Evaluating a Novel Prehospital Emergency Trauma Care Assessment Tool (PETCAT) for Low‐ and Middle‐Income Countries in Sierra Leone
Peter G. DelaneyZachary J. EisnerAlfred H. ThullahBenjamin D. MullerKpawuru SandyPhilip S. BoonstraJohn W. ScottKrishnan Raghavendran
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We hypothesized that an emergency short-stay ward (ESSW) mainly operated by emergency medicine physicians may reduce the length of patient stay in emergency department without expense of clinical outcomes.We retrospectively analysed adult patients who visited the emergency department of the study hospital and were subsequently admitted to wards from 2017 to 2019. We divided study participants into three groups: patients admitted to ESSW and treated by the department of emergency medicine (ESSW-EM), patients admitted to ESSW and treated by other departments (ESSW-Other) and patients admitted to general wards (GW). The co-primary outcomes were ED length of stay and 28-day hospital mortality.In total, 29,596 patients were included in the study, and 8,328 (31.3%), 2,356 (8.9%), and 15,912 (59.8%) of them were classified as ESSW-EM, ESSW-Other and GW groups, respectively. The ED length of stay of the ESSW-EM (7.1 h ± 5.4) was shorter than those of the ESSW-Other (8.0 ± 6.2, P < 0.001) and the GW (10.2 ± 9.8, P < 0.001 for both). Hospital mortality of ESSW-EM (1.9%) was lower than that of GW (4.1%, P < 0.001). In the multivariable linear regression analysis, the ESSW-EM was independently associated with shorter ED length of stay compared with the both ESSW-Other (coefficient, 1.08; 95% confidence interval, 0.70-1.46; P < 0.001) and GW (coefficient, 3.35; 95% confidence interval, 3.12-3.57; P < 0.001). In the multivariable logistic regression analyses, the ESSW-EM was independently associated with lower hospital mortality compared with both the ESSW-Other group (adjusted P = 0.030) and the GW group (adjusted P < 0.001).In conclusion, the ESSW-EM was independently associated with shorter ED length of stay compared with both the ESSW-Other and the GW in the adult ED patients. Independent association was found between the ESSW-EM and lower hospital mortality compared with the GW.
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Importance
Unscheduled short-term return visits to the emergency department (ED) are increasingly monitored as a hospital performance measure and have been proposed as a measure of the quality of emergency care.Objective
To examine in-hospital clinical outcomes and resource use among patients who are hospitalized during an unscheduled return visit to the ED.Design, Setting, and Participants
Retrospective analysis of adult ED visits to acute care hospitals in Florida and New York in 2013 using data from the Healthcare Cost and Utilization Project. Patients with index ED visits were identified and followed up for return visits to the ED within 7, 14, and 30 days.Exposures
Hospital admission occurring during an initial visit to the ED vs during a return visit to the ED.Main Outcomes and Measures
In-hospital mortality, intensive care unit (ICU) admission, length of stay, and inpatient costs.Results
Among the 9 036 483 index ED visits to 424 hospitals in the study sample, 1 758 359 patients were admitted to the hospital during the index ED visit. Of these patients, 149 214 (8.5%) had a return visit to the ED within 7 days of the index ED visit, 228 370 (13.0%) within 14 days, and 349 335 (19.9%) within 30 days, and 76 151 (51.0%), 122 040 (53.4%), and 190 768 (54.6%), respectively, were readmitted to the hospital. Among the 7 278 124 patients who were discharged during the index ED visit, 598 404 (8.2%) had a return visit to the ED within 7 days, 839 386 (11.5%) within 14 days, and 1 205 865 (16.6%) within 30 days. Of these patients, 86 012 (14.4%) were admitted to the hospital within 7 days, 121 587 (14.5%) within 14 days, and 173 279 (14.4%) within 30 days. The 86 012 patients discharged from the ED and admitted to the hospital during a return ED visit within 7 days had significantly lower rates of in-hospital mortality (1.85%) compared with the 1 609 145 patients who were admitted during the index ED visit without a return ED visit (2.48%) (odds ratio, 0.73 [95% CI, 0.69-0.78]), lower rates of ICU admission (23.3% vs 29.0%, respectively; odds ratio, 0.73 [95% CI, 0.71-0.76]), lower mean costs ($10 169 vs $10 799; difference, $629 [95% CI, $479-$781]), and longer lengths of stay (5.16 days vs 4.97 days; IRR, 1.04 [95% CI, 1.03-1.05]). Similar outcomes were observed for patients returning to the ED within 14 and 30 days of the index ED visit. In contrast, patients who returned to the ED after hospital discharge and were readmitted had higher rates of in-hospital mortality and ICU admission, longer lengths of stay, and higher costs during the repeat hospital admission compared with those admitted to the hospital during the index ED visit without a return ED visit.Conclusions and Relevance
Compared with adult patients who were hospitalized during the index ED visit and did not have a return visit to the ED, patients who were initially discharged during an ED visit and admitted during a return visit to the ED had lower in-hospital mortality, ICU admission rates, and in-hospital costs and longer lengths of stay. These findings suggest that hospital admissions associated with return visits to the ED may not adequately capture deficits in the quality of care delivered during an ED visit.Hospital admission
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Emergency Department overcrowding with admitted inpatients is a common international occurrence. We undertook a retrospective review to compare patient admission rates from patients presenting to our Emergency Department with the level of overcrowding with admitted inpatients on that particular day in the Emergency Department. Over the 2-year study period there was no change in the rate or absolute number of admissions per day compared with the level of inpatient overcrowding.
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Wild mushroom poisoning (MP) is an important medical emergency that may have bad clinical outcome. We aimed to evaluate the clinical and laboratory features of patients with wild MP admitted to our emergency department in the Central Black Sea Region and to inform the emergency department physicians about early diagnosis and management of wild MP in the light of obtained data.
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In the Boarders in the Emergency Department (BED) study the impact of overcrowding due to boarders on patients' mortality and the likelihood of being diagnosed with methicillin resistant Staphylococcus aureus (MRSA) during admission was examined. With regard to efficiency, the impact of overcrowding on the time to first medical assessment for admitted patients, the number of patients leaving without being seen, and the rate of admission as a percentage of total emergency department attendances was explored.The retrospective cohort analysis study of all emergency department admissions was performed using information accessed via the Diver Solution. The software integrated information from several databases.The average number of patients awaiting hospital admission in the emergency department at 09:00 was 20.4 (range 0-45). The average duration of stay in the emergency department following the decision to admit was 16.1 h (range 0-161 h). The number who did not wait (DNW) to be seen was strongly correlated with the time waiting for medical assessment, which in turn was correlated with the total number of attendances to the emergency department (p<0.001). The elderly waited longer for admission and had the highest mortality and the highest chance of being diagnosed with MRSA during their overall admission.It is wrong for patients who are sick enough to require admission to hospital to be kept in the emergency department, and the entire health system must respond to their plight.
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