Emergency Care: Then, Now, And Next

Kellermann, Arthur L.; Hsia, Renee Y.; Yeh, Charlotte S.; Morganti, Kristy Gonzalez

doi:10.1377/hlthaff.2013.0683

Cited by 57 publications

(41 citation statements)

References 32 publications

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“…Moreover, new triage mechanisms may be utilized to best manage patients. For example, the Institute of Medicine Committee on the Future of Emergency Care recommends the development of a regionalized system of emergency care to increase access to specialty care . In a regionalized system, hospitals, emergency care providers, and administrators coordinate specialist expertise to allocate resources.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of otologic diagnoses inUnitedStates emergency departments

et al. 2015

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Objective Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient population. We aim to identify utilization of EDs by patients with primary otologic complaints. Study Design Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011. Methods The NEDS database was queried for patient encounters with a primary otologic diagnosis based on ICD9 codes (380–389). Weighted estimates for demographic, diagnostic characteristics, SES, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression. Results A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (Standard Error [SE] = 0.23). Overall, 62.7% of patients that presented with an otologic complaint were 0–17 years old. The most common diagnoses among all age groups included otitis media NOS (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%). Conclusions We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrates significant number of visits related to otologic complaints, especially in the pediatric population, that are non-emergent.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of otologic diagnoses inUnitedStates emergency departments

et al. 2015

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“…The Institute of Medicine Committee on the Future of Emergency Care recommended the development of a regionalized system of emergency care to increase access to specialty care. 23 In a regionalized system, hospitals, emergency care providers, nurses and administrators work together to coordinate expertise and distribution of resources. The model of direct access to specialists is currently in development for patients with diagnoses of cardiac arrest and stroke, as well as for pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…The model of direct access to specialists is currently in development for patients with diagnoses of cardiac arrest and stroke, as well as for pediatric patients. 23 While all otolaryngologic complaints often do not require specialist-level care, a regionalized system of expertise, whether a stand-alone ER or a dedicated team focused on otolaryngologic complaints by emergency room and/or otolaryngology providers, may lead to improved care coordination and address many of the concerns previously introduced. Moreover, as the implementation of the Patient Protection and Affordable Care Act nears completion, the anticipated number of common otolaryngologic complaints seen in EDs will likely increase significantly.…”

Section: Discussionmentioning

confidence: 99%

Subspecialty emergency room as alternative model for otolaryngologic care: Implications for emergency health care delivery

Sethi

Kozin

Remenschneider

et al. 2014

American Journal of Otolaryngology

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Purpose A dedicated otolaryngology emergency room (ER) represents a specialized surgical evaluation and treatment setting that may be an alternative triage pathway for acute otolaryngologic complaints. We aim to characterize practice patterns in this setting and to provide insight into the epidemiology of all-comer, urgent otolaryngologic complaints in the United States. Methods and Methods Electronic medical records were reviewed for all patients who registered for otolaryngologic care and received a diagnosis in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Predictors of inpatient admission were identified using multivariable regression. Geocoding analysis was performed to characterize catchment area. Results A total of 12,234 patient visits were evaluated with a mean age of 44.7. Auditory and vestibular problems constituted the most frequent diagnoses (50.0%). The majority of patients were discharged home (92.3%). Forty-three percent of patients underwent a procedure in the ER; the most common procedure was diagnostic nasolaryngoscopy (52%). Predictors of inpatient admission were post-operative complaint (odds ratio [OR] 7.3, p<0.0001), arrival overnight (OR 3.3, p<0.0001), and laryngeal complaint (OR 2.4, p<0.0001). Patients travelled farther for evaluation of hearing loss (11 miles) and less for common diagnoses including impacted cerumen (7.1 miles) (p<0.0001). Conclusion In this report, we investigate practice patterns of a dedicated otolaryngology emergency room to explore an alternative to standard acute otolaryngologic health care delivery mechanisms. We identify key predictors of inpatient admission. This study has implications for emergency health care delivery models.

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“…Hospital‐based emergency care has made remarkable progress in research, training, and technical capabilities, but such achievements might be compromised by growing demand and declining financial support (Kellermann et al. ).…”

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confidence: 99%