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88: Effect of Continuity of Care on Emergency Department Utilization
ICEM 2008 Scientific Abstract Program
88
Effect of Continuity of Care on Emergency Department Utilization
Chih PS/En Chu Kong Hospital, Taipei, Taiwan
Background: Emergency department is an indispensable part of the health care delivery system. Increased emergency department utilization may contribute to emergency department overcrowding, and may divert the scarce emergency health care resource away from those who really need them. The health care quality may therefore be jeopardized. The reasons involved with emergency department crowding are multi-factorial. The continuity of care among health care system has important effect on the emergency department utilization, yet the results remained controversial in the relevant literatures. Study Objective: The purpose of the study was to explore the effect of continuity of care on emergency department utilization. Method: The ambulatory visit file of the first 50000-person cohort database from the National Health Research Database in year 2001, 2002, and 2003 were analyzed. Those with at least 4 ambulatory visits in year 2001 and 2002 were included in the study. The dependent variable was non-traumatic emergency visit frequency in year 2003. Continuity of care score derived from year 2001 and 2002 ambulatory visits was used as independent variable. Control variable included age, sex, residency location, and health care need. The health care need factor were represented by comorbidity and total ambulatory visits in year 2001 and 2002. Negative binomial regression was used in the analysis. The analysis was repeated by applying logistic regression when the dependent variable was dichotomized as whether use emergency department or not. Results: Results: In 36510 people who met the inclusion criteria, 4597(12.59%) people ever visited emergency department in year 2003. The average emergency department visits was 0.19 (SD 0.66, Max 24, Min 0). The average continuity of care score was 0.33(SD 0.22, Max 1, Min 0). The result of negative binomial regression revealed that more emergency department visits was associated with lower continuity of care score (RR, 0.70; 95% CI 0.60, 0.81). When logistic regression was applied, the Odd Ratio of having at least one emergency department for those with the highest continuity of care score was 0.65 (95% CI 0.56, 0.76), when those with the lowest continuity of score were compared with. Conclusion: The results of the study may provide insights for health policy makers and health care facility administrators when dealing with emergency crowding. Methods facilitating the continuity of care may improve emergency crowding.
89
Electronic Radiograph Reports in the Emergency Department
Buckley A, Eccles S, Gant L/Homerton University Hospital, London, United Kingdom
Study Objectives: Evidence demonstrates the rapid reporting and checking of radiographs is crucial to maintaining quality standards in the emergency department (ED). Despite this, many departments still rely on paper reports which can cause significant delays. This study aims to assess the efficiency of a new system of radiograph reporting in the ED by comparing the previous paper reporting or old system, with the new electronic system (EPR). Methods: All radiograph reports for ED were reviewed over the course of two weeks. Reports were assessed using both old and new systems. All radiograph reports were included. Patients with fracture clinic follow up or current inpatient status were excluded as both groups are exempt from review under new and old systems. Average time taken to pull notes and contact patients was recorded. Time taken using the old system was averaged from historic data. Results: Over the two week period there were 687 x-rays reports generated. 332 (48%) were reported as abnormal; of these 215 (31%) were excluded as they had fracture clinic follow up or had been admitted. This left 117 (17%) patients, of whom in the new system 74 (11%) had appropriate discharge summaries immediately viewable on EPR This left 43 (6%) sets of notes to be pulled and a further 22 (3%) of patients requiring contact. The same 117 (17%) patients were assessed as if in the old system. All 117 notes would have been pulled. In 64 (9%) of cases there was an appropriate plan recorded in the notes. The remaining 53 (8%) of patients would have been contacted. Since it takes 5 minutes to pull a set of notes and 5 minutes to contact a patient, this equates to 325 minutes of administrative time in the new system, and 850 minutes in the old system over the two weeks.
498 Annals of Emergency Medicine
We can see in the new system that we contact less than half the number of patients (22 v 53). We also save 4 hours 23 minutes of administration time per week. Historic data also suggests that we contact patients two weeks sooner. Conclusion: This study shows how the EPR system of reporting radiographs saves time for both patients and staff. Fewer patients are recalled unnecessarily, reducing anxiety for patients and relatives. Our faster turnaround time also improves patient safety. We believe this system acts as an efficient safety net to reduce risk in the emergency department. It would be interesting to perform further studies with the introduction of the Picture Archiving and Communications System (PACS), which should increase efficiency even further.
90
Can One Hospital Quality Team Make a Difference in the Emergency Department Pediatric Asthma Population?
