterion were available in case of 59 hospitals (25%), while no such information was on the website in Opole and West Pomeranian Provinces. Information concerning the 2nd criterion was placed by 51 hospitals. In 28 cases the information was described as ”complete” and in 23 as “incomplete”. Conclusions: The majority of hospitals failed to observe the obligation to provide the information included in the Regulation.

QuickStats: Percentage of Emergency Department (ED) Visits for Pain* at Which Opioids† Were Given or Prescribed, by Patient Age and Year - National Hospital Ambulatory Medical Care Survey, 2005-2016.

QuickStats: Percentage of Emergency Department (ED) Visits for Pain* at Which Opioids† Were Given or Prescribed, by Patient Age and Year - National Hospital Ambulatory Medical Care Survey, 2005-2016.

Presence and Treatment of Asthma Exacerbation in Infants and Children

We sought to determine that asthma exacerbation exists in infants and can be treated effectively with inhaled corticosteroids. The sample included 1500 consecutive children aged <5 years who attended a tertiary pediatric asthma clinic in 2000-2013 because of an asthma exacerbation that failed to be controlled in the community. Clinical characteristics and response to treatment were compared between the infants and older children (age 1-5 years). Thirty-one percent of the children were infants. There was no difference between infants and older children in rate of asthma in the family, percentage of emergency department visits or hospitalizations, duration of asthma symptoms, and beta-2 agonist and oral corticosteroid use. All patients had a history of prolonged cough and were coughing during their first visit; 45% were also wheezing. During the treatment period, the rate of emergency department visits and hospitalization for asthma exacerbations decreased significantly without use of oral corticosteroids. Most patients (88%), with or without wheezing, had a good response to treatment, with no significant difference between infants and older children. Asthma is present in infants and has the same clinical characteristics as in older children. In both age groups, asthma exacerbations respond equally well to inhaled corticosteroids, regardless of the presence of wheezing.

The Role of the School Psychologist in Assisting Student-Athletes Return-to- Learn Post-Concussion

Over the next few weeks, here in the United States (US), hundreds of thousands of children and adolescents will be returning to school from the summer recess. Many of them, both boys and girls, will be participating in interscholastic competition in one or more of the generally recognized “contact” sports (e.g., football, soccer, lacrosse, basketball, field hockey, and volleyball). Invariably, some will experience some level of head trauma. Some of the most recent statistics indicate that there has been a significant increase in the percentage of emergency department visits for Sport- and Recreation- Related Traumatic Brain Injuries (SSR-TBIs) per 100,000 of the population from 2001 to 2012.

Implementation of crowding solutions from the American College of Emergency Physicians Task Force Report on Boarding

Study ObjectiveWe sought to measure the self-reported implementation of the crowding solutions outlined in the 2008 American College of Emergency Physicians (ACEP) Boarding Task Force report “Emergency Department Crowding: High-Impact Solutions.” We also tested the hypothesis that the self-reported crowding of emergency departments (EDs) was positively associated with the implementation of these solutions.MethodsIn early 2009, we mailed a survey to all medical or nursing directors from EDs in four US states asking for information regarding their EDs in 2008. Geographic information about the EDs was included in the analysis, along with survey responses about their ED capacity status and implementation of specific ACEP crowding solutions.ResultsA total of 284 of 351 EDs responded (81%). The majority of EDs were in urban areas (56%), non-teaching hospitals (93%), and not critical access hospitals (76%). The percentage of EDs “over capacity” ranged from 10–49% in each state. The mean number of crowding solutions used in EDs that were at or over capacity ranged from 3.6–4.6 in each state. EDs with visit volumes greater than or equal to three patients/hour were more likely to be over capacity than at capacity or at a good balance (46% vs. 31% and 15%, respectively). In terms of the use of high-impact crowding solutions, hospitals over capacity were more likely to utilize inpatient full capacity protocols (40% vs. 25% and 25%) but not inpatient discharge coordination (29% vs. 27% and 34%) or surgical schedule smoothing (31% vs. 28% and 32%). Hospitals over capacity were also more likely to have fast track units (44% vs. 32% and 16%) and physicians at triage (48% vs. 29% and 17%).ConclusionLess than half of EDs in each state reported operation above capacity. Implementation of some crowding solutions was more common in the above-capacity EDs, although these solutions were not consistently used across geographic locations and hospitals. Given that the majority of EDs were not over capacity, the implementation of these solutions does not seem to be universally necessary.

Influenza Vaccination in the Emergency Department: Are Our Patients at Risk?

Abstract Background: Influenza is responsible for substantial morbidity and mortality annually. Vaccination strategies target high-risk patients. The percentage of Emergency Department (ED) patients at high risk is largely unknown. Objectives: The percentage of patients at high risk for influenza was determined and compared to the United States (US) population. Methods: Medical records of a convenience sample of all patients presenting to the ED of a university-affiliated hospital in Tucson, Arizona from February 1–7, 2006 were reviewed (n = 1359). Patients were stratified as 1) at high risk for influenza or its complications, 2) health care workers (HCW), household contacts of high-risk patients, and other target populations, and (3) otherwise healthy adults. Additionally, vaccination status and prior ED utilization within that season's vaccination period was determined. Results: Of all patients presenting to the ED, 41.5% were at high risk for influenza or its complications (US 30.8%, p < 0.001). Of all ED patients, 10.8% were household contacts, HCWs, or in another target group (US 42.8%, p < 0.001). Of high-risk ED patients, 43.5% had been vaccinated that season (US 47.1%, p < 0.001) and 13.7% had had at least one visit to the ED within the preceding 3 months. Conclusion: There is a higher percentage of patients at high risk for influenza in the ED population than the general US population. The ED may be a novel location in which to effectively identify and immunize high-risk individuals. Benefits to ED vaccination may include subsequent reductions in mortality and morbidity as well as a decrease in ED utilization and hospitalization for influenza and its complications.

