Use of the Emergency Room in a Community Hospital

White, H. A.; O'Connor, P

doi:10.2307/4593817

Cited by 25 publications

(6 citation statements)

References 2 publications

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“…Our data reveal several aspects of ED care of the elderly not described before. Though on the average older people make more visits to physicians per year than younger people, our study confirms previous studies indicating that older people do not visit EDs much more often than younger people 4,6,8–13 . However, the over‐representation of the very elderly (≥75 years of age) in an ED population has not been previously reported.…”

Section: Discussionsupporting

confidence: 88%

“…We do not know how this might affect the comparisons of demographic data between the catchment area and the ED population. Large differences have been noted in ED care between facilities in different areas of the same city based on the characteristics of the local population 4,8–15 . Second, our population had higher rates of insurance coverage than many other EDs.…”

Section: Discussionmentioning

confidence: 82%

“…Although demographic data exist on ED patients, 4,6,8–13 few have been analyzed by age. Furthermore, few data are available on the process of care given patients in the ED and how care given to elderly patients differs from that given to younger people.…”

mentioning

confidence: 99%

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Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care

Baum

Rubenstein

1987

J American Geriatrics Society

167

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Little is known about how the care received in emergency departments (ED) by the elderly population differs from that received by younger people. We prospectively abstracted ED records of 1620 consecutive patients visiting a large community hospital ED over a 22-day period in 1984 for demographic and medical variables. Charts of patients presenting with five specific complaints (dyspnea, chest pain, abdominal pain, syncope, and motor vehicle accidents) were also analyzed for process of care variables and, for patients hospitalized, the accuracy of the ED diagnosis. Older people (ie, those greater than or equal to 65 years of age) do not seem to be overutilizers of the ED for minor complaints, in fact, they tend to be more acutely ill on presentation than younger people. Older people were more likely to be hospitalized (46% v 10%, P less than .001), to arrive by ambulance (35% v 10%, P less than .001), and to have an identified source of primary care (95% v 64%, P less than .01). Older people stayed longer in the ED than younger people if they were eventually released home but shorter if admitted to the hospital. Test ordering patterns for specific complaints varied by patient age (eg, older patients had more electrocardiograms performed for chest pain and fewer urinalyses for abdominal pain than younger patients). Therapy for specific complaints showed less age effect. Although generally more diagnostic tests were performed on older patients, the ED diagnosis tended to be more accurate for younger patients. Our data indicate that the process of ED care may be substantially different for the elderly population and have implications for future planning and financing of medical care.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 82%

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Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care

Baum

Rubenstein

1987

J American Geriatrics Society

167

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“…These findings are in accord with those of other surveys of psychiatric emergencies (l ,6, 10,17) but not for emergency visits as a whole (3,15,18,22), where the age range is skewed to favour children and the elderly.…”

Section: Commentssupporting

confidence: 82%

Utilization of Emergency Departments for Psychiatric Treatment

1978

Canadian Psychiatric Association Journal

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A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

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“…This trend has continued over the past five decades. A preponderance of the literature regarding the ER addresses issues of inefficiency, high cost, and over utilization (Alpert, Kosa, and Haggerty 1969;Buesching, Jablonowski and Vesta 1985;Gill and Riley, 1996;White and O'Connor 1970). The primary role of the ER/ED is to treat patients with lifethreatening conditions, although that role continues to be expanded to include the treatment of a greater number of patients with minor illness.…”

Section: Introduction Background Informationmentioning

confidence: 99%

A Descriptive Analysis of Nonurgent Emergency Room Utilization at William Beaumont Army Medical Center

Kuntz¹

1999

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Report Documentation PageForm Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. REPORT DATE APR 19992. REPORT TYPE The object of this study was to determine the percentage of patients seen in the WBAMCER for conditions triaged as nonurgent during a seven-month period from June to December in 1998. Additionally, the study, utilizing pre-recorded data, desired to determine if 12 independent variables were associated with nonurgent utilization of the ER. The registered nurses on duty triaged a total of 2,173 patients that met inclusion criteria. A large number (n=1260, 58% of sample) were triage to level 4 (nonurgent). Patients triaged to level 3 (treat within 24 hours) accounted for 37.8% (n=821). The remaining level two (urgent) and level one (emergent) accounted for nearly equal percentages of the population at 2.3% (n=49) and 2.0% (n=43) respectively. The typical profile of ER utilization by frequency showed the greatest usage by female active duty dependents between the ages of 18-35 who are CHAMPUS eligible and enrolled in TRICARE Prime. This profile also depicts the typical user as someone who presents with a sprain or strain on a weekday during the hours of 0700-1500. This profile is further typified by a person or sponsor between the rank of E5 and E9 with no third party insurance, lived in zip code 79924 (6 miles from WBAMC) and released without limitation after being treated in the ER. This study strengthens and quantifies the long-standing belief among practitioners and administrators regarding the prevalence of nonurgent use in the ER at WBAMC. These nonurgent patients may be candidates for referral to a more appropriate level of care, typically primary care, without a significant risk for deterioration of their condition. Identifying and quantifying this population is the first step in shaping important organizational initiative aimed at self-care education, utilization of telephone advice and triage, and other out patient medical management programs. Thank you to everyone who made this project a truly rewarding experience. SUBJECT TERMS Nonurgent Emergency Room Utilizationii AbstractThe object of this study was to determine the percentage of patients seen in the WBAMC ER for conditions triaged as nonurgent during a seven-month period from Ju...

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Use of the Emergency Room in a Community Hospital

Cited by 25 publications

References 2 publications

Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care

Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care

Utilization of Emergency Departments for Psychiatric Treatment

A Descriptive Analysis of Nonurgent Emergency Room Utilization at William Beaumont Army Medical Center

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