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Mol S, Gaakeer MI, van der Linden MC, Baan-Kooman ECM, Backus BE, de Ridder VA. Crowding, perceived crowding and workload in Dutch emergency departments: should we continue on the same road? Eur J Emerg Med 2023; 30:229-230. [PMID: 37115965 DOI: 10.1097/mej.0000000000001034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Sander Mol
- Emergency Department, Franciscus Gasthuis & Vlietland, Rotterdam
| | | | | | | | - Barbra E Backus
- Emergency Department, Franciscus Gasthuis & Vlietland, Rotterdam
| | - Victor A de Ridder
- Emergency Department, Department of Trauma Surgery and Pediatric Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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2
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van Loon-van Gaalen M, Voshol IE, van der Linden MC, Gussekloo J, van der Mast RC. Frequencies and reasons for unplanned emergency department return visits by older adults: a cohort study. BMC Geriatr 2023; 23:309. [PMID: 37198554 DOI: 10.1186/s12877-023-04021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND As unplanned Emergency Department (ED) return visits (URVs) are associated with adverse health outcomes in older adults, many EDs have initiated post-discharge interventions to reduce URVs. Unfortunately, most interventions fail to reduce URVs, including telephone follow-up after ED discharge, investigated in a recent trial. To understand why these interventions were not effective, we analyzed patient and ED visit characteristics and reasons for URVs within 30 days for patients aged ≥ 70 years. METHODS Data was used from a randomized controlled trial, investigating whether telephone follow-up after ED discharge reduced URVs compared to a satisfaction survey call. Only observational data from control group patients were used. Patient and index ED visit characteristics were compared between patients with and without URVs. Two independent researchers determined the reasons for URVs and categorized them into: patient-related, illness-related, new complaints and other reasons. Associations were examined between the number of URVs per patient and the categories of reasons for URVs. RESULTS Of the 1659 patients, 222 (13.4%) had at least one URV within 30 days. Male sex, ED visit in the 30 days before the index ED visit, triage category "urgent", longer length of ED stay, urinary tract problems, and dyspnea were associated with URVs. Of the 222 patients with an URV, 31 (14%) returned for patient-related reasons, 95 (43%) for illness-related reasons, 76 (34%) for a new complaint and 20 (9%) for other reasons. URVs of patients who returned ≥ 3 times were mostly illness-related (72%). CONCLUSION As the majority of patients had an URV for illness-related reasons or new complaints, these data fuel the discussion as to whether URVs can or should be prevented. TRIAL REGISTRATION For this cohort study, we used data from a randomized controlled trial (RCT). This trial was pre-registered in the Netherlands Trial Register with number NTR6815 on the 7th of November 2017.
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Affiliation(s)
- Merel van Loon-van Gaalen
- Emergency Department, Haaglanden Medical Center, P.O. Box 432, 2501 CK, The Hague, The Netherlands.
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, CAPRI-University Antwerp, Antwerp, Belgium
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van Nieuwkerk JL, van der Linden MC, Verheul RJ, Gaalen MVLV, Janmaat M, van der Linden N. The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial. World J Emerg Med 2023; 14:257-264. [PMID: 37425086 PMCID: PMC10323509 DOI: 10.5847/wjem.j.1920-8642.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed. METHODS The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals. RESULTS Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05). CONCLUSION For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples.
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Affiliation(s)
- Johan L. van Nieuwkerk
- Emergency Department, Haaglanden Medical Centre & Emergency Medical Services Haaglanden, the Hague 2501 CB, the Netherlands
| | | | - Rolf J. Verheul
- Laboratory Services, Haaglanden Medical Centre, the Hague 2501 CK, the Netherlands
| | | | - Marije Janmaat
- Faculty of Health, University of Applied Sciences Leiden, Leiden 2300 AJ, the Netherlands
| | - Naomi van der Linden
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft 2628 BX, the Netherlands
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Gifford R, van der Vaart T, Molleman E, van der Linden MC. Working together in emergency care? How professional boundaries influence integration efforts and operational performance. IJOPM 2022. [DOI: 10.1108/ijopm-10-2021-0644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeEmergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.Design/methodology/approachTo provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.FindingsThe authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.Originality/valueThis study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.
