Emergency Department Observation Units and the Older Patient

Moseley, Mark; Hawley, Miles P.; Caterino, Jeffrey M.

doi:10.1016/j.cger.2012.09.002

Cited by 37 publications

(30 citation statements)

References 92 publications

(128 reference statements)

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“…Over the past decade, the use of ED observation units (EDOU) has risen sharply, with over one third of all EDs having an EDOU [21]. Patients are commonly placed in the EDOU for a short course of IV antibiotics before discharge home [22,23]. This is the first report on ED patients treated as outpatients and risk factors for AAD/CDI.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics

Haran

Hayward

Skinner

et al. 2014

The American Journal of Emergency Medicine

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Objective Antibiotic-associated diarrhea (AAD) and Clostridium difficile infection (CDI) are well-known outcomes from antibiotic administration. Because emergency department (ED) visits frequently result in antibiotic use, we evaluated the frequency of AAD/CDI in adults treated and discharged home with new prescriptions for antibiotics to identify risk factors for acquiring AAD/CDI. Methods This prospective multicenter cohort study enrolled adult patients who received antibiotics in the ED and were discharged with a new prescription for antibiotics. Antibiotic-associated diarrhea was defined as 3 or more loose stools for 2 days or more within 30 days of starting the antibiotic. C difficile infection was defined by the detection of toxin A or B within this same period. We used multivariate logistic regression to assess predictors of developing AAD. Results We enrolled and followed 247 patients; 45 (18%) developed AAD, and 2 (1%) developed CDI. Patients who received intravenous (IV) antibiotics in the ED were more likely to develop AAD/CDI than patients who did not: 25.7% (95% confidence interval [CI], 17.4–34.0) vs 12.3% (95% CI, 6.8–17.9). Intravenous antibiotics had adjusted odds ratio of 2.73 (95% CI, 1.38–5.43), and Hispanic ethnicity had adjusted odds ratio of 3.04 (95% CI, 1.40–6.58). Both patients with CDI had received IV doses of broad-spectrum antibiotics. Conclusion Intravenous antibiotic therapy administered to ED patients before discharge was associated with higher rates of AAD and with 2 cases of CDI. Care should be taken when deciding to use broad-spectrum IV antibiotics to treat ED patients before discharge home.

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Section: Discussionmentioning

confidence: 99%

Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics

Haran

Hayward

Skinner

et al. 2014

The American Journal of Emergency Medicine

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“…Yaşlılar daha muhtemel olarak sersemlik hissine sebep olan tıbbi tedavi alıyor olabilirler. Presenkop riski de yaşla birlikte artmaktadır ve ortostatik hipotansiyon, otonomik fonksiyon bozukluğu ve ritim bozukluklarıyla ilişkili olabilir 30,31 .…”

Section: Fizyopatolojiunclassified

Acil Serviste Vertigoya Yaklaşım

Koçer¹,

Avcı²,

Karakısa³

et al. 2017

Arşiv Kaynak Tarama Dergisi

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Vertigo is one of the frequent causes of admissions to emergency services. Vertigo and dizziness should be distinguished on admission. It should be well known that dizziness might based on more underlying problems with vital abnormalities compared to vertigo. Medication reduces the symptoms and mainstay of treatment is vestibular tests. The aims of this review are to distinguish central and peripheral vertigo, evaluate approaches to discharge patients form the emergency room with simple maneuvers and describe general approach to the patients that require further evaluation and treatment.

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“…asthma, chest pain) and who need a short period of additional monitoring and therapy before going home. The observation unit can function as a temporary shelter for an injured older adult, 29 but in most cases difficult decisions will still need to be made regarding the site of further care. Establishing partnerships between ED observation units and local assisted living facilities might help to expedite the transition for patients with the ability to pay for this resource, but this is not a solution for patients with limited financial resources.…”

Section: Paths Out Of Purgatorymentioning

confidence: 99%

A Modern‐Day Purgatory: Older Adults in the Emergency Department with Nonoperative Injuries

Platts‐Mills

T.²,

McBride

2014

J American Geriatrics Society

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Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These patients typically do not meet criteria for an ‘inpatient’ hospital admission. However, because of the limited reimbursement for observation patients, admitting physicians are often reluctant to accept these patients in to observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in-home care is also often difficult or impossible. As a result, older patients with non-operative injuries often spend a long time in the ED waiting for an appropriate disposition. We describe the challenges of identifying an appropriate disposition for these patients, the consequences for patients, and some potential solutions to this commonly encountered problem.

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Emergency Department Observation Units and the Older Patient

Cited by 37 publications

References 92 publications

Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics

Factors influencing the development of antibiotic associated diarrhea in ED patients discharged home: risk of administering IV antibiotics

Acil Serviste Vertigoya Yaklaşım

A Modern‐Day Purgatory: Older Adults in the Emergency Department with Nonoperative Injuries

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