Urgent Care Research Articles

An Analysis of Healthcare Usage & Place of Death in England for All Adults Who Died in 2021/22.

We wanted to examine the healthcare use and non-elective activity in the UK population of expected deaths over an 1-year period to highlight and examine the reasons for variation. We did this to identify areas to focus interventions or resources on to reduce unnecessary emergency care use at the end of life. We assembled a data set of approximately 400000 adults who died in England in the financial year 2021/22 (April 2021-March 2022). Any adults classified as a 'sudden death' were excluded. We used available data to ensure outcome measures were relevant used expert consensus to agree what to examine. We recorded place of death and examined urgent care in terms of admissions in the last year and 90days of life. We also used recorded hospital care days as elective and non-elective usage. There were over 400000 decedents included in our regression models. Close to half died in hospital (44%). Three-quarters (77%) had at least one day of unplanned hospital care in the 90days before they died, and half (56%) had at least one day of planned hospital care. Reliance on urgent care for those approaching end-of-life may indicate poor care planning and integration of services. A relatively modest increase in the amount of community care a person receives at end-of-life can substantially reduce the likelihood of dying in hospital. Those with a cancer cause of death are far less likely to die in hospital.

Engagement in GI Behavioral Health Is Associated with Reduced Portal Messages, Phone Calls, and ED Visits.

Chronic digestive disorders are associated with increased costs for healthcare systems and often require provision of both urgent care and non-face-to-face (non-F2F) care, such as responding to patient messages. Numerous benefits of integrated gastroenterology (GI) behavioral health have been identified; however, it is unclear if integrated care impacts healthcare utilization, including urgent care and non-F2F contact. We sought to investigate the association between patient engagement with GI behavioral health and healthcare utilization. We performed a retrospective chart review study of adult patients who were referred for and completed at least one behavioral health appointment between January 1, 2019 and December 21, 2021 in the Gastroenterology and Hepatology department of a large academic medical center. Data on electronic medical record (EMR) messages, phone calls, and Emergency Department utilization were collected 6months before and 9months after patient engagement with GI behavioral health. 466 adult patients completed at least one behavioral health visit from 2019 to 2021. Overall, messages, phone calls, and ED visits all decreased significantly from the 6months before behavioral health treatment to 6months after (all P values < 0.001). Engagement with integrated GI behavioral health is associated with reduced non-F2F care and emergency department utilization in patients with chronic digestive disorders. Increasing access to GI behavioral health may result in reduced provider workload and healthcare system costs.

Antibiotics Not Associated with Shorter Duration or Reduced Severity of Acute Lower Respiratory Tract Infection.

Antibiotic use remains common for the treatment of lower respiratory tract infections. The objective of this study was to evaluate the impact of antibiotic use on the duration and severity of acute lower respiratory tract infection (LRTI). Adult patients presenting to US primary or urgent care sites with a chief complaint of cough and symptoms consistent with LRTI. Collected data included demographics, comorbidities, symptoms, and 48 viral and bacterial respiratory pathogens by PCR. Severity of signs/symptoms was reported for up to 28days using diaries and text messages. Interpolation was used where data were missing. Of 718 patients with baseline data, 29% had an antibiotic prescribed at baseline. The most common antibiotics were amoxicillin-clavulanate, azithromycin, doxycycline, and amoxicillin in 85% of patients. Provision of an antibiotic had no effect on the duration or overall severity of cough, including in patients with viral, bacterial, and mixed infections. Receipt of an antibiotic did reduce the likelihood of a follow-up visit (14.1% vs 8.2%, aOR 0.47, 95% CI 0.26-0.84), perhaps by removing the motivation of getting an antibiotic at a follow-up visit. However, they were also more likely to receive a systemic corticosteroid (31.9% vs 4.5%, p < 0.001) and were also more likely to receive an albuterol inhaler (22.7% vs 7.6%, p < 0.001). Patients believed that receiving an antibiotic would reduce the duration of their illness by nearly 4days. In this large prospective study in the US primary and urgent care setting, antibiotics had no measurable impact on the severity or duration of cough due to acute LRTI. Patients had unrealistic expectations regarding the duration of LRTI and the effect of antibiotics which should be the target of antibiotic stewardship efforts.

