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EMERGENCY DEPARTMENT: Use of home-based care

Just over half of the 682 emergency physicians who responded to this 2015 survey indicated that they have chosen home-based care options (overseen by a nurse or physician) instead of observation stays or inpatient admissions for elderly patients who visit the emergency department.  This is not a frequent occurrence  – the majority of ED physicians reported doing this for 5 or fewer patients per month.  The most common barrier to home-based care after an ED visit was reported to be the sense of an unsafe or unstable environment at home.  Patients who were recommended most frequently for home-based care had these diseases or conditions:

  • cellulitis
  • urinary tract infection
  • diabetes
  • pneumonia, community acquired

Note: This is a medical journal article reporting the results of a survey.  The authors are with West Health Institute (La Jolla, CA) and UC San Diego Medical Center.

Source: Stuck, A.R., and others. (2017, November). National survey of emergency physicians concerning home-based care options as alternatives to emergency department-based hospital admissions. The Journal of Emergency Medicine, 53(5), 623-628.  Click here for free full text: http://www.jem-journal.com/article/S0736-4679(17)30488-2/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EDs: What markets are more likely to have freestanding emergency departments [FSEDs]?

For hospital administrators, this research suggests that FSEDs are a practical strategic tool for expanding markets.”

Characteristics of health service areas in which hospitals are more likely to offer freestanding emergency departments (FSEDs) were studied based on data from 14 states during the period 2002 to 2011.

Market Characteristics: More Likely to Find FSEDs

  • Higher income
  • Younger and growing population
  • More specialists
  • More intense competition
  • Presence of other freestanding emergency departments
  • Higher market penetration rates for Medicare managed care

The study also drew conclusions about the characteristics of hospitals that are more likely to provide freestanding emergency departments.

Source: Patidar, N., and others. (2017, July-September). Contextual factors associated with hospitals’ decision to operate freestanding emergency departments. Health Care Management Review, 42(3), 269-279. Click here for publisher’s website http://journals.lww.com/hcmrjournal/Abstract/2017/07000/Contextual_factors_associated_with_hospitals_.9.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY DEPARTMENTS: New capacity metric finds 6 ED beds per 10,000 ED visits in California hospitals

Our novel metrics capturing both supply of beds and visit demand demonstrate that recent trends of hospital supply may be insufficient to keep pace with growing ED patient demand and evolving, complex medical conditions.”

The change in supply of emergency department facilities and in demand for emergency care in California hospitals from 2005 to 2014 was studied using data from the California Office of Statewide Health Planning and Development (OSHPD).  The total number of ED visits in California increased by about one-third over this ten-year period, reaching a total of over 13 million visits in 2015, or 342 ED visits/1,000 population.  The number of emergency departments in California remained about the same – 339 facilities in 2014 – but the number of ED beds increased about 30 percent to 7663 in 2014.

The researchers developed a new metric – ED bed supply per ED visit.  Over the ten-year study period, there was a small decrease of about 4 percent in this metric.  It was roughly 6 ED beds per 10,000 ED visits in both 2005 and 2014.

Sources:

Chow, J.L., Niedzwiecki, M.J., and Hsia, R.Y. (2017, May 11). Trends in the supply of California’s emergency departments and inpatient services, 2005-2014: A retrospective analysis. BMJ Open, 7(5).  Click here for free full text: http://bmjopen.bmj.com/content/bmjopen/7/5/e014721.full.pdf

For more information on OSHPD data, click here: https://www.oshpd.ca.gov/HID/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY: Factors involved in multiple ED visits

Patterns of multiple ED visits are likely driven by patients’ health conditions and care needs rather than by PCP-related factors.  Multiple ED visits also appear to be complementary, rather than substitutionary, to physician office visits.  This implies that multiple ED visits are not indicative of discretionary use.  The finding also suggests PCP-focused interventions aimed at reducing ED use are unlikely to have a significant impact.”

