Predictors of Frequent Emergency Department Utilization for Mental Health Reasons

The Journal of Behavioral Health Services & Research - Overcrowding in emergency departments (ED) jeopardizes quality and access to health care, which represents a major issue for service...     

Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization

Maternal and Child Health Journal - Pediatric primary care and home visiting programs seek to reduce health disparities and promote coordinated health care use. It is unclear whether these services...     

浅析医院急诊科医疗设备的安全有效利用

本文简要阐述了急诊科设备的基本配备和仪器设备的安全使用,希望能为同行用以借鉴。     

急诊科建设与管理

急诊科是近20年来兴起的一门多个专业临床独立学科,具有应急性、综合性、风险性和不间断性的特点,在急性病、危重病的救治以及应对突发公共卫生事件和灾难事件上发挥越来越重要的作用。本文论述了当前急诊科建设和管理中存在的6个方面的主要问题,提出了加强急诊科管理和建设5个方面的措施。     

Factors Associated With Emergency Department Utilization By Urban Lesbian, Gay, And Bisexual Individuals

There are no published studies to date on emergency department (ED) utilization by the lesbian, gay, and bisexual (LGB) community despite documented lack of access to health care for this community. This study explored the frequency of ED visits and socio-demographic and health-related factors associated with ED utilization among a convenience sample of LGB individuals. A sample of 360 LGB individuals was interviewed to assess socio-demographics, sexual practices, mental health, drug use, chronic disease history, and frequency of emergency department use. Emergency department utilization was categorized as 0, 1, or ≥2 visits. Bivariate statistics were applied to assess the association of various factors with emergency department utilization. Patient characteristics were as follows: age, 29.0; male, 53.1 percent; Hispanic, 57.8 percent; Black, 37.2 percent; and reported less than a college degree, 79.4 percent. Most (77.7 percent) had a primary care doctor and (86.3 percent) were comfortable discussing LGB-related health issues with their provider. Over 12 months, 25.3 percent had 1 ED visit and 16.4 percent had ≥2 ED visits. One or more emergency department visits was significantly associated with lower age, lower education, lower income, recent psychological distress, recent mental health counseling or medications, desired mental health treatment, abuse by partner, cigarette use, marijuana use, and asthma (p < 0.05). Despite reported access to primary care, our LGB sample exhibited a higher proportion of single and ≥2 ED visits than comparable populations. Mental health and cigarette use were associated with emergency department utilization and deserve further exploration for reducing emergency department visitation by and improving emergency department care for LGB individuals.     

Visiting the Emergency Department for Dental Problems: Trends in Utilization, 2001 to 2008

Objectives. We tested the hypothesis that between 2001 and 2008, Americans increasingly relied upon emergency departments (EDs) for dental care.Methods. Data from 2001 through 2008 were collected from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Population-based visit rates for dental problems, and, for comparison, asthma, were calculated using annual US Census Bureau estimates. As part of the analysis, we described patient characteristics associated with large increases in ED dental utilization.Results. Dental visit rates increased most dramatically for the following subpopulations: those aged 18 to 44 years (7.2–12.2 per 1000, P < .01); Blacks (6.0–10.4 per 1000, P < .01); and the uninsured (9.5–13.2 per 1000, P < .01). Asthma visit rates did not change although dental visit rates increased 59% from 2001 to 2008.Conclusions. There is an increasing trend in ED visits for dental issues, which was most pronounced among those aged 18 to 44 years, the uninsured, and Blacks. Dental visit rates increased significantly although there was no overall change in asthma visit rates. This suggests that community access to dental care compared with medical care is worsening over time.Medically underserved patients are increasing their reliance upon emergency departments (EDs) as a safety net provider because of absent or inadequate access to other sources of medical care.1 Many Americans turn to the ED for a variety of health care needs, including dental care, when access to professional dental care is limited.2 Visits to the ED for dental issues have been shown to increase as Medicaid reimbursement declines or is eliminated.3,4 Recent literature has linked the loss of state Medicaid dental benefits along with increases in dental ED use and expenditures to the decrease in utilization of preventive services.5,6 Age-related trends in dental disease may contribute to an overall increased need for dental services over time. Specifically, middle-aged and older adults are experiencing greater rates of tooth retention, thus increasing the demand for care in this cohort.To date, there are no published reports that quantify temporal trends in national ED utilization patterns for dental issues, although there are several reasons to believe dental care is more difficult to access than medical care. Dental insurance coverage, in addition to provider workforce, health beliefs, and social determinants of health, is one of many important factors in promoting dental care utilization, particularly for vulnerable populations.7–10 First, a greater number of Americans have medical insurance compared with dental insurance, with estimates of as many as 130 million Americans without dental coverage.11 Second, public and private insurance programs tend to cover medical care more extensively than dental care for adults, resulting in higher out-of-pocket cost for dental care.12–14 Medicaid-covered adult dental benefits vary between states but generally are limited to individuals with incomes well below the poverty line and to emergency dental care. Recent state budget cuts have further limited adult dental care options. The majority of low-income adults do not receive basic dental care and experience limited coverage, access, and use of dental care.15 As a result, access to dental care is dependent on both insurance coverage and sufficient discretionary income. Third, although medical care for the uninsured and underinsured is supported by an extensive public health safety net, the dental public health infrastructure is quite limited.16 Federally Qualified Health Centers (FQHCs) and FQHC Look-Alikes (community health centers that resemble FQHCs but do not receive grant funding) serve an increasing role in providing primary care to underserved areas. From 2007 to 2010 the number of FQHCs increased from 1067 (16 050 835 patients) to 1124 (19 469 467 patients).17 The FQHC patient demographic comprises mostly low-income, underinsured patients or those on public insurance programs. FQHCs and Look-Alikes that receive federal grant funding must provide access to dental services for their patients. However, FQHCs face difficulties in recruitment and retention of dental providers.18In the absence of adequate community-based dental care, another source of dental care for vulnerable populations are EDs, which are staffed by medical providers and rarely employ dentists. Seeking care in the ED for a dental issue often results in temporizing treatment through symptomatic relief (antibiotics and narcotics), which does not definitively treat the underlying disease process.19a Therefore, use of the ED for dental problems is a marker for disparities in dental care quality and access.We hypothesized that with secular changes over time (e.g., economic downturn, increased unemployment, budget deficits, public program reductions), access to appropriate sources of dental care would decrease, resulting in increased ED utilization for dental problems. The unemployment rate, according to the Bureau of Labor Statistics, was 4.6% before the most recent recession (2006) and peaked at 10.3% (2009).19b We hypothesized that there is a positive relationship between the recent economic recession and higher utilization of EDs for untreated dental problems, which serves as a marker for reduced access to preventive dental care. We also hypothesized that, although similar factors would also impact access to medical care, there would be a more substantial rise in ED dental visits for the reasons discussed above. Therefore, we expected a greater increase in ED dental utilization compared with ED use for ambulatory-care sensitive conditions.     

