- Email: [email protected]
163: Improving Prenatal Counseling In the Nation's Capital
Research Forum Abstracts by others of recent depressed mood (33.2% versus 39.1%, p⬍0.05); or a physical health problem (13.8% versus 27.7%, p⬍0.001). Hispanics were more likely to have drug abuse (11.8% versus 8.4%, p⬍0.05), but not alcohol-related problems. There were no differences with respect to financial, relationship, job or legal troubles. However, more Hispanic suicides occurred in jail (4.6% versus 1.3%, p⬍0.001). After adjustment for age and sex, Hispanic victims were significantly less likely to have a report by others of recent depressed mood (OR 0.78; 95% CI 0.63-0.97), a diagnosed mental illness (OR 0.53; 95% CI 0.41-0.7), or current mental health treatment (OR 0.47; 95% CI 0.43-0.77). Also, Hispanic suicides were still more likely to occur in jail (adjusted OR 2.68; 95% CI 1.55-4.65). Conclusions: Although there are limitations to the COVDRS data, these results suggest that, to prevent Hispanic suicides, stronger partnerships are needed among public health, mental health and law enforcement professionals. Differences in reports of mental health diagnoses and treatment might suggest a lack of access to psychiatric care in the Hispanic population. Suicide prevention strategies could include screening for suicidal behavior during criminal justice proceedings, improved access to mental health services and culturally appropriate outreach and education in Hispanic communities.
163
Improving Prenatal Counseling In the Nation’s Capital
Ybarra MA/Georgetown University/Washington Hospital Center, Washington, DC
Study Objectives: Despite being one of the most influential cities in the world, Washington, DC boasts one of the highest infant mortality rates in the country. A 1995-1998 CDC study found the rate to be 17.5 (deaths/1,000 live births) for nonHispanic blacks. The rate for the entire United States is 6.26. The rate in Washington, DC for the urban population is on par with developing countries such as Libya, Aruba, and Syria. The reason for this health disparity is multi-factorial, due in part due to poor access to primary care for the underserved population, lower levels of education, and a high prevalence of drug and alcohol use. Though controversial, emergency department (ED) visits provide an excellent opportunity to counsel pregnant patients on concrete actions they can take to have a healthy pregnancy. It is difficult in a busy ED to discuss each point that should be addressed in what should be an initial obstetric visit. However, printed discharge instructions are a helpful alternative and can include important patient-centered information. The purpose of this study is to improve the counseling for pregnant patients seen in the ED and increase the prescribing of prenatal vitamins prior to discharge. Methods: Washington Hospital Center is an urban teaching hospital with a busy ED (approximately 90,000 visits per year). In the past, the group physician practice for prenatal counseling, follow-up, and prescribing pre-natal vitamins has been variable. A simple one-page discharge instruction sheet was created using recommendations from national guidelines (guidelines.gov) and advocacy organizations (for example the March of Dimes, National Organization on Fetal Alcohol Syndrome) titled “How to Have a Healthy Pregnancy.” These instructions are available to physicians to choose from a drop-down menu when discharging a patient. After the physician chooses the instructions the electronic medical record prompts the provider to prescribe prenatal vitamins. These new discharge instructions were introduced to the faculty and the utilization was measured by retrospective chart review. Results: The new discharge instructions and electronic prompts were introduced and reinforced over a three-month period. 853 charts were reviewed for documentation of prenatal counseling and prescriptions for prenatal vitamins. During the control period (prior to the new instructions being available), there was no documentation of prenatal counseling in the ED chart (0 of 181). For each month of the intervention period, there was a statistically significant increase in documentation of prenatal counseling (23.5%, p⬍0.001). During the control period, the percent of pregnant patients receiving prescriptions for prenatal vitamins was 17%. Each month of the intervention period had an increased percentage of patients receiving a prescription for prenatal vitamins (25%, p⫽0.044). Conclusions: Prepared discharge instructions are an effective way of improving documentation of counseling and prompting providers to make important clinical decisions. In this study, discharge instructions titled “How to Have a Healthy Pregnancy” improved the documentation of prenatal counseling and increased the prescribing of prenatal vitamins. The cause of high infant mortality rates is multifactorial, particularly in urban areas. Simple ED changes and improvements can begin to chip away at this significant public health problem.