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

The “red code” (RC) represents the highest level of emergency in the emergency department (ED). This study retrospectively analyzed RCs in the Regina Margherita Children’s Hospital ED, a regional referral center in north Italy, between 1 July 2020 and 30 June 2023. The aim was to describe RC characteristics and to identify significant correlations between presenting complaints and clinical management. The study includes 934 RCs (0.9% of overall ED admissions); 64% were assigned based on the Pediatric Assessment Triangle alteration. Most patients, 86.5%, followed the medical pathway, while 13.5% were surgical cases. Admission complaints were respiratory (46.9%), neuropsychiatric (26.7%), traumatic (11.8%), cardiologic (9.3%), metabolic (3.8%), and surgical (1.5%). Seventy-six percent of patients received vascular access, and intraosseous access was obtained in 2.2% of them. In one-third of RCs, an urgent critical care evaluation was necessary, and 19% of cases required admission to the intensive care unit. The overall mortality rate was 3.4% (0.4% in ED setting). The study identified six distinct diagnostic pathways, each associated with specific characteristics in clinical presentation, management, therapeutic interventions, and outcomes. Our findings underscore the need for a systematic approach in pediatric emergency settings, supported by international and national guidelines but also by clearly defined diagnostic pathways, aiming to enhance the quality of care and patient outcomes.

Unscheduled healthcare interactions in multiple myeloma patients receiving T cell redirection therapies

Outcomes for relapsed/refractory multiple myeloma (RRMM) patients have dramatically improved following the development and now growing utilization of B cell maturation antigen targeted chimeric antigen receptor (CAR) T cell therapy and bispecific antibody (BsAb) therapy. However, healthcare utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled healthcare interactions (UHIs) among RRMM patients responding to B-cell maturation antigen targeted BsAbs and CAR T cell therapies (N = 46). This included analysis of remote UHIs including calls to physicians’ offices and messages sent through an online patient portal. Our results showed that nearly all (89%) RRMM patients receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. RRMM patients responding to BsAbs were significantly more likely to remotely contact their physicians' offices (1.8-fold increase, p = 0.038) or visit an urgent care center (>3-fold increase, p = 0.012) than RRMM patients responding to CAR T cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that RRMM patients experience while receiving CAR T cell or BsAb therapies. This preemptive management may significantly reduce unnecessary healthcare utilization in this vulnerable patient population.

Head Injury Treatment With Healthy and Advanced Dietary Supplements: A Pilot Randomized Controlled Trial of the Tolerability, Safety, and Efficacy of Branched Chain Amino Acids in the Treatment of Concussion in Adolescents and Young Adults.

Concussion is a common injury in the adolescent and young adult populations. Although branched chain amino acid (BCAA) supplementation has shown improvements in neurocognitive and sleep function in pre-clinical animal models of mild-to-moderate traumatic brain injury (TBI), to date, no studies have been performed evaluating the efficacy of BCAAs in concussed adolescents and young adults. The goal of this pilot trial was to determine the efficacy, tolerability, and safety of varied doses of oral BCAA supplementation in a group of concussed adolescents and young adults. The study was conducted as a pilot, double-blind, randomized controlled trial of participants ages 11-34 presenting with concussion to outpatient clinics (sports medicine and primary care), urgent care, and emergency departments of a tertiary care pediatric children's hospital and an urban tertiary care adult hospital, between June 24, 2014 and December 5, 2020. Participants were randomized to one of five study arms (placebo and 15 g, 30 g, 45 g, and 54 g BCAA treatment daily) and followed for 21 days after enrollment. Outcome measures included daily computerized neurocognitive tests (processing speed, the a priori primary outcome; and attention, visual learning, and working memory), symptom score, physical and cognitive activity, sleep/wake alterations, treatment compliance, and adverse events. In total, 42 participants were randomized, 38 of whom provided analyzable data. We found no difference in our primary outcome of processing speed between the arms; however, there was a significant reduction in total symptom score (decrease of 4.4 points on a 0-54 scale for every 500 g of study drug consumed, p value for trend = 0.0036, [uncorrected]) and return to physical activity (increase of 0.503 points on a 0-5 scale for every 500 g of study drug consumed, p value for trend = 0.005 [uncorrected]). There were no serious adverse events. Eight of 38 participants reported a mild (not interfering with daily activity) or moderate (limitation of daily activity) adverse event; there were no differences in adverse events by arm, with only two reported mild adverse events (both gastrointestinal) in the highest (45 g and 54 g) BCAA arms. Although limited by slow enrollment, small sample size, and missing data, this study provides the first demonstration of efficacy, as well as safety and tolerability, of BCAAs in concussed adolescents and young adults; specifically, a dose-response effect in reducing concussion symptoms and a return to baseline physical activity in those treated with higher total doses of BCAAs. These findings provide important preliminary data to inform a larger trial of BCAA therapy to expedite concussion recovery.

Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services.

During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.

Street Fights and Social Reproduction: The Role of Health Mutualism in Berkeley’s People’s Park Struggle

Abstract: In the social movement literature, the relationship between the political work of collective survival and the politics of the streets remains undertheorized despite robust research on the significance of direct social actions (DSAs). This article revives the work of the Berkeley Free Church during the People’s Park struggles in 1969. Through waves of intense street conflict, the Berkeley Free Church ran grassroots health programs and helped launch a free healthcare clinic. The Free Church’s health programs served both those with daily needs and those needing urgent care in the streets when police responded to demonstrations with violence. This historical case adds complexity to the social movement literature because the Berkeley Free Church’s work reveals a dynamic, interconnected relationship: health mutualism became central to street protest, and street protest in turn made the goals of building projects of health mutualism more feasible.

Suicide risk screening and evaluation among patients accessing VHA services and identified as being newly homeless.

To evaluate universal suicide risk screening and evaluation processes among newly homeless Veterans. Not applicable. Examination of Veterans Health Administration (VHA) using newly homeless patients' health record data in Calendar Year 2021. Not applicable. Health record data. Most patients received suicide risk screening and/or evaluation in the year prior to and/or following homeless identification (n = 49,505; 87.4%). Smaller percentages of patients were screened and/or evaluated in close proximity to identification (n = 7358; 16.0%), 1-30 days prior to identification (n = 12,840; 39.6%), or 1-30 days following identification (n = 14,263; 34.3%). Common settings for screening included primary care, emergency and urgent care, and mental health services. Of positive screens (i.e., potentially elevated risk for suicide), 72.6% had a Comprehensive Suicide Risk Evaluation (CSRE) completed in a timely manner (i.e., same day or within 24 h). Age, race, and sex were largely unrelated to screening and/or evaluation. Although many newly identified homeless patients were screened and/or evaluated for suicide risk, approximately 13% were not screened; and 27% of positive screens did not receive a timely CSRE. Continued efforts are warranted to facilitate suicide risk identification to ensure homeless patients have access to evidence-based interventions.

Gastric perforation after polyurethane foam ingestion

Introduction Acute intoxication rarely produces conditions that require urgent surgical care. Case summary A 45-year-old man presented to the emergency department with severe abdominal pain after the deliberate ingestion of 200 cm3 of polyurethane mixed with methylene diphenyl diisocyanate and urethane primers. On an initial laparoscopic examination, foreign material was observed in the peritoneal space with haemoperitoneum. Emergency exploration was then undertaken for suspected gastric perforation. Full-thickness damage was identified on the stomach wall during the operation. The material in the gastrointestinal tract and peritoneal space was gently removed. Moulded casts of the entire stomach and distal oesophagus were extracted successfully. The patient was discharged 14 days after surgery. Images Computed tomography revealed foreign material occupying the entire gastric chamber, as well as diffuse gastric perforation. Conclusions Life-threatening gastric perforation can occur after polyurethane foam ingestion. Clinical/medical toxicologists and emergency physicians need to be aware of the highly expandable nature of this agent.

HSR24-167: Improved Access Through an Integrated Supportive Care Model Reduced Urgent Care Referral and Admission Rates for Patients With Gastrointestinal Malignancy.

