A Retrospective Review of Emergency Department Visits That May Be Appropriate for Management in Non-Emergency Settings.

Autor: Tapia AD; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA.; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN 37830, USA., Howard JT; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN 37830, USA.; Department of Public Health, University of Texas at San Antonio, San Antonio, TX 78249, USA.; Consequences of Trauma Working Group, Center for Community-Based and Applied Health Research, University of Texas at San Antonio, San Antonio, TX 78249, USA., Bebo NL; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA., Pfaff JA; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA., Chin EJ; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA., Trueblood WA; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA., April MD; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA.; 40th Forward Resuscitative Surgical Team, Fort Carson, CO 80918, USA., Long BJ; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA., Long AN; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA., Fernandez WG; Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA., Schauer SG; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA.; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Department of Military and Emergency Medicine, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA.
Jazyk: angličtina
Zdroj: Military medicine [Mil Med] 2022 Aug 25; Vol. 187 (9-10), pp. e1153-e1159.
DOI: 10.1093/milmed/usab553
Abstrakt: Background: Emergency departments (EDs) continue to struggle with overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for non-emergent medical issues or injuries that could readily be handled in a primary care setting. We analyzed encounters in the ED at the Brooke Army Medical Center-the largest hospital in the Department of Defense-to determine the percentage of visits that could potentially be managed in a lower cost, appointment-based setting.
Materials and Methods: We conducted a retrospective chart review of patients within our electronic medical record system from September 2019 to August 2020, which represented equidistance from the start of the COVID-19 pandemic, resulting in a shift in ED used based on previously published data. Our study also compared the number of ED visits pre-covid vs. post-covid. We defined visits to be primary care eligible if they were discharged home and received no computed tomography imaging, ultrasound, magnetic resonance imaging, intravenous medications, or intramuscular-controlled substances.
Results: During the 12 month period, we queried data on 75,205 patient charts. We categorized 56.7% (n = 42,647) of visits as primary care eligible within our chart review. Most primary-care-eligible visits were ESI level 4 (59.2%). The largest proportion of primary-care-eligible patients (28.3%) was seen in our fast-track area followed by our pediatric pod (21.9%). The total number of ED visits decreased from 7,477 pre-covid to 5,057 post-covid visits. However, the proportion of patient visits that qualified as primary care eligible was generally consistent.
Conclusions: Over half of all ED visits in our dataset could be primary care eligible. Our findings suggest that our patient population may benefit from other on-demand and appointment-based healthcare delivery to decompress the ED.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze: MEDLINE
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