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van Loon-van Gaalen M, van der Linden MC, Gussekloo J, van der Mast RC. Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial. J Am Geriatr Soc 2021; 69:3157-3166. [PMID: 34173229 PMCID: PMC9290482 DOI: 10.1111/jgs.17336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/10/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Background/Objectives Telephone follow‐up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow‐up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge. Design Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group. Setting Two ED locations of a non‐academic teaching hospital in The Netherlands. Participants Community‐dwelling adults aged ≥70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104). Intervention Intervention group patients: semi‐scripted telephone call from an ED nurse within 24 h after discharge to identify post‐discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call. Measurements Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge. Secondary outcomes: separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge. Results Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30‐day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96–1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group. Conclusion Telephone follow‐up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30 days. These results raise the question of whether other outcomes could be improved by post‐discharge ED telephone follow‐up.
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Affiliation(s)
| | | | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University Antwerp, Antwerp, Belgium
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6
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Lemmens CMC, van der Linden MC, Jellema K. The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department. Front Neurol 2021; 12:663353. [PMID: 34040577 PMCID: PMC8141591 DOI: 10.3389/fneur.2021.663353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Headache is among the most prevalent complaints in patients presenting to the emergency department (ED). Clinicians are faced with the difficult task to differentiate primary (benign) from secondary headache disorders, since no international guidelines currently exist of clinical indicators for neuroimaging in headache patients. Methods: We performed a retrospective review of 501 patients who presented at the ED with headache as a primary complaint between April 2018 and December 2018. Primary outcomes included the amount of diagnostic imaging, the different conclusions provided by diagnostic imaging, and the clinical factors associated with abnormal imaging results. Results: About half of the patients were diagnosed with a primary headache disorder. Cranial CT imaging at the ED was performed regularly (61% of the patients) and led to the diagnosis of underlying pathology in 1 in 7.6 patients. In a multivariate model, factors significantly associated with abnormal cranial CT results were age 50 years or older, presentation within 1 h after headache onset, clinical history of aphasia, and focal neurological deficit at examination. Conclusions: As separate clinical characteristics have limited value in detecting severe underlying headache disorders, cranial imaging is regularly performed in the ED. Clinical prediction model tools applied to headache patients may identify patients at risk of intracranial pathology prior to diagnostic imaging and reduce cranial imaging in the future.
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Affiliation(s)
| | | | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
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7
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Veen M, van der Zwaal P, van der Linden MC. Documentation of Procedural Sedation by Emergency Physicians. Drug Healthc Patient Saf 2021; 13:95-100. [PMID: 33854381 PMCID: PMC8039431 DOI: 10.2147/dhps.s278507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/12/2021] [Indexed: 11/23/2022]
Abstract
Introduction Patients presenting to the emergency department (ED) frequently require procedural sedation and analgesia (PSA) to facilitate procedures, such as joint reduction. Proper documentation of screening demonstrates awareness of the necessity of presedation assessment. It is unknown if introducing emergency physicians (EPs) at the ED improves presedation assessment and documentation. In this study the differences in documentation of ED sedation and success rates for reduction of hip dislocations in the presence versus absence of EPs are described. Methods In this retrospective descriptive study, we analyzed data of patients presenting with a dislocated hip post total hip arthroplasty (THA) shortly after the introduction of EPs. The primary outcome measure was the presence of documentation of presedation assessment. Secondary outcomes were documentation of medication, vital signs, and success rate of hip reductions. Results In the two-year study period, 133 sedations for hip reductions were performed. Sixty-eight sedations were completed by an EP. The documentation of fasting status, airway screening, analgesia use, and vital signs was documented significantly more often when an EP was present (respectively 64.9%, 80.3%, 37.4%, and 72.7%, all P < 0.001). There was no difference in success rate of hip reductions between the groups. Conclusion PSA in the ED is associated with superior documentation of presedation assessment, medication, and vital signs when EPs are involved.
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Affiliation(s)
- Mischa Veen
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Peer van der Zwaal
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
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8
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van Loon-van Gaalen M, van Winsen B, van der Linden MC, Gussekloo J, van der Mast RC. The effect of a telephone follow-up call for older patients, discharged home from the emergency department on health-related outcomes: a systematic review of controlled studies. Int J Emerg Med 2021; 14:13. [PMID: 33602115 PMCID: PMC7893958 DOI: 10.1186/s12245-021-00336-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background Older patients discharged from the emergency department (ED) are at increased risk for adverse outcomes. Transitional care programs offer close surveillance after discharge, but are costly. Telephone follow-up (TFU) may be a low-cost and feasible alternative for transitional care programs, but its effects on health-related outcomes are not clear. Aim We systematically reviewed the literature to evaluate the effects of TFU by health care professionals after ED discharge to an unassisted living environment on health-related outcomes in older patients compared to controls. Methods We conducted a multiple electronic database search up until December 2019 for controlled studies examining the effects of TFU by health care professionals for patients aged ≥65 years, discharged to an unassisted living environment from a hospital ED. Two reviewers independently assessed eligibility and risk of bias. Results Of the 748 citations, two randomized controlled trials (including a total of 2120 patients) met review selection criteria. In both studies, intervention group patients received a scripted telephone intervention from a trained nurse and control patients received a patient satisfaction survey telephone call or usual care. No demonstrable benefits of TFU were found on ED return visits, hospitalization, acquisition of prescribed medication, and compliance with follow-up appointments. However, many eligible patients were not included, because they were not reached or refused to participate. Conclusions No benefits of a scripted TFU call from a nurse were found on health services utilization and discharge plan adherence by older patients after ED discharge. As the number of high-quality studies was limited, more research is needed to determine the effect and feasibility of TFU in different older populations. PROSPERO registration number CRD42019141403. Supplementary Information The online version contains supplementary material available at 10.1186/s12245-021-00336-x.
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Affiliation(s)
- Merel van Loon-van Gaalen
- Emergency Department, Haaglanden Medical Center, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Britt van Winsen
- Emergency Department, Haaglanden Medical Center, P.O. Box 432, 2501, CK, The Hague, The Netherlands
| | | | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University, Antwerp, Belgium
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9
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de Kok BM, Eijlers B, van der Linden MC, Quarles van Ufford HME. Lean-driven interventions, including a dedicated radiologist, improve diagnostic imaging turnaround time and radiology report time at the emergency department. Emerg Radiol 2020; 28:23-29. [PMID: 32577933 DOI: 10.1007/s10140-020-01803-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Emergency departments (EDs) worldwide face crowding, which negatively affects patient care. Diagnostic imaging plays a major role in management of ED patients and contributes to patients' length of stay at the ED. In this study, the impact of Lean-driven interventions on the imaging process at the ED was assessed. METHODS During a 6-month multimodal intervention period, Lean-driven interventions and a dedicated radiologist present at the ED were implemented during peak hours (12 a.m.-8 p.m.). Data concerning patient population, radiology department turnaround time (RDTT), radiology report time (RRT), and examination time (ET) for ED patients were compared with a control period of 6 months 1 year earlier. RESULTS RDTT, RRT, and ET were significantly shorter in the intervention period compared with those in the control period. Median RDTT was respectively 36 min (interquartile range (IQR) 24-56) and 70 min (IQR 39-127), RRT 11 min (IQR 6-21) and 37 min (IQR 15-88), and ET 22 min (IQR 14-35) and 23 min (14-38). CONCLUSION Lean-driven interventions on the imaging process at the ED significantly reduced RDTT, RRT, and ET.
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Affiliation(s)
- Bente M de Kok
- Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands.
| | - Bram Eijlers
- Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands
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10
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Richards JR, Placone TW, Wang CG, van der Linden MC, Derlet RW, Laurin EG. Methamphetamine, Amphetamine, and MDMA Use and Emergency Department Recidivism. J Emerg Med 2020; 59:320-328. [PMID: 32546441 DOI: 10.1016/j.jemermed.2020.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emergency department (ED) recidivism and the use of amphetamine and associated derivatives such as methamphetamine and MDMA (MAE), are intersecting public health concerns. OBJECTIVE This study aims to determine the frequency of ED recidivism of patients who use MAE and associated factors. METHODS The study was a retrospective 6-year electronic medical record review of patients with MAE-positive toxicology screens and single and multiple ED visits in the span of 12 months. RESULTS There were 7844 ED visits by 5568 MAE-positive patients. Average age was 42 ± 13 years. The majority were male (65%), white (46%), tobacco smokers (55%), and in the psychiatric discharge diagnostic-related group (41%), followed by blunt trauma (20%). Admission rate was 35%, with another 17% transferred to inpatient psychiatric treatment facilities. Occasional (2-5 visits/year), heavy (6-11 visits/year), and super users (≥12 visits/year) altogether accounted for 20% of patients and 43% of visits. Heavy and super users combined represented 2% of patients and 10% of visits, with significant differences for race/ethnicity, health insurance, tobacco smoking, and psychiatric/cardiovascular/trauma discharge diagnostic-related groups. Heavy and super users were less likely to be admitted and more likely to be discharged to an inpatient psychiatric treatment facility. Regression analysis revealed racial/ethnic differences, female gender, and tobacco smoking to be associated with super and heavy use. Heavy users were more likely to have cardiovascular-related discharge diagnoses. CONCLUSIONS The prevalence of ED recidivism in patients who use MAE is similar to published ranges for general ED users. Significant differences in demographics, discharge diagnoses, insurance, smoking, and disposition exist between nonfrequent and frequent ED users.
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Affiliation(s)
- John R Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Taylaur W Placone
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Colin G Wang
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Robert W Derlet
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Erik G Laurin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
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van der Linden MC, van den Wijngaard IR, van der Linden S, van der Linden N. Night-time confusion in an elderly woman post-stroke. BMJ Case Rep 2020; 13:13/5/e230693. [PMID: 32444438 DOI: 10.1136/bcr-2019-230693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Recently hospitalised patients are not only recovering from their acute illness; they also experience a period of generalised risk for a range of adverse events. At the same time, elderly generally prefer living in their own homes and should be discharged from the hospital and return home as quickly as possible. Both premature and delayed discharge are potential threats to patient well-being. We present a 90-year-old patient who underwent successful thrombectomy but suffered from night-time confusion at the hospital and discuss the transition process from hospital to home.
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Affiliation(s)
| | | | | | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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12
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van Loon M, Van der Mast RC, van der Linden MC, van Gaalen FA. Routine alcohol screening in the ED: unscreened patients have an increased risk for hazardous alcohol use. Emerg Med J 2020; 37:206-211. [PMID: 31932395 DOI: 10.1136/emermed-2019-208721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/07/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Routine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use. METHODS This is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients. RESULTS Of the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate. CONCLUSION Patients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage.
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Affiliation(s)
- Merel van Loon
- Emergency Department, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Roos C Van der Mast
- Department of Psychiatry, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands.,Department of Psychiatry, CAPRI, Antwerp, Belgium
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
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13
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Mérelle SYM, Boerema I, van der Linden MC, Gilissen R. [Issues in emergency care for people who attempted suicide]. Ned Tijdschr Geneeskd 2018; 162:D2463. [PMID: 30040297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine issues in care for patients who come to the emergency department after a suicide attempt. DESIGN Cross-sectional multicentre questionnaire survey. METHOD In 2015, 7 emergency departments across the Netherlands participated in a questionnaire survey of the 113 Suicide Prevention (113 Zelfmoordpreventie) service as a part of the 2014-2017 National Suicide Prevention Agenda. Emergency physicians and nurses and managers answered 25 multiple-choice questions about: (a) current treatment of and contact with patients who attempted suicide, (b) available knowledge and skills of emergency physicians and nurses and (c) after-care for patients who attempted suicide. RESULTS In total, 33 emergency physicians, 40 emergency nurses and 5 managers completed the questionnaire. When a patient comes to the emergency department after a suicide attempt, emergency physicians and nurses often consult with the crisis service, psychiatrist or a colleague and they request extra diagnostics. The most important issue indicated by emergency staff is that they do not have enough time, knowledge and skills to estimate the suicide risk and to conduct a conversation with the patient about her or his suicidal thoughts. One-fifth of the respondents indicated that they do not always treat patients who committed a previous suicide attempt with respect. The respondents also thought that the emergency department environment is too restless or unsafe and thought that they have to wait for the crisis service for a long time. The majority of the emergency physicians and nurses worried about the condition of the patient after her or his discharge, especially when they estimate a high probability of another suicide attempt. CONCLUSION Insufficient knowledge and skills of emergency department staff, a sometimes negative attitude towards people who attempted suicide and a heavy workload are hindering care at the emergency department for people who attempted suicide. Targeted training, a quiet area and deployment of specialised care could improve this care.
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van Veelen MJ, van den Brand CL, Reijnen R, van der Linden MC. Effects of a general practitioner cooperative co-located with an emergency department on patient throughput. World J Emerg Med 2016; 7:270-273. [PMID: 27942343 DOI: 10.5847/wjem.j.1920-8642.2016.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2013 a General Practitioner Cooperative (GPC) was introduced at the Emergency Department (ED) of our hospital. One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED. To determine the change in patient flow, we assessed the number of self-referrals, redirection of self-referrals to the GPC and back to the ED, as well as ward and ICU admission rates and length of stay of the remaining ED population. METHODS We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands. RESULTS More than half of our ED patients were self-referrals. At triage, 54.5% of these self-referrals were redirected to the GPC. After assessment at the GPC, 8.5% of them were referred back to the ED. The number of patients treated at the ED declined with 20.3% after the introduction of the GPC. In the remaining ED population, there was a significant increase of highly urgent patients (P<0.001), regular admissions (P<0.001), and ICU admissions (P<0.001). Despite the decline of the number of patients at the ED, the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period, a total increase of 270 hours in two months (P<0.001). CONCLUSION Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.
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Affiliation(s)
- Michiel J van Veelen
- Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, Botswana
| | | | - Resi Reijnen
- Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands
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van der Linden MC, Lindeboom R, van der Linden N, van den Brand CL, Lam RC, Lucas C, de Haan R, Goslings JC. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral. Int J Emerg Med 2014; 7:28. [PMID: 25097670 PMCID: PMC4110705 DOI: 10.1186/s12245-014-0028-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. METHODS A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ (2) tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. RESULTS Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were 'accessibility and convenience' and perceived 'medical necessity'. CONCLUSIONS A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem.
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Affiliation(s)
| | - Robert Lindeboom
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, The Netherlands
| | - Crispijn L van den Brand
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Rianne C Lam
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Cees Lucas
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Rob de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
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16
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van der Linden MC, Lindeboom R, de Haan R, van der Linden N, de Deckere ER, Lucas C, Rhemrev SJ, Goslings JC. Unscheduled return visits to a Dutch inner-city emergency department. Int J Emerg Med 2014; 7:23. [PMID: 25045407 PMCID: PMC4100563 DOI: 10.1186/s12245-014-0023-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems. METHODS All unscheduled return visits occurring within 1 week and related to the initial ED visit were selected. Multivariable logistic regression was conducted to determine independent factors associated with unscheduled return, using patient information available at the initial visit. Reasons for returning unscheduled were categorized into illness-, patient- or physician-related. Post-ED disposition was compared between patients with unscheduled return visits and the patients who did not return. RESULTS Five percent (n = 2,492) of total ED visits (n = 49,341) were unscheduled return visits. Patients with an urgent triage level, patients presenting during the night shift, with a wound or local infection, abdominal pain or urinary problems were more likely to return unscheduled. Reasons to revisit unscheduled were mostly illness-related (49%) or patient-related (41%). Admission rates for returning patients (16%) were the same as for the patients who did not return (17%). CONCLUSIONS Apart from abdominal complaints, risk factors for unscheduled return differ from previous studies. Short-term follow-up at the outpatient clinic or general practitioner for patients with urgent triage levels and suffering from wounds or local infections, abdominal pain or urinary problem might prevent unscheduled return.
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Affiliation(s)
| | - Robert Lindeboom
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Rob de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands
| | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam 3000 DR, The Netherlands
| | - Ernie Rjt de Deckere
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Cees Lucas
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Steven J Rhemrev
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - J Carel Goslings
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
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van den Brand CL, van der Linden MC, van der Linden N, Rhemrev SJ. Fracture prevalence during an unusual period of snow and ice in the Netherlands. Int J Emerg Med 2014; 7:17. [PMID: 24872860 PMCID: PMC4017960 DOI: 10.1186/1865-1380-7-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background The objective of the current study was to assess the effect of an unusual 10-day snow and ice period on the prevalence of fractures in an emergency department (ED) in the Netherlands. Furthermore, patients with fractures during the snow and ice period were compared to those in the control period with respect to gender, age, location of accident, length of stay, disposition, and anatomical site of the injury. Methods Fracture prevalence during a 10-day study period with snow and ice (January 14, 2013 until January 23, 2013) was compared to a similar 10-day control period without snow or ice (January 16, 2012 until January 25, 2012). The records of all patients with a fracture were manually selected. Besides this, basic demographics, type of fracture, and location of the accident (inside or outside) were compared. Results A total of 1,785 patients visited the ED during the study period and 1,974 during the control period. A fracture was found in 224 patients during the study period and in 109 patients during the control period (P <0.01). More fractures sustained outside account for this difference. No differences were found in gender, mean age, and length of ED stay. However, during the snow and ice period the percentage of fractures in the middle-aged (31–60 yrs) was significantly higher than in the control period (P <0.01). Conclusions The number of fractures sustained more than doubled during a period with snow and ice as compared to the control period. In contrast to other studies outside the Netherlands, not the elderly, but the middle-aged were most affected by the slippery conditions.
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Affiliation(s)
- Crispijn L van den Brand
- Emergency Department, Medical Centre Haaglanden, P.O. box 432, 2501 CK The Hague, The Netherlands
| | | | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Steven J Rhemrev
- Department of Trauma Surgery, Medical Centre Haaglanden, P.O. box 432, 2501 CK The Hague, The Netherlands
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van der Linden MC, van den Brand CL, van der Linden N, Rambach AH, Brumsen C. Rate, characteristics, and factors associated with high emergency department utilization. Int J Emerg Med 2014; 7:9. [PMID: 24499684 PMCID: PMC3931321 DOI: 10.1186/1865-1380-7-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent visitors (FV) and highly frequent visitors (HFV) is necessary in order to plan more effective interventions. In the Netherlands, the incidence of high ED utilization is unknown. The purpose of this study was to investigate if the well-documented international high ED utilization also exists in the Netherlands and if so, to characterize these patients. Therefore, we assessed the proportion of FV and HFV; compared age, sex, and visit outcomes between patients with high ED utilization and patients with single ED visits; and explored the factors associated with high ED utilization. Methods A 1-year retrospective descriptive correlational study was performed in two Dutch EDs, using thresholds of 7 to 17 visits for frequent ED use, and greater than or equal to 18 visits for highly frequent ED use. Results FV and HFV (together accounting for 0.5% of total ED patients) attended the ED 2,338 times (3.3% of the total number of ED visits). FV and HFV were equally likely to be male or female, were less likely to be self-referred, and they suffered from urgent complaints more often compared to patients with single visits. FV were significantly older than patients with single visits and more often admitted than patients with single visits. Several chief complaints were indicative for frequent and highly frequent ED use, such as shortness of breath and a psychiatric disorder. Conclusions Based on this study, high ED utilization in the Netherlands seems to be less a problem than outlined in international literature. No major differences were found between FV and HFV, they presented with the same, often serious, problems. Our study supports the notion that most patients with high ED utilization visit the ED for significant medical problems.
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