LO51: Incidence of clinically relevant medication errors after implementation of an electronic medication reconciliation process

Abstract

Inter-rater review of 4.5% of abstracted health records revealed a kappa score of 0.8. Conclusion: This study highlights that a remarkably low proportion of HFUs received allied health consultations at the study sites, likely corresponding to a lack of available consultants outside of daytime work hours. Our findings suggest the need to address significant gaps in order to balance the clinical needs of patients who frequent the ED with currently available resources. Keywords: frequent users, administration, emergency department crowding LO50 Headache presentations to emergency departments in Alberta: understanding investigative approaches C. Alexiu, BSc, L. Krebs, MPP, MSc, C. Villa-Roel, MD, PhD, S.W. Kirkland, MSc, B.R. Holroyd, MD, MBA, M. Ospina, PhD, C. Pryce, BScN, MN, J. Bakal, PhD, S.E. Jelinski, PhD, DVM, E. Lang, MD, G. Innes, MD, B.H. Rowe, MD, MSc, University of Alberta, Edmonton, AB Introduction: Headaches are a common emergency department (ED) presentation. The objective of this study was to characterize headache presentations in Alberta over a five-year period and explore the proportion of patients with potentially severe pathology. Methods: Administrative health data for Alberta (years 2011-2015) were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (>17 years) headache presentations (ICD-10-CA: G43, G44, R51). Patients with a primary or secondary diagnosis code of headache were eligible for inclusion in the study. Exclusions were made using the following criteria: 1) sites without computed tomography (CT) scanners; 2) presentations with a Canadian Triage and Acuity Scale (CTAS) score of 1; 3) patients with trauma or external mechanism of injury (e.g., ICD-10-CA codes S,T, V,W,X,Y); and 4) presentations receiving an enhanced/contrast CT (head). NACRS data were linked with a provincial diagnostic imaging data. Data are reported as means and standard deviation (SD), medians and interquartile range (IQR) or proportions, as appropriate. Results: From 2011-2015, 98,333 presentations were made by 66,970 patients (~0.3 presentations per patient per year; equivalent to one presentation every 3.4 years). Headache presentations increased from 15,643 in 2011 to 21,636 in 2015. The median age was 38 years (IQR: 29, 51 years); more patients were female (69.3%), had a CTAS score of 3 (55%) and arrived at the ED without ambulance (90.3%). The majority of patients had a primary ED diagnosis of headache (88%) and the most common co-diagnosis was benign hypertension (2.8%). Additional diagnoses indicating severe or pathological headaches, included: stroke (0.63%), subarachnoid hemorrhage (0.43%), infection (i.e., meningitis) (0.11%), and other brain hemorrhages (0.08%). Overall, the ED management of approximately 25% of presentations involved a head CT. Most patients were discharged from the ED (89.4%) after a median length of stay of 3.5 hours (IQR: 2.1, 5.2 hours). Conclusion: Headache-related ED presentations are increasing in Alberta, yet few severe/pathological diagnoses are ...