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Emergency room revisits

Susan L Prescott, Alan C Logan, David L Katz
Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the 'waiting room' and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health-denoting the interconnections between the health of person and place at all scales-emerged from the environmental and preventive health movements of the 1970⁻1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse...
January 16, 2019: International Journal of Environmental Research and Public Health
Humberto Morales, Marshall Kong
Stroke is caused by occlusion of a medium- or large-sized vessel in the brain. The treatment with either intravenous or intra-arterial thrombolysis is based on an accurate and time-sensitive diagnosis. On clinical and imaging grounds a number of entities-seizures, toxic-metabolic, infectious, or demyelinating diseases-can mimic stroke. Identifying them is paramount as the treatment differs significantly. Prior imaging reviews have focused on the nonterritorial distribution of these mimics. However, some important questions arise here...
October 2018: Seminars in Ultrasound, CT, and MR
Yonggu Lee, Hwan-Cheol Park, Jinho Shin
Using optical coherence tomography (OCT), we found that there were morphological differences in the coronary intima between patients with vasospasm-induced acute coronary syndrome (VACS) and those with stable variant angina. We investigated whether aspirin use would protect against chest pain recurrence in patients with VACS. A retrospective cohort study was performed. Patients with ST-segment elevation who were confirmed to have VACS by a provocation test were included. OCT was performed at the index event and when chest pain recurred to assess intimal morphology...
June 19, 2018: International Journal of Cardiovascular Imaging
Vishwaratn Asthana, Miel Sundararajan, Ruth Linda Ackah, Vivek Karun, Arunima Misra, Allison Pritchett, Pallavi Bugga, Angela Siler-Fisher, William Frank Peacock
BACKGROUND: Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients. METHODS: HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group...
December 2018: American Journal of Emergency Medicine
Kayla Durkin, Tricia Montgomery, Kristen Lamberjack, Cindy C Hafer, James Naprawa, Shannon Yarosz
Background: Prescription fill rates for children being discharged from the emergency department (ED) after asthma exacerbations are low, placing the child at risk for additional ED visits or admissions for asthma. This article describes the implementation of an ED asthma prescription delivery service designed to improve pharmacy prescription capture and decrease ED revisit rates. Methods: A core group developed a service to provide asthma prescriptions and education to patients in their ED room before discharge...
July 2017: Pediatric Quality & Safety
João Paulo de Almeida Tavares, Pedro Sá-Couto, Marie Boltz, Elizabeth Capezuti
INTRODUCTION: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED. METHODS: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered...
November 2017: International Emergency Nursing
I-S Chang, K-T Kang, C-C Tseng, W-C Weng, T-Y Hsiao, P-L Lee, W-C Hsu
OBJECTIVE: To investigate emergency room (ER) revisits and hospital readmissions following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and correlations between SDB severity and ER revisits. DESIGN: Retrospective chart review study. SETTING: Tertiary referral centre. PARTICIPANT: 610 consecutive children underwent T&A for treating SDB. MAIN OUTCOME MEASURES: Sleep-disordered breathing severity was defined according to the apnoea-hypopnoea index (AHI) (primary snoring = AHI < 1; mild = AHI 1-5; moderate = AHI 5-10; and severe = AHI > 10)...
February 2018: Clinical Otolaryngology
Paulo Ricardo Nazário Viecili, Brenda da Silva, Gabriela E Hirsch, Fernando G Porto, Mariana M Parisi, Alison R Castanho, Michele Wender, Jonatas Z Klafke
This review discusses the role of triglycerides (TGs) in the normal cardiovascular system as well as in the development and clinical manifestation of cardiovascular diseases. Regulation of TGs at the enzymatic and genetic level, in addition to their possible relevance as preclinical and clinical biomarkers, is discussed, culminating with a description of available and emerging treatments. Due to the high complexity of the subject and the vast amount of material in the literature, the objective of this review was not to exhaust the subject, but rather to compile the information to facilitate and improve the understanding of those interested in this topic...
2017: Advances in Clinical Chemistry
Roby Sebastian, Todd Ratliff, Peter D Winch, Dmitry Tumin, Daniel Gomez, Joseph Tobias, Mark Galantowicz, Aymen N Naguib
BACKGROUND: The majority of allogeneic transfusions occur in the perioperative setting, especially during cardiac surgery. In addition to the economic implications, there is emerging evidence that blood transfusion may increase both morbidity and mortality. Acute normovolemic hemodilution (ANH) may limit the need for blood products. OBJECTIVES: The primary objective of this study was to determine if the method of blood collection (syringe or bag) during the ANH process impacted the platelet count and function...
January 2017: Paediatric Anaesthesia
Mohamed Khalifa, Ibrahim Zabani
Among the most common and chronic problems in the healthcare system worldwide is the crowding of emergency rooms (ER); leading to many serious complications. King Faisal Specialist Hospital and Research Center utilized health analytics methods to identify areas of deficiency and suggest potential improvements to ER performance. The project implemented solutions and monitored two indicators; ER length of stay (LOS), reflecting efficiency, and percentage of patients leaving without treatment, reflecting effectiveness of the ER...
