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1.
Background
Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS.Methods
We performed a retrospective analysis of all patients < 18 years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables.Results
Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p = 0.37). Mean ED LOS was 209 min shorter for TA patients (148 min vs. 357 min, p = 0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference ?198 min, p = 0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p < 0.001).Conclusions
Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization. 相似文献2.
Lee M. Flowers Kayse T. Maass Gabrielle J. Melin Ronna L. Campbell Paul J. Novotny Jessica J. Westphal David M. Nestler Kalyan S. Pasupathy 《The American journal of emergency medicine》2018,36(11):2029-2034
Objective
Psychiatric patient boarding in emergency department (ED) is a severe and growing problem. In July 2013, Minnesota implemented a law requiring jailed persons committed to state psychiatric facilities be transferred within 48-h of commitment. This study aims to quantify the effect of this law on a large ED's psychiatric patient flow.Methods
A pre- and post- comparison of 2011–2015 ED length of stay (LOS) for adult psychiatric patients was performed using electronic medical record data. Comparisons of the median LOS were assessed using a segmented regression model with time series error, and risk differences (RD) were used to determine changes in the proportion of patients with LOS ≥3 and ≥5 days. Changes in patient disposition proportions were assessed using risk ratios.Results
The median ED LOS for patients admitted for psychiatric care increased by 5.22 h from 2011 to 2015 (95% CI: (4.33, 7.15)), while the frequency of patient encounters remained constant. Although no significant difference in the rate of ED LOS increase was found pre- and post- implementation, the proportion of adults with LOS ≥3 days and ≥15 days increased (RD 0.017 (95% CI: (0.013, 0.021)); 0.002 (95% CI: (0.001,0.004)), respectively).Conclusions
The proportion of ED adult psychiatric patients experiencing prolonged LOS increased following the implementation of a statewide law requiring patients committed through the criminal justice system be transferred to a state psychiatric hospital within 48 h. Identifying characteristics of subsets of psychiatric patients disproportionally affected could suggest focused healthcare system improvements to improve ED psychiatric care. 相似文献3.
4.
Suprat Saely Wilson Gregory M. Kwiatkowski Scott R. Millis John D. Purakal Arushi P. Mahajan Phillip D. Levy 《The American journal of emergency medicine》2017,35(1):126-131
Objectives
The purpose of this study was to compare health care resource utilization among patients who were given intravenous nitroglycerin for acute heart failure (AHF) in the emergency department (ED) by intermittent bolus, continuous infusion, or a combination of both.Methods
We retrospectively identified 395 patients that received nitroglycerin therapy in the ED for the treatment of AHF over a 5-year period. Patients that received intermittent bolus (n = 124) were compared with continuous infusion therapy (n = 182) and combination therapy of bolus and infusion (n = 89). The primary outcomes were the frequency of intensive care unit (ICU) admission and hospital length of stay (LOS).Results
On unadjusted analysis, rates of ICU admission were significantly lower in the bolus vs infusion and combination groups (48.4% vs 68.7% vs 83%, respectively; P < .0001) and median LOS (interquartile range) was shorter (3.7 [2.5-6.2 days]) compared with infusion (4.7 [2.9-7.1 days]) and combination (5.0 [2.9-6.7 days]) groups; P = .02. On adjusted regression models, the strong association between bolus nitroglycerin and reduced ICU admission rate remained, and hospital LOS was 1.9 days shorter compared with infusion therapy alone. Use of intubation (bolus [8.9%] vs infusion [8.8%] vs combination [16.9%]; P = .096) and bilevel positive airway pressure (bolus [26.6%] vs infusion [20.3%] vs combination [29.2%]; P = .21) were similar as was the incidence of hypotension, myocardial injury, and worsening renal function.Conclusions
In ED patients with AHF, intravenous nitroglycerin by intermittent bolus was associated with a lower ICU admission rate and a shorter hospital LOS compared with continuous infusion. 相似文献5.
