Emergency department patients who leave before treatment is complete
HEALTH facilities; CONFIDENCE intervals; DESCRIPTIVE statistics; MEDICAL cooperation; METROPOLITAN areas; RESEARCH; RETROSPECTIVE studies; PATIENTS; EMERGENCY medical services; LONGITUDINAL method; MEDICAL screening; MEDICAL appointments
Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system. Methods: This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit. Results: During the study period 626,548 ED visits occurred; 20,158 (3.2%) LBTC index encounters occurred, and 6745 (33.5%) returned within 30 days. The majority (41.7%) returned in <24 hours with 76.1% returning in 10 days and 66.4% returning to index ED. Median return time was 43.3 hours, and 23.2% were admitted. Urban community EDs had the highest 30-day return rate (37.8%, 95% confidence interval, 36.41-39.1). Patients categorized as LSBS had longer median return hours (66.0) and higher admission rates (29.8%) than the LWBS cohort. There was a net potential realization rate of $9.5 million to the healthcare system. Conclusion: In our system, LSBS patients had longer return times and higher admission rates than LWBS patients. There was significant potential financial impact for the system. Further studies should examine how healthcare systems can reduce risk and financial impacts of LBTC patients.
Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS
Western Journal Of Emergency Medicine
2021
2021-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.5811/westjem.2020.11.48427" target="_blank" rel="noreferrer noopener">10.5811/westjem.2020.11.48427</a>
Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients
Risk, stratification, patients, team, primary care, healthcare, high risk, care management
Risk stratification uses a mix of objective and subjective data to assign risk levels to patients. Practices can systematically use patient risk levels to make care management decisions, such as providing greater access and resources to patients in higher risk levels. Risk stratification helps practices to better focus on their sickest patients, reduce costs, and improve care.
James DomDera
Family Practice Management
2019
James DomDera
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="https://www.aafp.org/fpm/2019/0500/p21.html" target="_blank" rel="noreferrer noopener">https://www.aafp.org/fpm/2019/0500/p21.html</a><br /><br />Author's ORCID: <a href="https://orcid.org/0000-0002-8730-5610" target="_blank" rel="noreferrer noopener">https://orcid.org/0000-0002-8730-5610 </a><br /><br />PMID:<span> </span>31083868
Alcohol Use Disorder History Moderates The Relationship Between Avoidance Coping And Posttraumatic Stress Symptoms
accident survivors; administered ptsd scale; alcohol use disorder; avoidance coping; cue reactivity; drug-use; follow-up; major depression; patients; posttraumatic stress disorder (PTSD); Psychology; sexual assault survivors; social support; structured clinical interview; Substance Abuse; substance use disorder; Substance Abuse
Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration >= 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity.
Hruska B; Fallon W; Spoonster E; Sledjeski E M; Delahanty D L
Psychology of Addictive Behaviors
2011
2011-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1037/a0022439" target="_blank" rel="noreferrer noopener">10.1037/a0022439</a>
Altered Mental Status In Older Patients In The Emergency Department
agitation-sedation scale; cognitive impairment; Coma; confusion assessment method; critically-ill; Delirium; diagnosis; elderly; Emergency department; epidemiology; Geriatrics & Gerontology; glasgow coma scale; hospitalized-patients; intensive-care unit; length-of-stay; management; multicomponent geriatric intervention; patients; risk-factors; Stupor
Altered mental status is a common chief compliant among older patients in the emergency department (ED). Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. Although stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute changes in mental status the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple causes may exist concurrently.