HSR24-167: Improved Access Through an Integrated Supportive Care Model Reduced Urgent Care Referral and Admission Rates for Patients With Gastrointestinal Malignancy.

The Rise of Urgent Care Centers: Implications for Competition and Access to Health Care

The Rise of Urgent Care Centers: Implications for Competition and Access to Health Care

Implementation of a Self-Audit Tool Improves Regulatory Compliance for Point-of-Care Respiratory Virus Testing in the Emergency Department.

Point-of-care testing in the emergency department decreases wait times and supports evidence-based patient care. However, hurdles to successful implementation include management of interdisciplinary work flows and establishment of an effective quality control program. As COVID-19 testing is now integrated into screening protocols in emergency and urgent care settings, hospital systems must maintain flexible and adaptable respiratory virus testing to adapt to regional trends in transmission. In response to this challenge, our hospital system established a point-of-care respiratory virus laboratory within the emergency department to test for COVID, influenza A/B, and respiratory syncytial virus (RSV). However, maintaining regulatory compliance and standardized protocols within such a dynamic environment became challenging. We launched a quality improvement initiative to support improved performance and efficiency in the point-of-care laboratory with a focus on regulatory benchmarks. Following a period of observation and discussion with key stakeholders in the emergency department and pathology, an audit tool was developed and to be deployed in collaboration with ED nursing. Utilizing the new tool, ED nursing would perform audits in parallel to audits performed by point-of-care staff. Prior to the intervention, the average audit score was approximately 55%; 6 months following the intervention, audit scores have remained stable at approximately 80%, representing a significant improvement in regulatory compliance. Creation of a regulatory tool enabled real-time cross-departmental monitoring of regulatory compliance. These findings underscore the importance of developing transparent interdisciplinary work flows and effective communication to improve patient care.

Thresholds in PROMIS Scores Anchored to Subsequent Unscheduled Health Service Use Among People Diagnosed With Cancer.

To establish thresholds in the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, physical function, fatigue, and depression scores on the basis of their association with subsequent use of the emergency department (ED) or urgent care by people diagnosed with cancer. Retrospective data from 952 people seen at Henry Ford Cancer and insured through the Health Alliance Plan were analyzed using generalized linear mixed-effects models. The log odds of ED or urgent care use during 14 or 30 days after each patient-reported outcome (PRO) assessment were related to PRO scores, while adjusting for comorbidity, sociodemographic, and tumor characteristics. Pain interference and physical function were associated with subsequent ED or urgent care visits, but fatigue and depression were not, and the results for 14- and 30-day visits were similar. Thresholds anchored in the likelihood of these visits differed according to cancer stage. For people with advanced cancer, a pain interference score of 60 or higher (odds ratio [OR] 3.75, [95% CI, 1.53 to 7.87]) and a physical function score lower than 40 (OR 2.94, [95% CI, 1.22 to 7.06]) produced the largest ORs with narrowest CIs for 30-day visits. For people with nonadvanced cancer, the thresholds of 65 for pain interference (OR 2.64, [95% CI, 1.40 to 5.01]) and 35 for physical function (OR 1.87, [95% CI, 1.01 to 3.45]) produced largest ORs with narrowest CIs for 30-day visits. These anchor-based thresholds in PROMIS scores can inform clinicians' actions with the goal of preventing ED or urgent care visits.

Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series

OBJECTIVE Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and ­patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy. METHODS In a prospective case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period. RESULTS Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a ­median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital ­readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate. CONCLUSIONS Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers.

Penile fracture : Our experience

Background: Penile fracture, though rare are more commonly seen in modern-day urological practice. It necessitates urgent and immediate surgical care. It can lead to severe mental and physical agony with functional limitations which could be either sexual or urinary or both. Precise and timely management combined with proper follow–up is mandatory. The emergency care surgeon/ Urologist should be abreast with the evaluation and prompt intervention can result in favourable outcomes.Materials and Methods: We performed a retrospective observational study at a tertiary care referral centre. The objective was to evaluate the causes, clinical presentation and outcome.Results: Nine (09) patients who reported at our centre were treated successfully and were later followed up for two years. The mean reporting time to the hospital was 40.8 hours (35 min-7 days) and all patients received prompt surgical management with 3 patients suffering minor complications at short-term follow-up. Vaginal intercourse was found to be the most common etiological cause for injury. Clinical evaluation and relevant history were sufficient to elucidate the diagnosis. No associated urethral injuries were presentConclusion: If typical symptoms are present (irrespective of signs) a diagnosis of penile fracture can be ascertained. Early exploration is preferable.