Robson K, Wojtczak H, Matteucci M, Griffith E/Naval Medical Center San Diego, San Diego, CA
Study Objectives: We examined whether a non-emergency department (ED) based Asthma Clinical Quality Team could impact pediatric asthma practice parameters in the emergency department. Methods: This retrospective study was conducted using the CHCS military data base and Emergency Department Treatment Records from January 1, 2003 to December 31, 2006. Patients included in the study were 0.3 to 17 years old, visited the Naval Medical Center San Diego ED, and received a diagnosis of Asthma or Reactive Airway Disease. A Data Collection sheet was used to record patient demographics, disposition from ED, primary care and specialist follow-up appointments kept and return ED visits. Practice parameters that were examined included: steroid use in the ED, chest x-rays taken in the ED, discharge with Betaagonist inhaler, discharge with steroids, use of nebulized beta-agonist medications in the ED, discharge with spacer or peak flow, discharge with long-term control inhalers, and discharge with asthma teaching. Total cost of ED visits and hospital stays at a military institution were also analyzed to quantify the cost-saving impact of the Asthma Quality Team. Results: 1660 patients met inclusion criteria. Using Fisher Exact testing, we found significant differences in patient admissions following the initiation of the Asthma Quality Team (p ⬍ 0.001). We additionally found significant differences in discharges with Beta-agonist inhalers (p ⫽ 0.008); discharges with long-term control inhalers (p ⬍ 0.001); and referrals to Pediatric Asthma Pulmonary specialists (p ⬍ 0.001). We did not find significant differences in areas of chest x-ray use, ED nebulized medications, steroids in the ED, discharges with steroids, discharges with teaching, discharges with spacers or peak flow meters, or primary care physician follow-up appointments kept. Overall 8 of the 10 variables examined showed positive treatment trends. The probability of 8 or more improvements by chance alone would be 5%, indicating a significant improvement in overall pattern. Conclusion: We find that a non-ED-based quality team can make a difference in the treatment of pediatric asthma in the ED. Overall treatment patterns have improved since the initiation of the Asthma Quality team. Steps to improve pediatric asthma treatment with standardized asthma pathways, asthma emergency treatment records, asthma teaching with the assistance of respiratory therapy, and consultation with pediatric asthma specialist have improved the overall quality of asthma treatment care in our emergency department.
91
Resident Productivity: Does Emergency Department Volume or Shift Time of Day Matter?
Jeanmonod R, Brook C, Winther M, Boyd M, Pathak S/Albany Medical College, Albany, NY
Background: It has been established in the emergency medicine (EM) literature that residents are able to evaluate more patients per hour (productivity) with increased training. Whether resident productivity varies as a function of ED patient volume or time of day has not been assessed. Study Objectives: To determine whether there is a difference in resident productivity as a function of ED volume or shift time of day. Methods: This is a retrospective chart review of patients evaluated in the ED by 1st, 2nd, and 3rd year residents in a tertiary care center. All ED resident shifts during the study period were included. Shift lengths were a combination of 9 hours, which include 8 hours of patient care and 1 hour of wrap-up time (2nd and 3rd year residents), and 12 hours (all classes). During the study period, no resident working a 9 hour shift initiated care on a patient after the eighth hour.
Volume , . : April
88
Effect of Continuity of Care on Emergency Department Utilization
Chih PS/En Chu Kong Hospital, Taipei, Taiwan
Background: Emergency department is an indispensable part of the health care delivery system. Increased emergency department utilization may contribute to emergency department overcrowding, and may divert the scarce emergency health care resource away from those who really need them. The health care quality may therefore be jeopardized. The reasons involved with emergency department crowding are multi-factorial. The continuity of care among health care system has important effect on the emergency department utilization, yet the results remained controversial in the relevant literatures. Study Objective: The purpose of the study was to explore the effect of continuity of care on emergency department utilization. Method: The ambulatory visit file of the first 50000-person cohort database from the National Health Research Database in year 2001, 2002, and 2003 were analyzed. Those with at least 4 ambulatory visits in year 2001 and 2002 were included in the study. The dependent variable was non-traumatic emergency visit frequency in year 2003. Continuity of care score derived from year 2001 and 2002 ambulatory visits was used as independent variable. Control variable included age, sex, residency location, and health care need. The health care need factor were represented by comorbidity and total ambulatory visits in year 2001 and 2002. Negative binomial regression was used in the analysis. The analysis was repeated by applying logistic regression when the dependent variable was dichotomized as whether use emergency department or not. Results: Results: In 36510 people who met the inclusion criteria, 4597(12.59%) people ever visited emergency department in year 2003. The average emergency department visits was 0.19 (SD 0.66, Max 24, Min 0). The average continuity of care score was 0.33(SD 0.22, Max 1, Min 0). The result of negative binomial regression revealed that more emergency department visits was associated with lower continuity of care score (RR, 0.70; 95% CI 0.60, 0.81). When logistic regression was applied, the Odd Ratio of having at least one emergency department for those with the highest continuity of care score was 0.65 (95% CI 0.56, 0.76), when those with the lowest continuity of score were compared with. Conclusion: The results of the study may provide insights for health policy makers and health care facility administrators when dealing with emergency crowding. Methods facilitating the continuity of care may improve emergency crowding.