Han J H; Wilber S T
Clinics in Geriatric Medicine
2013
2013-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.cger.2012.09.005" target="_blank" rel="noreferrer noopener">10.1016/j.cger.2012.09.005</a>
Clinical outcomes associated with conversion from epoetin alfa to darbepoetin alfa in hospitalized hemodialysis patients
anemia; anemia darbepoetin alfa; dialysis; disease; dose conversion; epoetin alfa; Health; hemodialysis; hospital; left-ventricular hypertrophy; mortality; patients; recombinant-human-erythropoietin; Urology & Nephrology
Background/Aims: Hemodialysis patients are often hospitalized, during which time they require continuity of care in the inpatient setting. The goal of the present study was to evaluate the clinical outcomes associated with a conversion algorithm from outpatient epoetin alfa to inpatient darbepoetin alfa in hospitalized hemodialysis patients at the St. Elizabeth Health Center. Methods: We conducted a retrospective chart review of hemodialysis patient hospital admissions after a therapeutic interchange from epoetin alfa to darbepoetin alfa was implemented at St. Elizabeth Health Center. Chronic hemodialysis patients admitted from December 2002 to October 2003 were identified as part of a therapeutic interchange cohort receiving inpatient darbepoetin alfa after conversion from outpatient epoetin alfa according to the Aranesp((R)) package insert during their hospitalization. After discharge, these patients were returned to their preadmission outpatient epoetin alfa dosages and frequencies. Patients admitted prior to implementation of the therapeutic interchange (January 2002 to April 2002) received epoetin alfa during hospitalization and served as a historical control. Hemoglobin values were recorded prior to hospital admission, at the time of discharge, and 30 days after discharge. Results: Mean hemoglobin levels declined from preadmission to discharge, in both the interchange and historical cohorts (6.6 and 2.5%, respectively) and rebounded at 30 days after discharge. Using a linear regression model, the only variables significantly associated with the hemoglobin level at discharge were the hemoglobin level before admission and receipt of a blood transfusion. Conclusion: An algorithm-based conversion from outpatient epoetin alfa to inpatient darbepoetin alfa for hospitalized chronic hemodialysis patients utilizing the dose conversion table specified in the Aranesp((R)) package insert is associated with hemoglobin outcomes similar to inpatient epoetin alfa. Copyright (c) 2006 S. Karger AG, Basel.
Sarac E; Chikyarappa A; Sabol B; Gemmel D; Globe D; Barlev A; Audhya P
American Journal of Nephrology
2006
2006
Journal Article
<a href="http://doi.org/10.1159/000098027" target="_blank" rel="noreferrer noopener">10.1159/000098027</a>
Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan
benefit; brain-injury; follow-up; intracranial injury; management; moderate; patients; serial computed-tomography; Surgery; utility
BACKGROUND: Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. STUDY DESIGN: Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. RESULTS: There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 +/- 22.5 years vs NPG, 45.2 +/- 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 +/- 8.1 vs NPG, 17.9 +/- 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 +/- 3.5 vs NPG, 10.9 +/- 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95% CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). CONCLUSIONS: Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted. (J Am Coll Surg 2012;214:965-972. (C) 2012 by the American College of Surgeons)
Muakkassa F F; Marley R A; Paranjape C; Horattas E; Salvator A; Muakkassa K
Journal of the American College of Surgeons
2012
2012-06
Journal Article
<a href="http://doi.org/10.1016/j.jamcollsurg.2012.02.004" target="_blank" rel="noreferrer noopener">10.1016/j.jamcollsurg.2012.02.004</a>
The consultation and referral process.
PATIENTS; PRIMARY care; PRACTICE of medicine; MEDICAL care; MEDICAL consultation; PHYSICIANS (General practice)
BACKGROUND. Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS. The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS. Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS. Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process. [ABSTRACT FROM AUTHOR]
Bourguet Claire; Gilchrist Valerie; McCord Gary
Journal of Family Practice
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Patients’ reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion.
PATIENTS; TOTAL knee replacement; HEALTH outcome assessment; KNEE surgery; POSTOPERATIVE pain; RANGE of motion of joints
The present study examines the reasons cited by 103 patients for their electing to undergo total knee arthroplastic surgery and the relationship between these reasons and their post-operative pain and range of motion. Results suggest that individuals who describe different reasons for undergoing surgery vary in their post-operative recovery. Specifically, patients who cite pain as the reason they are undergoing surgery report greater levels of pain during the early post-operative period. In contrast, patients who describe goals of regaining mobility or a specific activity as their reason for undergoing surgery achieve a greater range of motion during early post-operative physical therapy. Individuals who express avoidance goals for undergoing total knee arthroplasty report more severe post-operative pain at 1 and 3 months following surgery compared to patients who express approach goals. Interventions targeted towards patients reporting pre-operative pain or avoidance goals may decrease subsequent post-operative pain and increase mobility. [ABSTRACT FROM AUTHOR]
Cremeans-Smith Julie K; Boarts Jessica M; Greene Kenneth; Delahanty Douglas L
Journal of Behavioral Medicine
2009
2009-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s10865-008-9191-2" target="_blank" rel="noreferrer noopener">10.1007/s10865-008-9191-2</a>
A practical guide for protecting personnel, pregnant personnel, and patients during diagnostic radiography and fluoroscopy.