Volume , . : September
164
Smoking Parents of Our Pediatric Population Are Interested In Emergency Department Smoking Cessation Interventions
Llovera I, Barata I, Barton E, Ward M, Kohn N, Loscalzo K, Sama A/North Shore University Hospital, Manhasset, NY
Objectives: To identify smoking parents of our ED pediatric patients and their interest in ED smoking cessation (SC) interventions. Methods: Prospective, consecutive survey of smoking parents of our ED pediatric patients (presenting on day shift July-August, 2009) followed by enrollment in one year follow-up smoking cessation intervention. Survey identified parents who smoke, their smoking history (motivation/dependency) and their preferred cessation aides (ED counseling, prescription/medications, referrals to cessation programs or physician). Interested smokers were enrolled in one year follow-up SC intervention program that involved emails and telephone calls about quitting. Exclusions: child too sick, language barriers, incompetent. University hospital setting 70,000 visits/yr. Results: 234 parents approached, 193 eligible for survey, 11% were smokers, 60% of smokers enrolled in one-year intervention. Demographics of smoking parents: mean age 37⫹8, 64% female, 69% White, 66% ⬍ high school education, Fagerstrom mean dependency score 3.3/6, 43% smoke ⬎15 cigarettes/day, 79% plan to quit in next 6 months, 75% have a strong desire to quit, 71% made 1 or more quit attempts, 57% have a specific plan to quit in next 30 days, 50% quit for at least 1 week in the last year. Only 7% feel that their smoking is worsening their child’s medical problem. No one was in a smoking cessation program at the time of the survey. 57% were interested in an ED smoking cessation intervention; specifically, 75% (most of them) were interested in a prescription and medication to help them stop smoking, 25% were interested in a 15-minute ED counseling session, 25% were interested in written info on quitting, and 13% were interested in the quitline, referral to SC program, or their PMD for counseling. Conclusion: Most smoking parents of our ED pediatric population are interested in quitting (79% plan to quit in next 6 months) and 75% are interested in a prescription/medications to help them stop smoking. 60% of our smoking parents enrolled in our ED one-year smoking cessation followup program. Few (7%) feel that their smoking is worsening their child’s medical problem. Efforts should focus on identifying smoking parents in the ED and offering them prescriptions/medications and followup to help them stop smoking.
165
Schedule of Classes and Alcohol-Related Emergencies
Takacs ME, Heise W, Erbes J, Thompson L, Nugent A/University of Iowa, Iowa City, IA
Study Objectives: We hypothesize that an increase in Friday classes at the University of Iowa (U of I) will result in a reduction of alcohol-related emergencies in college students on Thursday night. Prior research has demonstrated through survey data an association between the amount of alcohol consumed on Thursday night and Friday class schedule. Subsequently, U of I increased the number of Friday classes from the 2007-2008 academic year (control year) to the 2008-2009 academic year (intervention year) to curb binge drinking. Methods: Data was obtained via a retrospective chart review on all U of I emergency department (ED) patients, ages 18 to 22, presenting Thursday night from the Fall 2007 semester through the Spring 2009 semester. A patient was considered to be an alcohol-related emergency if they had a positive blood alcohol test, if the medical record indicated alcohol was consumed just prior to arrival, or if they were given an alcohol-related diagnosis. From this data set, patient name and birth date were used with U of I student records to determine if a patient was indeed a U of I student. If a patient was not a U of I student, they were identified as the control group. Results: There were 270 patients in the control year and 309 patients in the intervention year. Of these, 78 patients presented with alcohol-related emergencies in the control year and 69 patients in the intervention year. After review of U of I student records, the number of alcohol-related emergencies in college students decreased from 51 to 37, while the number of alcohol-related emergencies in the control group increased from 27 to 32. The results were significant with t-test ⫺2.76, p⬍0.04. Conclusions: The increase of Friday classes has resulted in a significant reduction in alcohol-related ED visits among college students. Future work could be to extend this research to each day of the week and to look at specific class times.
Annals of Emergency Medicine S55
163
Improving Prenatal Counseling In the Nation’s Capital
Ybarra MA/Georgetown University/Washington Hospital Center, Washington, DC
Study Objectives: Despite being one of the most influential cities in the world, Washington, DC boasts one of the highest infant mortality rates in the country. A 1995-1998 CDC study found the rate to be 17.5 (deaths/1,000 live births) for nonHispanic blacks. The rate for the entire United States is 6.26. The rate in Washington, DC for the urban population is on par with developing countries such as Libya, Aruba, and Syria. The reason for this health disparity is multi-factorial, due in part due to poor access to primary care for the underserved population, lower levels of education, and a high prevalence of drug and alcohol use. Though controversial, emergency department (ED) visits provide an excellent opportunity to counsel pregnant patients on concrete actions they can take to have a healthy pregnancy. It is difficult in a busy ED to discuss each point that should be addressed in what should be an initial obstetric visit. However, printed discharge instructions are a helpful alternative and can include important patient-centered information. The purpose of this study is to improve the counseling for pregnant patients seen in the ED and increase the prescribing of prenatal vitamins prior to discharge. Methods: Washington Hospital Center is an urban teaching hospital with a busy ED (approximately 90,000 visits per year). In the past, the group physician practice for prenatal counseling, follow-up, and prescribing pre-natal vitamins has been variable. A simple one-page discharge instruction sheet was created using recommendations from national guidelines (guidelines.gov) and advocacy organizations (for example the March of Dimes, National Organization on Fetal Alcohol Syndrome) titled “How to Have a Healthy Pregnancy.” These instructions are available to physicians to choose from a drop-down menu when discharging a patient. After the physician chooses the instructions the electronic medical record prompts the provider to prescribe prenatal vitamins. These new discharge instructions were introduced to the faculty and the utilization was measured by retrospective chart review. Results: The new discharge instructions and electronic prompts were introduced and reinforced over a three-month period. 853 charts were reviewed for documentation of prenatal counseling and prescriptions for prenatal vitamins. During the control period (prior to the new instructions being available), there was no documentation of prenatal counseling in the ED chart (0 of 181). For each month of the intervention period, there was a statistically significant increase in documentation of prenatal counseling (23.5%, p⬍0.001). During the control period, the percent of pregnant patients receiving prescriptions for prenatal vitamins was 17%. Each month of the intervention period had an increased percentage of patients receiving a prescription for prenatal vitamins (25%, p⫽0.044). Conclusions: Prepared discharge instructions are an effective way of improving documentation of counseling and prompting providers to make important clinical decisions. In this study, discharge instructions titled “How to Have a Healthy Pregnancy” improved the documentation of prenatal counseling and increased the prescribing of prenatal vitamins. The cause of high infant mortality rates is multifactorial, particularly in urban areas. Simple ED changes and improvements can begin to chip away at this significant public health problem.