November 2016: Journal of Infection and Public Health
Mohamed Khalifa, Ibrahim Zabani
Emergency Room (ER) performance has been a timely topic for both healthcare practitioners and researchers. King Faisal Specialist Hospital and Research Center, Saudi Arabia worked on developing a comprehensive set of KPIs to monitor, evaluate and improve the performance of the ER. A combined approach using quantitative and qualitative methods was used to collect and analyze the data. 34 KPIs were developed and sorted into the three components of the ER patient flow model; input, throughput and output. Input indicators included number and acuity of ER patients, patients leaving without being seen and revisit rates...
2016: Studies in Health Technology and Informatics
Ali Kemal Erenler, Sinan Akbulut, Murat Guzel, Halil Cetinkaya, Alev Karaca, Burcu Turkoz, Ahmet Baydin
OBJECTIVES: In this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED. METHODS: We analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined. RESULTS: A total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013...
June 2014: Turkish Journal of Emergency Medicine
Patrick Proctor, David Ryan King, Nicole M Fesel, Sara Y Narveson, William E Anderson, Laszlo Littmann
OBJECTIVES: Heart failure (HF) is associated with high mortality and frequent hospitalizations. Disease management programs (DMPs) have a favorable impact on patients with HF. No data exist regarding the outcomes of patients discharged from such a program. METHODS: We examined the outcome of patients with severe systolic HF who were discharged from a DMP following full clinical and echocardiographic recovery. Data were reviewed for mortality, emergency room visits, hospitalizations, medication adherence and left ventricular ejection fraction (EF)...
2015: Cardiology
Ibrahim M Abbass, Trudy M Krause, Salim S Virani, J Michael Swint, Wenyaw Chan, Luisa Franzini
BACKGROUND: Recent studies cast doubt about the economic efficiency of observation units (OUs). OBJECTIVE: We aimed to reexamine the cost savings of OUs compared with inpatient care. METHODS: Claims for 15,851 patients who were admitted to inpatient or OUs between January 2009 and December 2012 following emergency room (ER) visits for chest pain were retrospectively examined. The two groups were compared for total cost of episode, length of stay (LOS), and utilization rates of diagnostic procedures, including standard exercise and echocardiography stress tests, myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA), and computed tomography (CT) chest scans...
March 2015: Managed Care
Amanda C Schondelmeyer, Jeffrey M Simmons, Angela M Statile, Kelsey E Hofacer, Rebecca Smith, Lori Prine, Patrick W Brady
BACKGROUND AND OBJECTIVES: Clinicians commonly use continuous pulse oximetry (CPOx) for hospitalized children with respiratory illnesses. The Choosing Wisely initiative recommended discontinuing CPOx for children on room air. We used quality improvement methods to reduce time on CPOx in patients with wheezing. METHODS: Our project took place on 1 unit of a children's hospital. We developed consensus-based criteria for CPOx discontinuation. Interventions included education, a checklist used during nurse handoff, and discontinuation criteria incorporated into order sets...
April 2015: Pediatrics
Sylvie Cossette, Nancy Frasure-Smith, Alain Vadeboncoeur, Jane McCusker, Marie-Claude Guertin
BACKGROUND: As yet there is no firm evidence about the types of intervention that can reduce emergency room revisits. However, the literature on emergency room revisits suggests patient difficulties with managing their health problems and treatments after discharge may play a role. OBJECTIVES: We carried out a randomized trial of an emergency department-based nursing intervention, but results showed no reduction in revisits (primary outcome). This paper describes the secondary outcomes of the trial: patient perceptions of continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence 30 days after emergency room discharge...
March 2015: International Journal of Nursing Studies
M Bruce Edmonson, Jens C Eickhoff, Chong Zhang
OBJECTIVES: To describe the clinical spectrum and frequency of acute care revisits after tonsillectomy in a population-based sample from a single state in the US. STUDY DESIGN: We used California state discharge databases from 2009 to 2011 to retrospectively identify retrospectively routine tonsillectomy discharges in residents <25 years of age and to establish record linkage to revisits within 30 days at ambulatory surgery, inpatient, and emergency department facilities statewide...
March 2015: Journal of Pediatrics
John Hedley-Whyte, Debra R Milamed
The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC...
September 2014: Ulster Medical Journal
Ibrahim M Abbass, Salim S Virani, J Michael Swint, Wenyaw Chan, Luisa Franzini
BACKGROUND: Observation services are provided in greatly variant settings. The aim of this study was to reexamine the effectiveness of observation services compared to inpatient units for patients with nonspecific chest pain. HYPOTHESIS: Patients admitted to observation units have similar outcomes to patients admitted to inpatient wards. METHODS: We conducted a claim-based retrospective study for 7549 patients who were admitted to observation and inpatient units...
October 2014: Clinical Cardiology
F Lammens, N Lemkens, G Laureyns, W Lemmens, L Van Camp, P Lemkens
OBJECTIVE: To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER). METHODS: Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated. RESULTS: Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy...
2014: B-ENT
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