Female; Humans; Pregnancy; United States; Workforce; *Safety; Film Dosimetry; Fluoroscopy/*adverse effects; Occupational Exposure/*prevention & control; Patients; Protective Devices; Radiation Protection/*methods; Radiography/*adverse effects; Hospital/*organization & administration; Women; Radiology Department; Working
The following article presents a comprehensive overview of the practical aspects of radiation protection for diagnostic radiology. The topics discussed include background radiation levels, typical exposure levels for radiologic technologists, risk estimates, the relationship between dose and effect, dose limits, personnel monitoring, protective devices, gonadal shielding, and the immobilization of patients. Special attention has been given to the concerns of pregnant personnel and pregnant patients.
Starchman D E; Hedrick W R
Radiology management
1993
1905-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The ethics of HIV testing and disclosure for healthcare professionals: what do our future doctors think?
Adult; Female; Humans; Male; Adolescent; Young Adult; United States; Focus Groups; Health Personnel; Health Care Surveys; Students; Anonymous Testing/ethics; Disclosure/*ethics; HIV Seropositivity/*diagnosis; Patients; Human; Thematic Analysis; Interviews; Student Attitudes; Truth Disclosure; Audiorecording; Medical; Medical/*psychology; Health Screening; Attitude to Illness; Mandatory Testing; Privacy and Confidentiality; HIV Infections – Diagnosis; HIV Infections – Ethical Issues
AIM: This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure. METHOD: A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author. RESULTS: Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals. CONCLUSION: This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.
Aultman Julie M; Borges Nicole J
Medical teacher
2011
2011
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/0142159X.2011.530311" target="_blank" rel="noreferrer noopener">10.3109/0142159X.2011.530311</a>
Buprenorphine Exposures Among Children and Adolescents Reported to US Poison Control Centers.
Young Adult; Child; Infant; United States; Odds Ratio; Patient Admission; Human; Adolescence; Preschool; BUPRENORPHINE; HOSPITAL admission & discharge; ODDS ratio; PATIENTS; POISON control centers; SUBSTANCE abuse; UNITED States; Buprenorphine – Poisoning – United States; Buprenorphine – Therapeutic Use; BUPRENORPHINE – Therapeutic use; Poison Control Centers – United States; Substance Use Disorders – Drug Therapy
OBJECTIVE: To investigate buprenorphine exposures among children and adolescents
Post Sara; Spiller Henry A; Casavant Marcel J; Chounthirath Thitphalak; Smith Gary A
Pediatrics
2018
2018-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1542/peds.2017-3652" target="_blank" rel="noreferrer noopener">10.1542/peds.2017-3652</a>
Cardiovascular Magnetic Resonance Imaging-Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study.
Cardiac-Gated Imaging Techniques; Cardiovascular Diseases – Diagnosis; Clinical Effectiveness; clinical impact; Cost Benefit Analysis; Cost Savings; Descriptive Statistics; Health Care Costs – Evaluation; Human; Magnetic resonance imaging; Magnetic Resonance Imaging – Evaluation; Outcome Assessment; Patients; Quality of Health Care; Retrospective Design
BACKGROUND: This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS: Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. CONCLUSIONS: Cardiovascular magnetic resonance imaging provides diagnostic image quality in \textgreater98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner.
Hegde Vinayak A; Biederman Robert Ww; Mikolich J Ronald
Clinical Medicine Insights. Cardiology
2017
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1179546817710026" target="_blank" rel="noreferrer noopener">10.1177/1179546817710026</a>
Optimal older adult emergency care: Introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
*Practice Guidelines as Topic; Aged; AMERICAN College of Emergency Physicians; AMERICAN Geriatrics Society; ELDER care; EMERGENCY medical services; EMERGENCY medical services – Standards; EMERGENCY medicine; Emergency Medicine – Standards; Emergency Medicine/*standards; EMERGENCY Nurses Association; Emergency Service; Emergency Service – Standards; GERIATRICS; Geriatrics – Standards; Geriatrics/*standards; HEALTH care teams; Hospital/standards; Humans; Interdisciplinary Communication; Interprofessional Relations; Medical; Medical Organizations; MEDICAL protocols; OLD age; PATIENTS; Practice Guidelines; QUALITY assurance; Societies; SOCIETY for Academic Emergency Medicine (U.S.); United States
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Annals of emergency medicine
2014
2014-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.annemergmed.2014.03.002" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2014.03.002</a>