Emergency Department Utilization Among American Indian Adolescents Who Made a Suicide Attempt: A Screening Opportunity

PurposeReservation-based American Indian adolescents are at significant risk for suicide. Preventive approaches have not focused on medical service utilization patterns on reservations, which are typically limited to one local emergency department (ED). Patterns of ED utilization before suicide attempts were evaluated to identify opportunities for screening and intervention.MethodsCross-sectional study of Apache adolescents (aged 13–19 years) who attempted suicide and consented to medical chart review. Lifetime presenting problems for Indian Health Service ED visits before the index suicide attempt were extracted and coded.ResultsA total of 1,424 ED visits from 72 Apache adolescents were extracted (median lifetime visits, n = 18). In the year before the attempt, 82% (n = 59) of participants had had an ED visit for any reason and 26% (n = 19) for a psychiatric reason, including suicidal thoughts or self-harm.ConclusionsService utilization data suggest that EDs are critical locations for reservation-based suicide prevention. Suicide screening for all ED patients could increase early identification and treatment of this at-risk group.     

自主型模式急诊科的功能与管理

目的探讨自主型模式急诊科的功能和管理.方法回顾性分析我院急救中心2002年1月至2003年12月的临床资料,急诊出车3 284次,急诊门诊接诊48 350例次,急诊抢救660例,收住急诊病房1896例,收住其它专科病房3 998例,急诊病房住院病人手术592例,其中危重病人手术54例.结果距医院5公里以内的出诊,10分钟以内可到达现场,经现场急救后,转运途中无死亡,急诊抢救成功率92%;一般手术无死亡,危重病手术死亡7例,死亡率13%.结论自主型模式急诊科集院前急救、院内急救、确定性急诊手术、重症监护治疗为一体,有利于急救程序的管理,明显提高了危重病抢救成功率,同时也培养和发展了一支急诊医学队伍.     

Rural Emergency Department Staffing and Participation in Emergency Certification and Training Programs

ABSTRACT:  Context: The practice of emergency medicine presents many challenges in rural areas. Purpose: We describe how rural hospitals nationally are staffing their Emergency Departments (EDs) and explore the participation of rural ED physicians and other health care professionals in selected certification and training programs that teach skills needed to provide high-quality emergency care. Methods: A national telephone survey of a random sample of rural hospitals with 100 or fewer beds was conducted in June to August 2006. Respondents included ED nurse managers and Directors of Nursing. A total of 408 hospitals responded (96% response rate). Findings: A majority of rural hospitals use more than one type of staffing to cover the ED. The type of staffing varies by time period and ED volume. On weekdays, about onethird of hospitals use physicians on their own medical staff; one third use contracted coverage; 18% use both; and 14% use physician assistants and/or nurse practitioners with a physician on-call. Hospitals are more likely to use a combination of medical staff and contracted coverage on evenings and weekends. Advanced Cardiac Life Support training is common, but Pediatric Advanced Life Support, Advanced Trauma Life Support, and training in working as a team are less common. More registered nurses working in rural EDs have taken the Trauma Nursing Core Course than the Emergency Nursing Pediatric Course. Conclusions: Rural ED staff would benefit from additional continuing education opportunities, particularly in terms of specialized skills to care for pediatric emergency patients and trauma patients and training in working effectively in teams .     

心理护理在急诊科的应用

目的观察心理护理对急诊科患者的应用效果。方法对120例急诊科就诊的患者实施心理护理干预,并调查患者满意度。结果患者满意度达99．5％。结论实施积极有效的心理护理方法,可明显改善急诊科的护患关系,杜绝护患纠纷发生,取得较好的社会效益。     

急诊科的现状及加强急诊工作的几点建议

鉴于该院急诊工作的现状及管理中存在的带有共性的问题,提出了加强急诊工作的几点建议:加强急诊工作领导必须高度重视;增加急诊医务人员配备,从根表上解决急诊一线人手紧缺、硕此失彼的状况;保证急诊医务人员的素质,使其胜任工作;发展进取,保证急诊专业的竞争优势;稳定急诊医务人员队伍势在必行;确保急诊医务人员的人身安全,维持正常的医疗工作秩序。     

急诊预检分诊制度的探讨

预检分诊标准直接影响绿色通道的救治质量。在研究国内外急诊预检分诊制度的基础上,结合实际,对急诊布局和预检分诊实践进行了探讨。