Volume , . : September
164
Smoking Parents of Our Pediatric Population Are Interested In Emergency Department Smoking Cessation Interventions
Llovera I, Barata I, Barton E, Ward M, Kohn N, Loscalzo K, Sama A/North Shore University Hospital, Manhasset, NY
Objectives: To identify smoking parents of our ED pediatric patients and their interest in ED smoking cessation (SC) interventions. Methods: Prospective, consecutive survey of smoking parents of our ED pediatric patients (presenting on day shift July-August, 2009) followed by enrollment in one year follow-up smoking cessation intervention. Survey identified parents who smoke, their smoking history (motivation/dependency) and their preferred cessation aides (ED counseling, prescription/medications, referrals to cessation programs or physician). Interested smokers were enrolled in one year follow-up SC intervention program that involved emails and telephone calls about quitting. Exclusions: child too sick, language barriers, incompetent. University hospital setting 70,000 visits/yr. Results: 234 parents approached, 193 eligible for survey, 11% were smokers, 60% of smokers enrolled in one-year intervention. Demographics of smoking parents: mean age 37⫹8, 64% female, 69% White, 66% ⬍ high school education, Fagerstrom mean dependency score 3.3/6, 43% smoke ⬎15 cigarettes/day, 79% plan to quit in next 6 months, 75% have a strong desire to quit, 71% made 1 or more quit attempts, 57% have a specific plan to quit in next 30 days, 50% quit for at least 1 week in the last year. Only 7% feel that their smoking is worsening their child’s medical problem. No one was in a smoking cessation program at the time of the survey. 57% were interested in an ED smoking cessation intervention; specifically, 75% (most of them) were interested in a prescription and medication to help them stop smoking, 25% were interested in a 15-minute ED counseling session, 25% were interested in written info on quitting, and 13% were interested in the quitline, referral to SC program, or their PMD for counseling. Conclusion: Most smoking parents of our ED pediatric population are interested in quitting (79% plan to quit in next 6 months) and 75% are interested in a prescription/medications to help them stop smoking. 60% of our smoking parents enrolled in our ED one-year smoking cessation followup program. Few (7%) feel that their smoking is worsening their child’s medical problem. Efforts should focus on identifying smoking parents in the ED and offering them prescriptions/medications and followup to help them stop smoking.
165
Schedule of Classes and Alcohol-Related Emergencies
Takacs ME, Heise W, Erbes J, Thompson L, Nugent A/University of Iowa, Iowa City, IA
Study Objectives: We hypothesize that an increase in Friday classes at the University of Iowa (U of I) will result in a reduction of alcohol-related emergencies in college students on Thursday night. Prior research has demonstrated through survey data an association between the amount of alcohol consumed on Thursday night and Friday class schedule. Subsequently, U of I increased the number of Friday classes from the 2007-2008 academic year (control year) to the 2008-2009 academic year (intervention year) to curb binge drinking. Methods: Data was obtained via a retrospective chart review on all U of I emergency department (ED) patients, ages 18 to 22, presenting Thursday night from the Fall 2007 semester through the Spring 2009 semester. A patient was considered to be an alcohol-related emergency if they had a positive blood alcohol test, if the medical record indicated alcohol was consumed just prior to arrival, or if they were given an alcohol-related diagnosis. From this data set, patient name and birth date were used with U of I student records to determine if a patient was indeed a U of I student. If a patient was not a U of I student, they were identified as the control group. Results: There were 270 patients in the control year and 309 patients in the intervention year. Of these, 78 patients presented with alcohol-related emergencies in the control year and 69 patients in the intervention year. After review of U of I student records, the number of alcohol-related emergencies in college students decreased from 51 to 37, while the number of alcohol-related emergencies in the control group increased from 27 to 32. The results were significant with t-test ⫺2.76, p⬍0.04. Conclusions: The increase of Friday classes has resulted in a significant reduction in alcohol-related ED visits among college students. Future work could be to extend this research to each day of the week and to look at specific class times.
Annals of Emergency Medicine S55