EMERGENCY: Which patients are likely to benefit the most from emergency care?

…we identified 51 condition groups most sensitive to emergency care, conditions where timely, high-quality emergency care is expected to make an impact on mortality and morbidity.”

A comprehensive list of emergency care sensitive conditions (ECSC) developed by an expert panel to represent adult patient conditions that are most appropriate for emergency care is the focus of this research article.  The conditions were then paired with national ED utilization data.  There were about 16 million (14 percent) of the roughly 114 million total ED visits in 2016 that were considered to be ECSC.  Here are the utilization data for the top 5 most frequent of these ECSC visits:

• 10.7 percent of all ECSC visits were related to sepsis and SIRS
•   7.9 percent were related to pneumonia
•   7.9 percent were related to chronic obstructive pulmonary disease
•   6.1 percent were related to asthma
•   5.7 percent were related to heart failure

You can also determine those conditions that are most likely to be admitted after presenting in the ED.  Here are the 5 highest:

• 94.8 percent of patients with sepsis and SIRS were admitted
• 88.1 percent with respiratory failure
• 83.9 percent with femur fractures
• 80.0 percent with cerebral infarction
• 79.7 percent with meningitis

Other patient disposition data and median emergency department charges are also included.

Source: Vashi, A.A., and others. (2019, August 7). Identification of emergency care-sensitive conditions and characteristics of emergency department utilization. JAMA Network Open, 2(8).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747479 Posted by AHA Resource Center (312) 422-2003 rc@aha.org

EMERGENCY: What is an emergency department-based ICU?

In 2015, the University of Michigan Health System created The Joyce and Don Massey Family Foundation Emergency Critical Care Center (EC3), an ICU within the ED of its flagship adult hospital.”

Patient outcomes related to the opening of a new model of intensive care unit that is adjacent to the emergency department of a university hospital (with about 75,000 adult ED visits annually) are described in this scholarly article.  The Joyce and Don Massey Family Foundation Emergency Critical Care Center, known as EC3, at Michigan Medicine (Ann Arbor) is a 7,800-sf unit with nine patient rooms and five resuscitation/trauma bays.  Patients stay in the EC3 for about 9 hours on average.  This new model of care was found to reduce mortality and decrease the rate of admission of ED patients to inpatient intensive care units.

Source: Gunnerson, K.J., and others. (2019, July 24). Association of an emergency department-based intensive care unit with survival and inpatient intensive care unit admissions. JAMA Network Open, 2(7).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738625  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

TURNAROUNDS: How to effect change quickly at a struggling hospital using ‘buddying’ mentoring approach

How a buddying partnership was used to implement a quality improvement initiative at Medway NHS Foundation Trust, a large general hospital located near London, England, is described in this detailed case study.  Medway’s partner in the buddying agreement was Guys and St. Thomas’ Hospitals Hospital NHS Foundation, which provided “advice, operational assistance, ‘compassionate’ leadership and pastoral staff…”  This team approach was successful in quickly improving patient throughput issues.

Source: Leach, R., Banerjee, S., Beer, G., and others. (2019). Supporting a hospital in difficulty: Experience of a ‘buddying’ agreement to implement a new medical pathway. Future Healthcare Journal, 6(1), 67-75. Click here for full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520082/pdf/futurehealth-6-1-67.pdf  Posted by AHA Resource Center (312) 422-2050,  rc@aha.org

ED VISITS: Comparing utilization in urban and rural areas

Changes in emergency department utilization rates from 2005 to 2016 in urban versus rural areas were studied based on data from the National Hospital Ambulatory Medical Care Survey.  The data used in the analysis are representative of the nation as a whole.  Here are the changes in visits per 100 population over the time period studied:

• Rural areas: 36.5 visits/100 population (2005) to 64.5 visits/100 population (2016)
• Urban areas: 40.2 visits/100 population (2005) to 42.8 visits/100 population (2016)

Reasons for the larger growth in the utilization rate per 100 population in rural areas are discussed.

Source: Greenwood-Ericksen, M.D., and Kocher, K. (2019, April 12). Trends in emergency department use by rural and urban populations in the United States. JAMA Network Open, 2(4). Full text here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730472  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

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