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

Abstract

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.

Predictors of returns to the emergency department after head and neck surgery

“…Emergency department visits are a common route of hospital readmission. Postoperative complications are a frequent reason for otolaryngology patients to present to the emergency department . Young et al reviewed 30dEDRs in patients who underwent thyroidectomy or parathyroidectomy.…”

Epidemiology of otologic diagnoses inUnitedStates emergency departments

“…Although this study was not geared to directly answer the question of access, patient presentation to the ED may to be related to patient education or difficulty obtaining immediate access to primary care providers, and significant research has addressed patient decision making for visiting the ED versus outpatient setting for other diagnoses . Prior studies evaluating dedicated otolaryngology and ophthalmology EDs have also demonstrated that the majority of problems evaluated in an “emergency” setting are actually not true emergencies, and these patients may place additional strain on the healthcare safety net . Moreover, as many otologic diagnoses are potentially due to an infectious etiology, there may be overuse (or incorrect use) of antibiotics …”

“…Although most otologic complaints do not require rapid evaluation and treatment, the concept of a regionalized system for triage of particular complaints may also be applied to more common diagnoses and provide an additional mechanism to decrease nonurgent complaints in EDs. Previous reports have demonstrated the potential for urgent care or retail clinics, or even subspecialty EDs adjacent to standard EDs that may be able to provide rapid access to specialists.…”

“…[26][27][28] Prior studies evaluating dedicated otolaryngology and ophthalmology EDs have also demonstrated that the majority of problems evaluated in an "emergency" setting are actually not true emergencies, and these patients may place additional strain on the healthcare safety net. [29][30][31][32][33][34] Moreover, as many otologic diagnoses are potentially due to an infectious etiology, there may be overuse (or incorrect use) of antibiotics. 35,36 The abundance of otologic-related visits raises important issues regarding training, staffing, and hospital-based resource allocation.…”

Referral patterns from emergency department to otolaryngology clinic

“…In 2011, it has been estimated that diagnoses such as dizziness and vertigo and otitis media and eustachian tube disorders accounted for almost 4 million and 2 million ED visits, respectively . The overwhelming number of ENT‐related ED visits has spawned the creation of otolaryngology‐specific EDs to address this high demand for services . Although these appear to be a cost‐beneficial method for addressing acute ENT complaints, can offload a sizeable number of general ED visits, and even augment residency education, staffing is a potential challenge and they have not yet become commonplace .…”