Michael A. Downes James K. Balshaw Tracy M. Muscat Nicole Ritchie Geoffrey K. Isbister 《The American journal of emergency medicine》2017,35(5):764-768
Objectives
This was a before and after study which sought to assess the impact of opening an ED short stay unit (ESSU) on the ED performance of poisoned patients.Methods
Data was collected from two groups of adult patients presenting to an ED with a tertiary referral inpatient Toxicology unit from the 2009 and 2012 calendar years, to assess the impact of the ESSU. The toxicology unit clinical database and hospital electronic medical records were interrogated for demographic, clinical and hospital flow details of presentations. The primary outcome was ED length of stay (LOS). Other outcomes included proportion of patients remaining in ED for their admission, 28 day re-presentations and hospital LOS.Results
During 2009, 795 patients met inclusion criteria, and during 2012, 762. The median LOS in ED was reduced from 8.5 h (IQR: 4.7–14 h) to 2.7 h (IQR: 1.6–4.6; p < 0.0001). The proportion of patients remaining in ED for their entire hospital stay was reduced from 515/795 (65%) to 56/762 (7.3%) [Absolute difference: 57%; 95% CI: 53 to 62%; p < 0.0001]. Total hospital LOS increased from 14.5 h (IQR: 8.4–21.8 h) to 16.7 h (IQR: 11.5–23; p < 0.0001), but there was a decrease in re-presentations with self-poisoning within 28 days from 6.9% in 2009 to 4.5% in 2012 (p < 0.038). There was no difference between disposition destination or toxins causing exposure between the two groups.Conclusions
The ESSU led to a significant improvement in ED performance of poisoned patients. It also potentially assisted in reducing ED overcrowding. 相似文献6.
Lauren R. Klein Brian E. Driver James R. Miner Marc L. Martel Jon B. Cole 《The American journal of emergency medicine》2018,36(7):1209-1214
Background
Emergency Department (ED) encounters for ethanol intoxication are becoming increasingly common. The purpose of this study was to explore factors associated with ED length of stay (LOS) for ethanol intoxication encounters.Methods
This was a multi-center, retrospective, observational study of patients presenting to the ED for ethanol intoxication. Data were abstracted from the electronic medical record. To explore factors associated with ED LOS, we created a mixed-effects generalized linear model.Results
We identified 18,664 eligible patients from 6 different EDs during the study period (2012–2016). The median age was 37 years, 69% were male, and the median ethanol concentration was 213 mg/dL. Median LOS was 348 min (range 43–1658). Using a mixed-effects generalized linear model, independent variables associated with a significant increase in ED LOS included use of parenteral sedation (beta = 0.30, increase in LOS = 34%), laboratory testing (beta = 0.21, increase in LOS = 23%), as well as the hour of arrival to the ED, such that patients arriving to the ED during evening hours (between 18:00 and midnight) had up to an 86% increase in LOS. Variables not significantly associated with an increase in LOS included age, gender, ethanol concentration, psychiatric disposition, using the ED frequently for ethanol intoxication, CT use, and daily ED volume.Conclusion
Variables such as diagnostic testing, treatments, and hour of arrival may influence ED LOS in patients with acute ethanol intoxication. Identification and further exploration of these factors may assist in developing hospital and community based improvements to modify LOS in this population. 相似文献7.
Implementation of Alere i Influenza A & B point of care test for the diagnosis of influenza in an ED
E. Trabattoni V. Le B. Pilmis G. Pean de Ponfilly C. Caisso C. Couzigou B. Vidal A. Mizrahi O. Ganansia A. Le Monnier B. Lina J.C. Nguyen Van 《The American journal of emergency medicine》2018,36(6):916-921
8.
