- Email: [email protected]
Ultra-Low Cost Uterine Balloon Tamponade Package for Postpartum Hemorrhage Control Among Health Providers in Kenya
Research Forum Abstracts
276
An Operational Analysis of Integrating Screening and Brief Intervention into the Normal Workflow of the Emergency Department Without Additional Resources
Slain T, Rickard-Aasen S, Pringle J, Hegde GG, Shang J, Johnjulio W, Venkat A /Allegheny General Hospital, Pittsburgh, PA; Program Evaluation Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA; Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA; West Penn Allegheny Health System, Pittsburgh, PA
Study Objectives: Screening and Brief Intervention (SBI) protocols for emergency department (ED) patients with evidence of alcohol or drug abuse can help prevent future at-risk behavior. However, to date, such ED programs have largely used external funding or additional personnel resources to execute SBI. Our objectives were to evaluate whether SBI could be integrated into the normal workflow of the ED without additional resources, identify demographic and operational factors associated with failure to properly perform the SBI protocol and report revenue collection from SBI. Methods: We conducted a retrospective, observational analysis of a protocol adding SBI to the normal workflow of a single, tertiary care ED (census: 50,000) for all adult patients in 2012. ED staff received ongoing training on SBI from 2010. From 1/12, ED nurses pre-screened for evidence of alcohol or drug abuse/at-risk behavior in adult patients during the social history triage assessment and, when positive, executed SBI during nursing care in the treatment area, all documented in our electronic medical record (EMR). We downloaded from the EMR demographic (age, sex, race, insurance status, acuity [ESI] level) and operational (mode and time of patient arrival, ED daily census, admission status) data on all adult ED visits in 2012 and whether pre-screening and, if positive, SBI was performed. Using multivariable logistic regression, we report demographic and operational factors significantly associated with failure to initiate and execute the SBI protocol by odds ratios (OR), 95CI and Wald Factors (initiation analysis alone due to its large sub-cohort size). Beginning in 10/12, we submitted itemized charges for brief intervention to discharged patients’ insurers and report collections. Results: A total of 47693 visits by 31525 patients met inclusion criteria (Mean Age: 48, 48.4% male, 63% white, 32% black). A total of 39758 (83.4%) eligible visits had triage SBI protocol initiation. Demographic and operational variables significantly associated with decreased odds of SBI protocol initiation were decreasing age (OR for rising age association with SBI initiation: 1.044 95CI (1.042-1.045), Wald: 2906.2), arrival by ambulance (OR: 0.37 95CI (0.35-0.40), Wald: 863.4) and ESI acuity level 1 or 2 (OR: 0.08 95CI (0.07-0.09), Wald: 2585.5). 971 visits (2% of all visits) had documented brief interventions. Two hundred fifty-one additional visits (0.53% of all visits, 20.5% of potential brief intervention visits) had no brief intervention documented despite the SBI protocol indicating by positive pre-screen and screen that this should have taken place. Demographic and operational variables associated with decreased odds of brief intervention execution were female sex (OR: 0.61 95CI (0.430.86)) and decreasing ED census (OR for rising ED census association with brief intervention execution: 1.012 95CI (1.01-1.02). $3617.53 was collected on $10829.15 charged (33.4% collection rate) from 262 visits with itemized billing for brief intervention. Conclusions: This trial indicates that SBI integration into the normal workflow of the ED is operationally feasible without additional resources. Variables most associated with failure to properly perform the SBI protocol were younger, female, higher acuity patients arriving by ambulance. Revenue collection for SBI remains challenging.
277 278
Withdrawn ‘From the ED2PMD’: A Text Messaging Program to Connect Adolescents to a Health Home
Malbon KM, Fleisher D, Soghomonian C, Paul A/Mount Sinai Adolescent Health Center, New York, NY; Mount Sinai Hospital, New York, NY
Background: Adolescents are frequent users of the ED often for non-urgent complaints. Those attending the ED frequently lack a medical home. Increased access to primary care for non-urgent complaints can decrease use of the ED. Proximity to an ED and inability to obtain a clinic appointment contribute to adolescents’ use of the ED and highlight the need for cost effective transition to a medical home. Adolescents report favorable attitudes towards communicating via texting with healthcare providers.