This study tackled the question: To what extent could expanded primary care options, such as changing physician office hours, substitute for emergency department care?  The data included records on over 20,000 adult patients of the Geisinger Health Plan (a Danville, PA, HMO) who visited the emergency department more than once a year during the study period 2015 to 2016.  These more frequent emergency department users tended to be younger adults (under 40 years old), Medicaid recipients, and patients with multiple clinical issues.  The more frequent users were also found to be patients with a higher number of primary care visits and inpatient hospital admissions.

Source: Maeng, D.D., Hao, J., and Bulger, J.B. (2017). Patterns of multiple emergency department visits: Do primary care physicians matter? The Permanente Journal, 21, 16-063.  Click here: http://www.thepermanentejournal.org/files/2017/16-063.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

VIOLENCE: Top 5 reasons why guns are fired in hospitals

These data were compiled based on reports of firearm discharges in hospitals over a 10-year period ending in December 2016.  During this time, a total of 416 firearm discharges occurred, killing 279 people.  A tendency for larger hospitals to have more frequent firearm discharges was observed.

Top 5 Motives for Firearm Discharge

  • 30 percent (suicide)
  • 15 percent (while violating another law)
  • 10 percent (domestic – family dispute)
  • 10 percent (related to care of patient who is a prisoner)
  •   6 percent (accidental)

Elderly people (over 70 years old) are disproportionately likely to be in this offender group.

Source: Aumack, T., York, T., and Eyestone, K. (2017). Firearm discharges in hospitals: An examination of data from 2006-2016. Journal of Healthcare Protection Management, 33(1), 1-8.  Click here for publisher’s website: http://www.iahss.org/?page=Journal  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ED: How to onboard and train staff at a new freestanding emergency department in a large city

Lenox Health-Greenwich Village, a division of Lenox Hill Hospital, was the first freestanding emergency department in New York City.  The facility, which opened July 17, 2014, was designed with 24 fully-equipped patient rooms and 2 more rooms with minimal furnishings for the safe care of behavioral health patients.  These rooms are all large enough to accommodate two patients each if needed.  The utilization for the first 6 months was 12,700 patients and by the end of the first year, over 30,000 were treated.  This article describes in some detail the simulation process and topics used to train staff prior to the opening of the new facility.  The video describes the construction projects that were underway to add ambulatory surgery space on the fourth floor, imaging upgrades to the fifth floor, and physician offices on the sixth.

Sources:

Kerner, R.L., and others. (2016, October). Simulation for operational readiness in a new freestanding emergency department. Simulation in Healthcare, 11(5), 345-356.  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172849/pdf/sih-11-345.pdf

Here is a video about the facility: https://www.northwell.edu/about/news/video/lenox-health-greenwich-village-what-emergency-care-should-be

Posted by AHA Resource Center (312) 422-2050  rc@aha.org

EMERGENCY DEPARTMENT: Hybrid pediatric inpatient/ED model for lower volume hospitals

Hospitals that do not have enough volume to support 24/7 availability of a pediatric emergency department might consider a hybrid or combination pediatric inpatient/ED unit.  Howard County General Hospital (Columbia, Md.), credited with being the pioneer of this concept nearly 20 years ago, has 6 inpatient beds and 12 emergency beds.  The annual utilization is 18,000 pediatric ED patients.  The recommended minimum volume to make this type of program successful is 10,000 to 12,000 pediatric ED visits per year.

Other hospitals that have established, or are in the process of setting up, a similar unit include Anne Arundel Medical Center (Annapolis, Md.) and Nash General Hospital (Rocky Mount, N.C.).

Why I like this article: It is based on interviews with practitioners and contains pragmatic details about their programs.  Also provided is contact information for each of the interviewees.

Source:

Combined pediatric ED/inpatient unit concept catches on with Maryland community hospitals. (2017, January). ED Management, 29(1), 6-11.  Click here https://www.ahcmedia.com/articles/139700-combined-pediatric-edinpatient-unit-concept-catches-on-with-maryland-community-hospitals

See also these hospital websites:

From the Howard County General Hospital website: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/pediatrics/the_childrens_care_center.html

From the Anne Arundel Medical Center website: http://www.aahs.org/peds/er.php

Posted by AHA Resource Center (312) 422-2050 rc@aha.org