A pilot mobile integrated healthcare program for frequent utilizers of emergency department services
Vicki A. Nejtek Subhash Aryal Deepika Talari Hao Wang Liam O&#x;Neill 《The American journal of emergency medicine》2017,35(11):1702-1705
Purpose
To examine whether or not a mobile integrated health (MIH) program may improve health-related quality of life while reducing emergency department (ED) transports, ED admissions, and inpatient hospital admissions in frequent utilizers of ED services.Methods
A small retrospective evaluation assessing pre- and post-program quality of life, ED transports, ED admissions, and inpatient hospital admissions was conducted in patients who frequently used the ED for non-emergent or emergent/primary care treatable conditions.Results
Pre- and post-program data available on 64 program completers are reported. Of those with mobility problems (n = 42), 38% improved; those with problems performing usual activities (N = 45), 58% reported improvement; and of those experiencing moderate to extreme pain or discomfort (N = 48), 42% reported no pain or discomfort after program completion. Frequency of ED transports decreased (5.34 ± 6.0 vs. 2.08 ± 3.3; p < 0.000), as did ED admissions (9.66 ± 10.2 vs. 3.30 ± 4.6; p < 0.000), and inpatient hospital admissions (3.11 ± 5.5 vs. 1.38 ± 2.5; p = 0.003).Conclusion
Results suggest that MIH participation is associated with improved quality of life, reduced ED transports, ED admissions, and inpatient hospital admissions. The MIH program may have potential to improve health outcomes in patients who are frequent ED users for non-emergent or emergent/primary care treatable conditions by teaching them how to proactively manage their health and adhere to therapeutic regimens. Programmatic reasons for these improvements may include psychosocial bonding with participants who received in-home care, health coaching, and the MIH team's 24/7 availability that provided immediate healthcare access. 相似文献9.
Nancy L. Dawson Christian Lachner Tyler F. Vadeboncoeur Michael J. Maniaci Veronica Bosworth Teresa A. Rummans Archana Roy M. Caroline Burton 《The American journal of emergency medicine》2018,36(3):392-395
Background
Violence against health care workers has been increasing. Health care workers in emergency departments (EDs) are highly vulnerable because they provide care for patients who may have mental illness, behavioral problems, or substance use disorders (alone or in combination) and who are often evaluated during an involuntary hold. Our objective was to identify factors that may be associated with violent behavior in ED patients during involuntary holds.Methods
Retrospective review of patients evaluated during an involuntary hold at a suburban acute care hospital ED from January 2014 through November 2015.Results
Of 251 patients, 22 (9%) had violent incidents in the ED. Violent patients were more likely to have a urine drug screen positive for tricyclic antidepressants (18.2% vs 4.8%, P = 0.03) and to present with substance misuse (68.2% vs 39.7%, P = 0.01), specifically with marijuana (22.7% vs 9.6%, P = 0.06) and alcohol (54.5% vs 24.9%, P = 0.003). ED readmission rates were higher for violent patients (18.2% vs 3.9%, P = 0.02). No significant difference was found between violent patients and nonviolent patients for sex, race, marital status, insurance status, medical or psychiatric condition, reason for involuntary hold, or length of stay.Conclusion
Violent behavior by patients evaluated during an involuntary hold in a suburban acute care hospital ED was associated with tricyclic antidepressant use, substance misuse, and higher ED readmission rates. 相似文献10.
Kito Lord Vivek Parwani Andrew Ulrich Emily B. Finn Craig Rothenberg Beth Emerson Alana Rosenberg Arjun K. Venkatesh 《The American journal of emergency medicine》2018,36(7):1246-1248
Objective
Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality.Method
We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015. This study was conducted in an urban, academic hospital with an annual adult ED census over 90,000. We defined boarding as patients with greater than 4 h from ED bed order to ED departure to hospital ward. The primary outcome was a composite of adverse outcomes in the first 24 h of admission, including RRT activation, care escalation to intensive care, or in-hospital mortality.Results
A total of 31,426 patient encounters were included of which 3978 (12.7%) boarded in the ED for 4 h or more. Adverse outcomes occurred in 1.92% of all encounters. Comparing boarded vs. non-boarded patients, 41 (1.03%) vs. 244 (0.90%) patients experienced a RRT activation, 53 (1.33%) vs. 387 (1.42%) experienced a care escalation, and 1 (0.03%) vs.12 (0.04%) experienced unanticipated in-hospital death, within 24 h of ED admission. In unadjusted analysis, there was no difference in the composite outcome between boarding and non-boarding patients (1.91% vs. 1.91%, p = 0.994). Regression analysis adjusted for patient demographics, acuity, and comorbidities also showed no association between boarding and the primary outcome. A sensitivity analysis showed an association between ED boarding and the composite outcome inclusive of the entire inpatient hospital stay (5.8% vs. 4.7%, p = 0.003).Conclusion
Within the first 24 h of hospital admission to a general medicine service, adverse hospitalization outcomes are rare and not associated with ED boarding. 相似文献11.