Volume 62, no. 4s : October 2013
Texting is a cost-effective means of increasing outpatient attendance and communicating with high-risk patients, but has not been studied in transitioning adolescents from the ED to primary care. We hypothesize that connecting adolescents to a “health home” will encourage fewer subsequent visits to the ED for primary care needs. Study Objectives: To evaluate the effect of text messaging on encouraging primary care follow-up at an adolescent health center (MSAHC), for adolescents who sought care at an emergency department (ED). Methods: The study took place at Mount Sinai Pediatric Emergency Department (ED) in New York City from November 2012 to March 2013. Male and female patients, ages 15-22 years, attending the ED were asked to indicate their interest in receiving text messages from the ED on the initial registration form. Patients who requested text messages provided their cell number, service provider, and preferred language (English/Spanish). Enrolled cell numbers were entered into a text messaging platform within twenty-four hours of attendance at the ED. They received a series of automated text messages encouraging appropriate primary care follow-up at an adolescent health center. Patients received two messages per week for four weeks, including health center information, hours and location. Mount Sinai Adolescent Health Center (MSAHC) is a non-profit clinic providing free primary care for uninsured adolescents, located within walking distance of the Mount Sinai ED. Demographics and diagnosis were abstracted from the electronic medical record (age, race and ethnicity, home address zip code, diagnosis, health insurance status). Previous attendance and follow-up at MSAHC within 10 weeks of their ED visit was documented. Results: There were 2440 patients, ages 15-22 years, enrolled in the study. Thirty-eight (38%) percent consented to receive texts. Preliminary analysis using a chi-square test revealed a significant relationship between receipt of texts and follow-up at the MSAHC within 10 weeks of the ED visit. X2 (1, N¼2440) ¼ 3.88, p¼0.049. Forty-six percent of adolescents who received text messages followed up at the AHC within 10 weeks of their first ED visit. Follow-up at MSAHC beyond 10 weeks of the ED visit was also significant. X2 (1, N¼2240) ¼ 4.5, p¼0.033. Sixty-two (62%) percent of adolescents who did not follow-up did not receive text messages. Conclusions: Text messaging is a feasible and effective tool for increasing outpatient follow-up after an ED visit at a primary care facility, potentially relieving an additional burden on the ED and promoting health care in the transition to adult medicine. Establishing a connection with a primary care provider will enable adolescents to have a better and more comprehensive health care that is otherwise absent for much of the ED-frequenting population.
279
Ultra-Low Cost Uterine Balloon Tamponade Package for Postpartum Hemorrhage Control Among Health Providers in Kenya
Burke TF, Nelson BD, Eckardt M, Dulo L, Oguttu M, Maua J, Qureshi Z, Ahn R /Massachusetts General Hospital, Division of Global Health and Human Rights, Boston, MA; African Institute for Innovation and Technology, Kisumu, Kenya; Division of Reproductive Health, Ministry of Health, Kenya, Kenya; University of Nairobi Medical School, Nairobi, Kenya
Study Objectives: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Emergency uterine balloon tamponade (UBT) has been shown to be an effective technique for managing uncontrolled PPH in developed countries; however, little is known about effectiveness of UBT to treat the larger burden of PPH among facility-based providers in resource-constrained settings. Our study objective is to test the hypothesis that a UBT package, including training and an ultra-low-cost uterine balloon for uncontrolled PPH, is effective and safe when used by maternal health providers in Kenya. Methods: A rigorous quantitative and qualitative analysis using case study methodology to examine UBT use by providers in 12 maternal health facilities in Kenya that have been trained on the UBT package. The simple UBT device is comprised of a catheter, condom, and syringe. Prospective enrollment data includes number of maternal deaths per severe hemorrhage cases per month per health facility, subsequent to UBT implementation. We also collected historical control data (i.e., 2 years prior to UBT implementation) on these same measures. Results: To date we have amassed individual use data on 16 cases of emergency UBT use and conducted study interviews associated with the same 16 cases. Trained maternal health providers in our study applied UBT in appropriate clinical situations, and UBT was effective in controlling PPH in these cases. No deaths occurred among
Annals of Emergency Medicine S101
Research Forum Abstracts the 16 cases. We will report on subsequent cases of UBT as they emerge throughout 2013. Conclusions: Preliminary analysis indicates that an ultra-low cost emergency uterine balloon implementation package is effective for managing uncontrolled PPH among community-based providers in Kenya. Further research is needed, however, given the compelling individual examples of mother’s lives saved strong consideration should be given to rapidly scaling UBT to a national level in Kenya, and beyond.