A Highly Sensitive ELISA D‐Dimer Increases Testing but Not Diagnosis of Pulmonary Embolism

To determine the effect of introducing a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer on the percentage of emergency department (ED) patients evaluated for pulmonary embolism (PE), the use of associated laboratory testing, pulmonary vascular imaging, and the diagnoses of PE. Patients evaluated for PE during three 120-day periods were enrolled: immediately before (period 1), immediately after (period 2), and one year after the introduction of a rapid ELISA D-dimer in the hospital. The frequency of ED patients evaluated for PE with any test, with D-dimer testing, and with pulmonary vascular imaging and the frequency of PE diagnosis during each time period were determined. The percentage of patients evaluated for PE nearly doubled; from 1.36% (328/24,101) in period 1 to 2.58% (654/25,318) in period 2 and 2.42% (583/24,093) in period 3. The percentage of patients who underwent D-dimer testing increased more than fourfold; from 0.39% (93/24,101) in period 1 to 1.83% (464/25,318) in period 2 and 1.77% (427/24,093) in period 3. The percentage of patients who underwent pulmonary vascular imaging increased from 1.02% (247/24,101) in period 1 to 1.36% (344/25,318) in period 2 and to 1.39% (334/24,093) in period 3. There was no difference in the percentage of patients diagnosed as having PE in period 1 (0.20% [47/24,101]), period 2 (0.27% [69/25,318]), and period 3 (0.24% [58/24,093]). In the study's academic ED, introduction of ELISA D-dimer testing was accompanied by an increase in PE evaluations, D-dimer testing, and pulmonary vascular imaging; there was no observed change in the rate of PE diagnosis.

Emergency department crowding and thrombolysis delays in acute myocardial infarction

We estimate the effect of emergency department (ED) crowding on door-to-needle time for patients given intravenous thrombolysis for suspected acute myocardial infarction. This was a retrospective observational study of patients thrombolyzed in the ED for suspected acute myocardial infarction in 1998 to 2000 in 25 community and teaching hospital EDs in Ontario. EDs located close together and sharing a common ambulance diversion system were grouped into networks consisting of 2 to 5 hospitals each. At patient registration in an ED, the ambulance diversion status of all EDs in the network was determined. Network crowding was calculated as the percentage of EDs that were diverting ambulances on patient registration, categorized as none (0%), moderate (<60%), and high (> or =60%). Door-to-needle time was defined as time from ED registration to drug administration. Multivariable quantile regression and logistic regression were carried out; covariates included age, sex, ECG characteristics, previous acute myocardial infarction, vital signs, time of presentation, and hospital type. A total of 3,452 thrombolysis patients were included: mean age was 62.9 years, and 73% were male patients. Overall median door-to-needle time was 43 minutes (interquartile ratio 27 to 80). Median door-to-needle time was 40, 45, and 47 minutes in conditions of none, moderate, and high network crowding, respectively ( P <.001). The adjusted odds ratios for door-to-needle time delay (>30 minutes) and major delay (>60 minutes) were 1.32 (95% confidence interval [CI] 0.98 to 1.79) and 1.40 (95% CI 1.12 to 1.75), respectively, for high network crowding compared with none, and 1.21 (95% CI 0.89 to 1.63) and 1.06 (95% CI 0.86 to 1.29), respectively, for moderate crowding compared with none. In multivariate analyses, moderate and high crowding conditions were associated with increased median door-to-needle time (3.0 minutes [95% CI 0.1 to 6.0] and 5.8 minutes [95% CI 2.7 to 9.0], respectively). ED crowding is associated with increased door-to-needle times for patients with suspected acute myocardial infarction and may represent a barrier to improving cardiac care in EDs.

Nonoccupational HIV postexposure prophylaxis (NPEP) protocols and barriers to NPEP utilization in massachusetts emergency departments

Study objectives: Nonoccupational HIV exposures are often evaluated in the emergency department (ED) for nonoccupational HIV postexposure prophylaxis (HIV-NPEP). The Massachusetts Department of Public Health conducted a survey of Massachusetts EDs in 1998, which revealed that only 15% of EDs had established NPEP protocols and that NPEP access varied by geography and clinical setting. The Massachusetts Department of Public Health then distributed a clinical advisory recommending development of written NPEP protocols, suggesting protocol components, and advertising a 24-hour advice line, reporting registry, and free medications for uninsured patients. We determine the change in percentage of EDs with an institutional HIV-NPEP protocol since the 1998 study and identify any remaining barriers to HIV-NPEP implementation. Methods: This was a structured survey mailed to directors of all 73 Massachusetts EDs. A subset of ED directors without protocols, or who did not return the survey, was contacted for a semistructured telephone interview. Data were analyzed with descriptive statistics and χ 2 analysis. Results: After 2 mailings, 49 (67.1%) of 73 questionnaires were returned. Compared with that in 1998, a greater proportion of EDs reported protocols (15% versus 44.9%, P P Conclusion: Although the use of HIV-NPEP in certain exposures is recommended by many state guidelines and experts, many EDs still lack protocols. Availability of resources (HIV clinic) is correlated with protocol development. Increased physician training and awareness is crucial.