Sangil Lee Karisa K. Harland Morgan Bobb Swanson Sara Lawson Elijah Dahlstrom Lance Clemson Elaine Himadi 《The American journal of emergency medicine》2018,36(11):1967-1974
Objectives
Among emergency department (ED) mental health and substance abuse (MHSA) patients, we sought to compare mortality and healthcare utilization by ED discharge disposition and inpatient bed request status.Methods
A retrospective cohort study of 492 patients was conducted at a single University ED. We reviewed three groups of MHSA patients including ED patients that were admitted, ED patients with a bed request that were discharged from the ED, and ED patients with no bed request that were discharged from the ED. We identified main outcomes as ED return visit, re-hospitalization and mortality within 12 months based on chart review and reference from the National Death Index.Results
The average age of patients presenting was 30.5 (SD16.4) years and 251 (51.0%) were female patients. Of these patients, 216 (43.9%) presented with mood disorder and 93 (18.9%) with self-harm. The most common reason for discharge from the ED after an admission request was placed was from stabilization of the patient (n = 138). An ED revisit within 12 months was significantly higher among patients discharged who had a bed request in place prior to departure (54.0%, p < 0.001), than those discharged from the ED (40.9%) or admitted to inpatient care (30.5%). The rate of suicide attempt and death did not show statistical significance (p = 0.55 and p = 0.88).Conclusion
MHSA patients who were discharged from ED after bed requests were placed were at greater risk for return visits to the ED. This implicates that these patients require outpatient planning to prevent further avoidable healthcare utilization. 相似文献12.
Ryan M. Gardner Nathan A. Friedman Michael Carlson Tamala S. Bradham Tyler W. Barrett 《The American journal of emergency medicine》2018,36(1):124-127
Background
Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput.Methods
This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area. We trialed the intervention from 1100–2300 on weekdays from January 13–26, 2016. Adult patients who were not likely to require intensive evaluations were eligible. Primary outcomes were throughput measures including: time to provider, ED length of stay (LOS), and LWBS. Pre- and post-intervention metrics were compared using the Mann-Whitney U test, given the non-normal distribution of the metrics.Results
The NP evaluated 120 patients of which 101 (84%) were discharged, 3 (2.5%) admitted, and 16 (13%) required more intense evaluation. Time to provider decreased from a median (IQR) of 42 (16, 114) to 27 (12.4, 81.5) minutes (p < 0.01) and ED LOS from 290 (194.8, 405.6) to 257 (171.2, 363.4) minutes (p < 0.01) for all patients not admitted and not requiring a consult. LWBS decreased from a pre-trial 4.6% to 2.2% (p < 0.01).Conclusion
The revised triage intervention was associated with improvements in several ED throughput metrics and a reduction in LWBS. 相似文献13.
R. Andrew Taylor Arjun Venkatesh Vivek Parwani Sharon Chekijian Marc Shapiro Andrew Oh David Harriman Asim Tarabar Andrew Ulrich 《The American journal of emergency medicine》2018,36(9):1534-1539
Background
Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights.Objectives
To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding.Methods
Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017. Times series were visualized through decompositional techniques accounting for seasonal trends, to determine the effect of boarding on ED performance metrics and to determine the impact of boarding “shocks” to the system on operational metrics over several days.Results
There were 226,461 visits with the mean (IQR) number of visits per day was 273 (258–291). Decomposition of the boarding count time series illustrated an upward trend in the last 2–3 quarters as well as clear seasonal components. All performance metrics were significantly impacted (p < 0.05) by boarding count, except for overall Press Ganey scores (p < 0.65). For every additional increase in boarder count, overall length-of-stay (LOS) increased by 1.55 min (0.68, 1.50). Smaller effects were seen for waiting room LOS and treat and release LOS. The impulse responses indicate that the boarding shocks are characterized by changes in the performance metrics within the first day that fade out after 4–5 days.Conclusion
In this study regarding the use of advanced analytics in daily ED operations, time series analysis provided multiple useful insights into boarding and its impact on performance metrics. 相似文献14.