280
Health-Related Behavior of Patients Presenting to an Urban Emergency Department
Kwon NS, Colucci A, McStay C, Chiang WK/NYU School of Medicine/Bellevue Hospital Center, New York, NY; NNYU School of Medicine/Bellevue Hospital Center, New York, NY; NYU School of Medicine/Bellevue Hospital CenterYU School of Medicine/Bellevue Hospital Center, New York, NY
Study Objectives: To survey the health care practices of patients presenting to the emergency department (ED) of an inner-city public hospital in 2011. Methods: A cross-sectional study was undertaken on a convenience sample of ED patients who were at least 18 years of age. Research associates (RAs) approached consecutive patients presenting to the ED during shifts. Survey questions included demographic information and questions regarding screening and preventative care, medical history, physical activity, use of poison control, advanced directives, and behavioral health. Means were utilized to analyze data. Results: A total of 1492 patients were entered in the study. Most patients considered themselves Hispanic (33%). More males (55%) than females (45%) were surveyed. The majority (54%) stated their primary source of health care advice was from the ED. The majority (83%) were unaware of a way to contact Poison Control in the event of an overdose. The medical conditions that patients reported in our sample closely matched national averages (hypertension 29%, diabetes 14%, heart disease 10%). A significant percentage of patients reported no physical activity in the past month (35%), and the majority of patients reported themselves to be at least a little overweight (56%). A large percentage of patients were self-reported smokers (28%), and many women reported that they lacked a regular source of gynecologic care (32%). Conclusions: Utilizing the ED as a primary source of health care is a significant problem. Many patients reported medical problems and behavioral health practices where the ED could be a location to provide intervention.
281
Exploratory Study of Emergency Physicians’ Use of a Prescription Drug Monitoring Program Using a Framework of Technology Acceptance
Fleming ML, Wattana MK, Hatfield MD, Todd KH/University of Houston, Houston, TX; MD Anderson Cancer Center, Houston, TX
Study Objective: Emergency physicians face the challenge of caring for acute and chronic pain patients daily and are among the top prescribers of opioids. The objective of this study was to understand factors influencing emerency physicians intention to use a prescription drug monitoring program (PDMP) during patient care. Information from this study can be used to guide future PDMP software enhancements and provider education to promote use of PDMPs as a tool to aid prescribing decisions. Methods: This was a cross-sectional study at a single institution. The study group consisted of emergency physicians attending a citywide emergency medicine conference. A 24-item questionnaire, based on a theoretical model of technology acceptance, was developed to assess physician adoption and attitudes toward the Texas PDMP (Prescription Access in Texas). Items related to technology acceptance (perceived ease of use, perceived usefulness, attitude and intention) were assessed using Likert scale responses (1¼strongly disagree to 5¼strongly agree). Descriptive statistics and multiple linear regression were used to assess predictors of intention. Results: The majority of respondents were from academic EDs (76.7%) with 51% being attending physicians. Females were less likely to be registered for PDMP access (p¼0.03). Among pre-adopters (not registered), perceived ease of use, perceived usefulness and attitude explained 65.6% of the variance in intention to utilize the PDMP. Emergency physicians attitude was the primary predictor of intention (b¼0.58, p<0.001). Lack of awareness (32.1%) was the primary reason cited by emergency physicians not registered. Conclusions: The theoretical framework of technology acceptance was shown to be useful in explaining emergency physicians intention to utilize the PDMP. Additionally,
S102 Annals of Emergency Medicine
emergency physicians expressed a very favorable attitude and intention towards PDMP use. Considering the positive perceptions expressed towards PDMP use, improving awareness through provider education may lead to increased registration and utilization. Emergency physicians use of the PDMP may play an integral role in mitigating prescription drug abuse, while improving patient care.
282
The Association Between Patient Demographics and the Acceptance of Routine HIV Screening in the Emergency Department
Acerra J, Hill A, Baner N, Goltser Y, Gurr D, Akerman M, Kintzer E, Haddad S, Silverman R, Ward MF/Long Island Jewish Medical Center, New Hyde Park, NY
Background: In 2006, the CDC released new recommendations stating that all patients between 13 and 64 years of age should be offered routine, opt-out HIV screening. Two New York City area emergency departments (EDs) (A and B) have recently enacted policies related to routine HIV testing in the ED to comply with this recommendation and a recent NY State law which mandates the CDC guidelines. Study Objective: The purpose of this study is to identify the factors associated with accepting or refusing HIV testing in two EDs (within the same health system) with diverse patient demographics. Methods: This was a prospective, anonymous study conducted in two suburban, university-affiliated EDs over three months. Patients in the ED were given a survey regarding the reasons for patients’ acceptance or refusal of HIV testing and were allowed privacy to complete the survey anonymously. This convenience sample included patients between the ages of 18 and 64. Patients known to be HIV-positive were excluded. Survey responses of subjects at each hospital were assessed for the association between demographic characteristics and willingness to undergo HIV testing. Univariate analyses using the chi-square test or Fisher’s exact test, as deemed appropriate for categorical data, were used to compare patients who accept or decline HIV screening. Results: A total of 250 surveys were completed at each site (n¼500). There were significant differences between the patient populations at each ED. There were differences in race at hospital A and B respectively (22% vs 40% Blacks, 6% vs 9% Asians, 12% vs 17% Other and 60% vs 34% White, p<.0001). Hospital A had a significantly higher percentage of individuals who held an Associate’s degree or higher (57% vs 44% respectively, p¼.0013) and had a household income of $50,000 or more (72% vs 46%, p<.0001). There was a significant difference in the acceptance rate for HIV testing between hospital A and B (27% vs 73%, p<0.0001). This difference was evident along demographic lines. Black patients at hospital B were more likely to accept HIV testing (56%) while white patients were more likely to opt out (37%, p<.0118); there was no significant difference in test acceptance along racial lines at Hospital A. Hispanic or Latino patients at hospital A were more likely to agree to an HIV test (21% vs 8%, respectively, p<.0258); there was no significant difference based on ethnicity at Hospital B. Conclusions: Although the study was conducted at two EDs in close proximity to one another, the patient populations were significantly different. These differences were significantly associated with the rate of HIV testing acceptance. Those individuals who presented to hospital A were more commonly white, affluent, more educated, and were significantly more likely to refuse testing. In comparison, hospital B saw more patients who were black, had less education, had a lower total household income, and were more likely to accept an ED HIV test.
283
Implementing a Diversion Clinic To Treat Lower-Acuity Emergency Department Patients and Provide Follow-Up Care
Lansburg JM, Roque P, Debartolo P, Anand N/Banner Health, Phoenix, AZ; Maricopa Medical Center, Phoenix, AZ
Study Objectives: We sought to evaluate the feasibility of implementing an outpatient, emergency department (ED) diversion clinic on the premises of a large medical center. Methods: This was a retrospective, descriptive study of patients treated in an outpatient, ED diversion clinic during an 11-month period. Low-acuity patients from the on-campus ED were evaluated by a provider and if eligible, were screened out and offered same-day, immediate care in the clinic. Demographics and satisfaction data for clinic patients was analyzed. Results: The clinic treated 6,101 patients from May 2012 through February 2013. Approximately 40% of clinic volume (n¼2447) accounted for patients who were
Volume 62, no. 4s : October 2013
276
An Operational Analysis of Integrating Screening and Brief Intervention into the Normal Workflow of the Emergency Department Without Additional Resources
Slain T, Rickard-Aasen S, Pringle J, Hegde GG, Shang J, Johnjulio W, Venkat A /Allegheny General Hospital, Pittsburgh, PA; Program Evaluation Research Unit, University of Pittsburgh School of Pharmacy, Pittsburgh, PA; Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA; West Penn Allegheny Health System, Pittsburgh, PA
Study Objectives: Screening and Brief Intervention (SBI) protocols for emergency department (ED) patients with evidence of alcohol or drug abuse can help prevent future at-risk behavior. However, to date, such ED programs have largely used external funding or additional personnel resources to execute SBI. Our objectives were to evaluate whether SBI could be integrated into the normal workflow of the ED without additional resources, identify demographic and operational factors associated with failure to properly perform the SBI protocol and report revenue collection from SBI. Methods: We conducted a retrospective, observational analysis of a protocol adding SBI to the normal workflow of a single, tertiary care ED (census: 50,000) for all adult patients in 2012. ED staff received ongoing training on SBI from 2010. From 1/12, ED nurses pre-screened for evidence of alcohol or drug abuse/at-risk behavior in adult patients during the social history triage assessment and, when positive, executed SBI during nursing care in the treatment area, all documented in our electronic medical record (EMR). We downloaded from the EMR demographic (age, sex, race, insurance status, acuity [ESI] level) and operational (mode and time of patient arrival, ED daily census, admission status) data on all adult ED visits in 2012 and whether pre-screening and, if positive, SBI was performed. Using multivariable logistic regression, we report demographic and operational factors significantly associated with failure to initiate and execute the SBI protocol by odds ratios (OR), 95CI and Wald Factors (initiation analysis alone due to its large sub-cohort size). Beginning in 10/12, we submitted itemized charges for brief intervention to discharged patients’ insurers and report collections. Results: A total of 47693 visits by 31525 patients met inclusion criteria (Mean Age: 48, 48.4% male, 63% white, 32% black). A total of 39758 (83.4%) eligible visits had triage SBI protocol initiation. Demographic and operational variables significantly associated with decreased odds of SBI protocol initiation were decreasing age (OR for rising age association with SBI initiation: 1.044 95CI (1.042-1.045), Wald: 2906.2), arrival by ambulance (OR: 0.37 95CI (0.35-0.40), Wald: 863.4) and ESI acuity level 1 or 2 (OR: 0.08 95CI (0.07-0.09), Wald: 2585.5). 971 visits (2% of all visits) had documented brief interventions. Two hundred fifty-one additional visits (0.53% of all visits, 20.5% of potential brief intervention visits) had no brief intervention documented despite the SBI protocol indicating by positive pre-screen and screen that this should have taken place. Demographic and operational variables associated with decreased odds of brief intervention execution were female sex (OR: 0.61 95CI (0.430.86)) and decreasing ED census (OR for rising ED census association with brief intervention execution: 1.012 95CI (1.01-1.02). $3617.53 was collected on $10829.15 charged (33.4% collection rate) from 262 visits with itemized billing for brief intervention. Conclusions: This trial indicates that SBI integration into the normal workflow of the ED is operationally feasible without additional resources. Variables most associated with failure to properly perform the SBI protocol were younger, female, higher acuity patients arriving by ambulance. Revenue collection for SBI remains challenging.
277 278
Withdrawn ‘From the ED2PMD’: A Text Messaging Program to Connect Adolescents to a Health Home
Malbon KM, Fleisher D, Soghomonian C, Paul A/Mount Sinai Adolescent Health Center, New York, NY; Mount Sinai Hospital, New York, NY
Background: Adolescents are frequent users of the ED often for non-urgent complaints. Those attending the ED frequently lack a medical home. Increased access to primary care for non-urgent complaints can decrease use of the ED. Proximity to an ED and inability to obtain a clinic appointment contribute to adolescents’ use of the ED and highlight the need for cost effective transition to a medical home. Adolescents report favorable attitudes towards communicating via texting with healthcare providers.
Volume 62, no. 4s : October 2013
Texting is a cost-effective means of increasing outpatient attendance and communicating with high-risk patients, but has not been studied in transitioning adolescents from the ED to primary care. We hypothesize that connecting adolescents to a “health home” will encourage fewer subsequent visits to the ED for primary care needs. Study Objectives: To evaluate the effect of text messaging on encouraging primary care follow-up at an adolescent health center (MSAHC), for adolescents who sought care at an emergency department (ED). Methods: The study took place at Mount Sinai Pediatric Emergency Department (ED) in New York City from November 2012 to March 2013. Male and female patients, ages 15-22 years, attending the ED were asked to indicate their interest in receiving text messages from the ED on the initial registration form. Patients who requested text messages provided their cell number, service provider, and preferred language (English/Spanish). Enrolled cell numbers were entered into a text messaging platform within twenty-four hours of attendance at the ED. They received a series of automated text messages encouraging appropriate primary care follow-up at an adolescent health center. Patients received two messages per week for four weeks, including health center information, hours and location. Mount Sinai Adolescent Health Center (MSAHC) is a non-profit clinic providing free primary care for uninsured adolescents, located within walking distance of the Mount Sinai ED. Demographics and diagnosis were abstracted from the electronic medical record (age, race and ethnicity, home address zip code, diagnosis, health insurance status). Previous attendance and follow-up at MSAHC within 10 weeks of their ED visit was documented. Results: There were 2440 patients, ages 15-22 years, enrolled in the study. Thirty-eight (38%) percent consented to receive texts. Preliminary analysis using a chi-square test revealed a significant relationship between receipt of texts and follow-up at the MSAHC within 10 weeks of the ED visit. X2 (1, N¼2440) ¼ 3.88, p¼0.049. Forty-six percent of adolescents who received text messages followed up at the AHC within 10 weeks of their first ED visit. Follow-up at MSAHC beyond 10 weeks of the ED visit was also significant. X2 (1, N¼2240) ¼ 4.5, p¼0.033. Sixty-two (62%) percent of adolescents who did not follow-up did not receive text messages. Conclusions: Text messaging is a feasible and effective tool for increasing outpatient follow-up after an ED visit at a primary care facility, potentially relieving an additional burden on the ED and promoting health care in the transition to adult medicine. Establishing a connection with a primary care provider will enable adolescents to have a better and more comprehensive health care that is otherwise absent for much of the ED-frequenting population.
279
Ultra-Low Cost Uterine Balloon Tamponade Package for Postpartum Hemorrhage Control Among Health Providers in Kenya
Burke TF, Nelson BD, Eckardt M, Dulo L, Oguttu M, Maua J, Qureshi Z, Ahn R /Massachusetts General Hospital, Division of Global Health and Human Rights, Boston, MA; African Institute for Innovation and Technology, Kisumu, Kenya; Division of Reproductive Health, Ministry of Health, Kenya, Kenya; University of Nairobi Medical School, Nairobi, Kenya
Study Objectives: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Emergency uterine balloon tamponade (UBT) has been shown to be an effective technique for managing uncontrolled PPH in developed countries; however, little is known about effectiveness of UBT to treat the larger burden of PPH among facility-based providers in resource-constrained settings. Our study objective is to test the hypothesis that a UBT package, including training and an ultra-low-cost uterine balloon for uncontrolled PPH, is effective and safe when used by maternal health providers in Kenya. Methods: A rigorous quantitative and qualitative analysis using case study methodology to examine UBT use by providers in 12 maternal health facilities in Kenya that have been trained on the UBT package. The simple UBT device is comprised of a catheter, condom, and syringe. Prospective enrollment data includes number of maternal deaths per severe hemorrhage cases per month per health facility, subsequent to UBT implementation. We also collected historical control data (i.e., 2 years prior to UBT implementation) on these same measures. Results: To date we have amassed individual use data on 16 cases of emergency UBT use and conducted study interviews associated with the same 16 cases. Trained maternal health providers in our study applied UBT in appropriate clinical situations, and UBT was effective in controlling PPH in these cases. No deaths occurred among
Annals of Emergency Medicine S101
Research Forum Abstracts the 16 cases. We will report on subsequent cases of UBT as they emerge throughout 2013. Conclusions: Preliminary analysis indicates that an ultra-low cost emergency uterine balloon implementation package is effective for managing uncontrolled PPH among community-based providers in Kenya. Further research is needed, however, given the compelling individual examples of mother’s lives saved strong consideration should be given to rapidly scaling UBT to a national level in Kenya, and beyond.
280
Health-Related Behavior of Patients Presenting to an Urban Emergency Department
Kwon NS, Colucci A, McStay C, Chiang WK/NYU School of Medicine/Bellevue Hospital Center, New York, NY; NNYU School of Medicine/Bellevue Hospital Center, New York, NY; NYU School of Medicine/Bellevue Hospital CenterYU School of Medicine/Bellevue Hospital Center, New York, NY
Study Objectives: To survey the health care practices of patients presenting to the emergency department (ED) of an inner-city public hospital in 2011. Methods: A cross-sectional study was undertaken on a convenience sample of ED patients who were at least 18 years of age. Research associates (RAs) approached consecutive patients presenting to the ED during shifts. Survey questions included demographic information and questions regarding screening and preventative care, medical history, physical activity, use of poison control, advanced directives, and behavioral health. Means were utilized to analyze data. Results: A total of 1492 patients were entered in the study. Most patients considered themselves Hispanic (33%). More males (55%) than females (45%) were surveyed. The majority (54%) stated their primary source of health care advice was from the ED. The majority (83%) were unaware of a way to contact Poison Control in the event of an overdose. The medical conditions that patients reported in our sample closely matched national averages (hypertension 29%, diabetes 14%, heart disease 10%). A significant percentage of patients reported no physical activity in the past month (35%), and the majority of patients reported themselves to be at least a little overweight (56%). A large percentage of patients were self-reported smokers (28%), and many women reported that they lacked a regular source of gynecologic care (32%). Conclusions: Utilizing the ED as a primary source of health care is a significant problem. Many patients reported medical problems and behavioral health practices where the ED could be a location to provide intervention.
281
Exploratory Study of Emergency Physicians’ Use of a Prescription Drug Monitoring Program Using a Framework of Technology Acceptance
Fleming ML, Wattana MK, Hatfield MD, Todd KH/University of Houston, Houston, TX; MD Anderson Cancer Center, Houston, TX
Study Objective: Emergency physicians face the challenge of caring for acute and chronic pain patients daily and are among the top prescribers of opioids. The objective of this study was to understand factors influencing emerency physicians intention to use a prescription drug monitoring program (PDMP) during patient care. Information from this study can be used to guide future PDMP software enhancements and provider education to promote use of PDMPs as a tool to aid prescribing decisions. Methods: This was a cross-sectional study at a single institution. The study group consisted of emergency physicians attending a citywide emergency medicine conference. A 24-item questionnaire, based on a theoretical model of technology acceptance, was developed to assess physician adoption and attitudes toward the Texas PDMP (Prescription Access in Texas). Items related to technology acceptance (perceived ease of use, perceived usefulness, attitude and intention) were assessed using Likert scale responses (1¼strongly disagree to 5¼strongly agree). Descriptive statistics and multiple linear regression were used to assess predictors of intention. Results: The majority of respondents were from academic EDs (76.7%) with 51% being attending physicians. Females were less likely to be registered for PDMP access (p¼0.03). Among pre-adopters (not registered), perceived ease of use, perceived usefulness and attitude explained 65.6% of the variance in intention to utilize the PDMP. Emergency physicians attitude was the primary predictor of intention (b¼0.58, p<0.001). Lack of awareness (32.1%) was the primary reason cited by emergency physicians not registered. Conclusions: The theoretical framework of technology acceptance was shown to be useful in explaining emergency physicians intention to utilize the PDMP. Additionally,
S102 Annals of Emergency Medicine
emergency physicians expressed a very favorable attitude and intention towards PDMP use. Considering the positive perceptions expressed towards PDMP use, improving awareness through provider education may lead to increased registration and utilization. Emergency physicians use of the PDMP may play an integral role in mitigating prescription drug abuse, while improving patient care.
282
The Association Between Patient Demographics and the Acceptance of Routine HIV Screening in the Emergency Department
Acerra J, Hill A, Baner N, Goltser Y, Gurr D, Akerman M, Kintzer E, Haddad S, Silverman R, Ward MF/Long Island Jewish Medical Center, New Hyde Park, NY
Background: In 2006, the CDC released new recommendations stating that all patients between 13 and 64 years of age should be offered routine, opt-out HIV screening. Two New York City area emergency departments (EDs) (A and B) have recently enacted policies related to routine HIV testing in the ED to comply with this recommendation and a recent NY State law which mandates the CDC guidelines. Study Objective: The purpose of this study is to identify the factors associated with accepting or refusing HIV testing in two EDs (within the same health system) with diverse patient demographics. Methods: This was a prospective, anonymous study conducted in two suburban, university-affiliated EDs over three months. Patients in the ED were given a survey regarding the reasons for patients’ acceptance or refusal of HIV testing and were allowed privacy to complete the survey anonymously. This convenience sample included patients between the ages of 18 and 64. Patients known to be HIV-positive were excluded. Survey responses of subjects at each hospital were assessed for the association between demographic characteristics and willingness to undergo HIV testing. Univariate analyses using the chi-square test or Fisher’s exact test, as deemed appropriate for categorical data, were used to compare patients who accept or decline HIV screening. Results: A total of 250 surveys were completed at each site (n¼500). There were significant differences between the patient populations at each ED. There were differences in race at hospital A and B respectively (22% vs 40% Blacks, 6% vs 9% Asians, 12% vs 17% Other and 60% vs 34% White, p<.0001). Hospital A had a significantly higher percentage of individuals who held an Associate’s degree or higher (57% vs 44% respectively, p¼.0013) and had a household income of $50,000 or more (72% vs 46%, p<.0001). There was a significant difference in the acceptance rate for HIV testing between hospital A and B (27% vs 73%, p<0.0001). This difference was evident along demographic lines. Black patients at hospital B were more likely to accept HIV testing (56%) while white patients were more likely to opt out (37%, p<.0118); there was no significant difference in test acceptance along racial lines at Hospital A. Hispanic or Latino patients at hospital A were more likely to agree to an HIV test (21% vs 8%, respectively, p<.0258); there was no significant difference based on ethnicity at Hospital B. Conclusions: Although the study was conducted at two EDs in close proximity to one another, the patient populations were significantly different. These differences were significantly associated with the rate of HIV testing acceptance. Those individuals who presented to hospital A were more commonly white, affluent, more educated, and were significantly more likely to refuse testing. In comparison, hospital B saw more patients who were black, had less education, had a lower total household income, and were more likely to accept an ED HIV test.
283
Implementing a Diversion Clinic To Treat Lower-Acuity Emergency Department Patients and Provide Follow-Up Care
Lansburg JM, Roque P, Debartolo P, Anand N/Banner Health, Phoenix, AZ; Maricopa Medical Center, Phoenix, AZ
Study Objectives: We sought to evaluate the feasibility of implementing an outpatient, emergency department (ED) diversion clinic on the premises of a large medical center. Methods: This was a retrospective, descriptive study of patients treated in an outpatient, ED diversion clinic during an 11-month period. Low-acuity patients from the on-campus ED were evaluated by a provider and if eligible, were screened out and offered same-day, immediate care in the clinic. Demographics and satisfaction data for clinic patients was analyzed. Results: The clinic treated 6,101 patients from May 2012 through February 2013. Approximately 40% of clinic volume (n¼2447) accounted for patients who were
Volume 62, no. 4s : October 2013