89
Electronic Radiograph Reports in the Emergency Department
Buckley A, Eccles S, Gant L/Homerton University Hospital, London, United Kingdom
Study Objectives: Evidence demonstrates the rapid reporting and checking of radiographs is crucial to maintaining quality standards in the emergency department (ED). Despite this, many departments still rely on paper reports which can cause significant delays. This study aims to assess the efficiency of a new system of radiograph reporting in the ED by comparing the previous paper reporting or old system, with the new electronic system (EPR). Methods: All radiograph reports for ED were reviewed over the course of two weeks. Reports were assessed using both old and new systems. All radiograph reports were included. Patients with fracture clinic follow up or current inpatient status were excluded as both groups are exempt from review under new and old systems. Average time taken to pull notes and contact patients was recorded. Time taken using the old system was averaged from historic data. Results: Over the two week period there were 687 x-rays reports generated. 332 (48%) were reported as abnormal; of these 215 (31%) were excluded as they had fracture clinic follow up or had been admitted. This left 117 (17%) patients, of whom in the new system 74 (11%) had appropriate discharge summaries immediately viewable on EPR This left 43 (6%) sets of notes to be pulled and a further 22 (3%) of patients requiring contact. The same 117 (17%) patients were assessed as if in the old system. All 117 notes would have been pulled. In 64 (9%) of cases there was an appropriate plan recorded in the notes. The remaining 53 (8%) of patients would have been contacted. Since it takes 5 minutes to pull a set of notes and 5 minutes to contact a patient, this equates to 325 minutes of administrative time in the new system, and 850 minutes in the old system over the two weeks.
498 Annals of Emergency Medicine
We can see in the new system that we contact less than half the number of patients (22 v 53). We also save 4 hours 23 minutes of administration time per week. Historic data also suggests that we contact patients two weeks sooner. Conclusion: This study shows how the EPR system of reporting radiographs saves time for both patients and staff. Fewer patients are recalled unnecessarily, reducing anxiety for patients and relatives. Our faster turnaround time also improves patient safety. We believe this system acts as an efficient safety net to reduce risk in the emergency department. It would be interesting to perform further studies with the introduction of the Picture Archiving and Communications System (PACS), which should increase efficiency even further.
90
Can One Hospital Quality Team Make a Difference in the Emergency Department Pediatric Asthma Population?
Robson K, Wojtczak H, Matteucci M, Griffith E/Naval Medical Center San Diego, San Diego, CA
Study Objectives: We examined whether a non-emergency department (ED) based Asthma Clinical Quality Team could impact pediatric asthma practice parameters in the emergency department. Methods: This retrospective study was conducted using the CHCS military data base and Emergency Department Treatment Records from January 1, 2003 to December 31, 2006. Patients included in the study were 0.3 to 17 years old, visited the Naval Medical Center San Diego ED, and received a diagnosis of Asthma or Reactive Airway Disease. A Data Collection sheet was used to record patient demographics, disposition from ED, primary care and specialist follow-up appointments kept and return ED visits. Practice parameters that were examined included: steroid use in the ED, chest x-rays taken in the ED, discharge with Betaagonist inhaler, discharge with steroids, use of nebulized beta-agonist medications in the ED, discharge with spacer or peak flow, discharge with long-term control inhalers, and discharge with asthma teaching. Total cost of ED visits and hospital stays at a military institution were also analyzed to quantify the cost-saving impact of the Asthma Quality Team. Results: 1660 patients met inclusion criteria. Using Fisher Exact testing, we found significant differences in patient admissions following the initiation of the Asthma Quality Team (p ⬍ 0.001). We additionally found significant differences in discharges with Beta-agonist inhalers (p ⫽ 0.008); discharges with long-term control inhalers (p ⬍ 0.001); and referrals to Pediatric Asthma Pulmonary specialists (p ⬍ 0.001). We did not find significant differences in areas of chest x-ray use, ED nebulized medications, steroids in the ED, discharges with steroids, discharges with teaching, discharges with spacers or peak flow meters, or primary care physician follow-up appointments kept. Overall 8 of the 10 variables examined showed positive treatment trends. The probability of 8 or more improvements by chance alone would be 5%, indicating a significant improvement in overall pattern. Conclusion: We find that a non-ED-based quality team can make a difference in the treatment of pediatric asthma in the ED. Overall treatment patterns have improved since the initiation of the Asthma Quality team. Steps to improve pediatric asthma treatment with standardized asthma pathways, asthma emergency treatment records, asthma teaching with the assistance of respiratory therapy, and consultation with pediatric asthma specialist have improved the overall quality of asthma treatment care in our emergency department.
91
Resident Productivity: Does Emergency Department Volume or Shift Time of Day Matter?
Jeanmonod R, Brook C, Winther M, Boyd M, Pathak S/Albany Medical College, Albany, NY
Background: It has been established in the emergency medicine (EM) literature that residents are able to evaluate more patients per hour (productivity) with increased training. Whether resident productivity varies as a function of ED patient volume or time of day has not been assessed. Study Objectives: To determine whether there is a difference in resident productivity as a function of ED volume or shift time of day. Methods: This is a retrospective chart review of patients evaluated in the ED by 1st, 2nd, and 3rd year residents in a tertiary care center. All ED resident shifts during the study period were included. Shift lengths were a combination of 9 hours, which include 8 hours of patient care and 1 hour of wrap-up time (2nd and 3rd year residents), and 12 hours (all classes). During the study period, no resident working a 9 hour shift initiated care on a patient after the eighth hour.
Volume , . : April