Jennica Siddle Peter S. Pang Christopher Weaver Elizabeth Weinstein Daniel O&#x;Donnell Thomas P. Arkins Charles Miramonti 《The American journal of emergency medicine》2018,36(5):843-845
Background
Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery.Study objective
To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization.Methods
This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after.Results
Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11).Conclusion
In this pilot before/after study, MIH significantly reduces acute care hospitalizations. 相似文献15.
Stacy A. Trent Michael A. Johnson Erica A. Morse Edward P. Havranek Jason S. Haukoos 《The American journal of emergency medicine》2018,36(8):1397-1404
Objectives
Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence.Methods
Design: Retrospective study at 3 hospitals in Colorado using standard medical record review. Population: Consecutive adults (≥ 18) hospitalized for acute coronary syndrome (ACS), ST-elevation myocardial infarction (STEMI), or acute ischemic stroke (AIS), who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. Outcome: ED adherence to the CPG (primary); in-hospital mortality and length-of-stay (secondary). Analysis: Multivariable logistic regression using generalized estimating equations was used.Results
Among 1053 patients, ED care was adherent in 84% with significant differences in adherence between CPGs (p < 0.001) and across institutions (p = 0.04). When patients presented with atypical chief complaints, the odds of receiving adherent care was 0.6 (95% CI 0.4–0.9). When the primary ED diagnosis was associated but not specific to the CPG, the odds of receiving adherent care was 0.5 (95% CI 0.3–0.9) and 0.3 (95% CI 0.2–0.5) for unrelated primary diagnoses.Conclusions
Adherence to ED CPGs for ACS, STEMI and AIS differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician. 相似文献16.
17.
Sarah Jorgensen Mira Zurayk Samantha Yeung Jill Terry Maureen Dunn Paul Nieberg Annie Wong-Beringer 《The American journal of emergency medicine》2018,36(1):12-17
Background
Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI.Methods
A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30 days (ERVs).Results
We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72 h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P < 0.05) in patients with the following: age ≥ 65 years; pregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature ≥ 38 °C heart rate > 100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible).Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P = 0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P = 0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; P < 0.05).Conclusions
ERV in UTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. 相似文献18.
Chih-Chia Hsieh Ching-Chi Lee Hsiang-Chin Hsu Hsin-I Shih Chien-Hsin Lu Chih-Hao Lin 《The American journal of emergency medicine》2017,35(1):39-44
Background/Purpose
To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).Methods
This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively.Results
For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05).Conclusions
For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation. 相似文献19.
Robert E. Molokie Chariz Montminy Corissa Dionisio Muhammad Ahmen Farooqui Michel Gowhari Yingwei Yao Marie L. Suarez Miriam O. Ezenwa Judith M. Schlaeger Zaijie J. Wang Diana J. Wilkie 《The American journal of emergency medicine》2018,36(1):88-92
Background
Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay.Methods
In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay.Findings
Pain on admission to the ED averaged 8.7 ± 1.5 and to the ACU averaged 8.0 ± 1.6. The average pain on discharge from the ED was 6.4 ± 3.0 and for the ACU was 4.5 ± 2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted.Conclusions
Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions. 相似文献20.
Gregory Gafni-Pappas Susanne D. DeMeester Michael A. Boyd Arun Ganti Adam M. Nicholson Jeremy Albright Juan Wu 《The American journal of emergency medicine》2018,36(10):1825-1831