Automatic Drug Dispensing Machine for Aayush Medicines

A vital component of society is healthcare, which is being improved by governments employing cutting-edge methods. With the use of an automated drug dispenser machine for Aayush Medicine (ADMAM), patients can fill urgent care and emergency prescriptions after clinic hours, increasing efficiency and cutting down on the amount of time pharmacists must spend working. The card reader, paper outlet, drug outlet, and touch screen are among the mechanical components of the ADMAM, which blends electrical, mechanical, and user interface components with a frame layout. The microprocessor, which connects all electrical parts, harmonically controls the dispensing procedure. With a barcode scanner for drug selection and an RFID card for prescriptions, the ADMAM design prioritizes safety. The ADMAM is simple to use; they only need a card and password to take their prescription. The ADMAM's continued existence is essential for bolstering. Keywords: card reader, drug, Automatic Drug Dispenser Machine for Aayush Medicine.

Humanized care for critically ill patients in Urgent and Emergency care units

To show the importance of the role of health professionals in providing care and humanized assistance in Urgent and Emergency Care Units. The chosen methodology was bibliographical research, of the integrative literature review type, and the search for manuscripts was carried out on the electronic pages: SCIELO, VHL, LILACS and MEDLINE, limiting those published between the years 2018 to 2022. Studies have shown that humanized assistance is of great relevance in urgent and emergency services and should have as its main objective the promotion of the patient's well-being, taking into account not only their clinical status, but also their emotional and mental health. their family members. These results are part of a search that found 142 articles, of which 29 were excluded for not meeting the research objective, 18 were excluded for being in English or Spanish, 34 were incomplete, 46 did not meet the time frame from 2018 to 2022 , with only 15 remaining included in the final sample of this review. Of these, 15 (100%) were in Portuguese, 06 (40%) are from 2018, 05 (33.33%) are from 2019, 01 (6.67%) are from 2020 and 03 (20%) are from 2021. Through the studies analyzed, it is concluded that even in the face of all the difficulties encountered, humanization and assistance in care, especially in the urgency and emergency sectors, are of great importance for all work performed to take place satisfactorily offering a quality service, trust, dignity and respect for human beings.

A case report of an atypical severe case of skin picking disorder managed by a multidisciplinary team

BackgroundWhile skin picking disorder remains relatively common, it often does not present to psychiatry until significant morbidity or comorbidities are reached. It is described as recurrent picking of skin leading to skin lesions, with repeated attempts to decrease or stop skin picking. It is also often associated with significant distress or functional impairment. There has been limited research in this specific disorder and treatment efficacy has often been poor in severe cases. For various reasons, only a small amount of patients with this disorder present to care, and often to a multidisciplinary team prior to psychiatry.Case presentationThis is a case presentation of a 44 year old male with a complex past psychiatric history, ultimately untreated for an underlying skin picking disorder. He presented for urgent medical care following a self-inflicted wound through the central frontal bone and dura over the course of 2 years. He was treated with current psychiatric evidence based medicine, including an SSRI, antipsychotic augmentation and NAC, along with habit reversal techniques during the admission. He was concurrently managed with the neurosurgery team, initially with a poor prognosis due to the severity of his presentation. He required debriding of the devitalized bone within the adjacent brain to cover the dural defect, IV antibiotics for 6 weeks, and an initial skin graft on his initial admission.ConclusionsThis case in particular highlighted the importance of urgent treatment via a multidisciplinary approach to avoid mortality. It highlights the importance of increasing awareness about the disorder and that treatment with SSRI’s, along with antipsychotic and NAC adjuncts remains the mainstay of acute treatment.

Pre-hospital emergency medicine: a spectrum of imaging findings.

The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings.