On the basis of estimates from a nationally representative sample of U.S. emergency departments from 2004 through 2013, approximately 23,000 emergency department visits annually are attributed to ...adverse events related to dietary supplements.
Herbals (botanical products), complementary nutritionals (e.g., amino acids), and micronutrients (vitamins and minerals) are all considered to be dietary supplements by the Dietary Supplement Health and Education Act of 1994.
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Although supplements cannot be marketed for the treatment or prevention of disease, they are often taken to address symptoms or illnesses, as well as to maintain or improve overall health.
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The estimated number of supplement products increased from 4000 in 1994
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to more than 55,000 in 2012 (the most recent year for which data are publicly available),
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and approximately half of all adults in the United States report having used . . .
Objective
To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a “patch” to the algorithm.
Data Sources
The ...Nationwide Emergency Department Sample.
Study Design
We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD‐9 diagnosis codes. We updated the algorithm with ICD‐9 and ICD‐10 codes added since 2001.
Principal Findings
The percentage of unclassifiable visits increased from 11.2 percent in 2006 to 15.5 percent in 2012 (p < .01), because of new diagnosis codes. Our update improves the classification rate by 43 percent in 2012 (p < .01).
Conclusions
Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research.
The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend ...EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England.
A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.
Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the ...implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED).
We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS).
There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval CI: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge.
A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.
Background Safety after the second dose of the SARS-CoV-2 vaccine remains to be elucidated, especially among individuals reporting adverse events after their first dose. This study aims to evaluate ...the impact of a delayed second dose on all-cause mortality and emergency services. Methods A territory-wide, retrospective cohort of people who had completed two doses of mRNA (BNT162b2) or inactivated SARS-CoV-2 (CoronaVac) vaccine between February 23 and July 3, 2021, in Hong Kong was analyzed, with linkage to electronic health records retrieved from the Hong Kong Hospital Authority. Vaccine recipients were classified as receiving a second dose within recommended intervals (21-28 days for BNT162b2; 14-28 days for CoronaVac) or delayed. Study outcomes were all-cause mortality, emergency department (ED) visits, and unscheduled hospitalizations within 28 days after the second dose of vaccination. Results Among 417,497 BNT162b2 and 354,283 CoronaVac second dose recipients, 3.8% and 28.5% received the second dose beyond the recommended intervals (mean 34.4 and 31.8 days), respectively. During the study period, there were < 5 daily new cases of COVID-19 infections in the community. Delaying the second dose was not associated with all-cause mortality (hazard ratio HR = 1.185, 95% CI 0.478-2.937, P = 0.714), risk of ED visit (HR = 0.966, 95% CI 0.926-1.008, P = 0.113), and risk of unscheduled hospitalization (HR = 0.956, 95% CI 0.878-1.040, P = 0.294) compared to that within the recommended interval for CoronaVac recipients. No statistically significant differences in all-cause mortality (HR = 4.438, 95% CI 0.951-20.701, P = 0.058), ED visit (HR = 1.037, 95% CI 0.951-1.130, P = 0.411), and unscheduled hospitalization (HR = 1.054, 95% CI 0.867-1.281, P = 0.597) were identified between people who received a second dose of BNT162b2 within and beyond the recommended intervals. Conclusions No significant association between delayed second dose of BNT162b2 or CoronaVac and all-cause mortality, ED visit, and unscheduled hospitalization was observed in the present cohort. Regardless of the recommended or delayed schedule for SARS-CoV-2 vaccination, a second dose of both vaccines should be administered to obtain better protection against infection and serious disease. The second dose should be administered within the recommended interval following the manufacturer's product information, until further studies support the benefits of delaying vaccination outweighing the risks.
Background: Emerging evidence has integrated short-term exposure to PMsub.1 with children's morbidity and mortality. Nevertheless, most available studies have been conducted on a daily scale, ...ignoring the exposure variations over the span of a day. Objective: The main intention of this study was to examine the association between pediatric emergency department visits (PEDVs) and intra-day exposures to PMsub.1 and PMsub.2.5. We also aimed to investigate whether a high PMsub.1/PMsub.2.5 ratio elevated the risk of PEDVs independent from PMsub.2.5 exposure within several hours. Methods: We collected hourly data on aerial PMsub.1 and PMsub.2.5 concentrations, all-cause PEDVs, and meteorological factors from two megacities (i.e., Guangzhou and Shenzhen) in southern China during 2015-2016. Time-stratified case-crossover design and conditional logistic regression analysis were used to assess the associations of PEDVs with exposures to PMsub.1 and PMsub.2.5 at different lag hours. The contribution of PMsub.1 to PMsub.2.5-associated risk was quantified by introducing PMsub.1/PMsub.2.5 ratio as an additional exposure indicator in the analysis adjusting for PMsub.2.5. Subgroup analyses were performed stratified by sex, age, and season. Results: During this study period, 97,508 and 101,639 children were included from Guangzhou and Shenzhen, respectively. PMsub.1 and PMsub.2.5 exposures within several hours were both remarkably related to an increased risk of PEDVs. Risks for PEDVs increased by 3.9% (95% confidence interval CI: 2.7-5.0%) in Guangzhou and 3.2% (95% CI: 1.9-4.4%) in Shenzhen for each interquartile range (Guangzhou: 21.4 μg/msup.3, Shenzhen: 15.9 μg/msup.3) increase in PMsub.1 at lag 0-3 h, respectively. A high PMsub.1/PMsub.2.5 ratio was substantially correlated with increased PEDVs, with an excess risk of 2.6% (95% CI: 1.2-4.0%) at lag 73-96 h in Guangzhou and 1.2% (95% CI: 0.4-2.0%) at lag 0-3 h in Shenzhen. Stratified analysis showed a clear seasonal pattern in PM-PEDVs relationships, with notably stronger risks in cold months (October to March of the following year) than in warm months (April to September). Conclusions: Exposures to ambient PMsub.1 and PMsub.2.5 within several hours were related to increased PEDVs. A high PMsub.1/PMsub.2.5 ratio may contribute an additional risk independent from the short-term impacts of PMsub.2.5. These findings highlighted the significance of reducing PMsub.1 in minimizing health risks due to PMsub.2.5 exposure in children.
Overcrowding is common in most emergency departments (ED). Despite the use of validated triage systems, some patients are at risk of delayed medical evaluation. The objective of this study was to ...assess the impact of a patient-flow physician coordinator (PFPC) on the proportion of patients offered medical evaluation within time limits imposed by the Swiss Emergency Triage Scale (SETS) and on patient flow within the emergency department of a teaching urban hospital.
In this before-after retrospective cohort study, we compared the proportions of patients who received their first medical contact within SETS-imposed time limits, mean waiting times before first medical consultation, mean length of stay, and number of patients who left without being seen by a physician, between two periods before and after introducing a PFPC. The PFPC was a senior physician charged with quickly assessing in the waiting area patients who could not immediately be seen and managing patient flow within the department.
Before introducing the PFPC position, 33,605 patients were admitted, versus 36,288 after. Introducing a PFPC enabled the department to increase the proportion of patients seen within the SETS-imposed time limits from 60.1% to 69.0% (p <0.0001). Waiting times until first medical consultation were reduced on average by 27.7 minutes (95% confidence interval 95% CI: 25.9-29.5, p < .0001). No significant differences were observed as to length of stay or number of patients who left without being seen between the two study periods.
Introducing a physician dedicated to managing patient flow enabled waiting times until first medical consultation to be reduced, yet had no significant benefit for patient flow within the ED, nor did it reduce the number of patients who left without being seen.
On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). As the number of persons hospitalized with COVID-19 increased, early reports from ...Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29-April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31-April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged ≤14 years, females, and the Northeast region. Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed. To minimize SARS-CoV-2, the virus that causes COVID-19, transmission risk and address public concerns about visiting the ED during the pandemic, CDC recommends continued use of virtual visits and triage help lines and adherence to CDC infection control guidance.
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services ...for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these ...recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates.
Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI.
Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P < .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management.
There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.
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