The Impact of "Emergency-only" Hemodialysis on Hospital Cost and Resource Utilization.

Introduction: Undocumented immigrants are excluded from benefits that help compensate for scheduled outpatient hemodialysis (HD), compelling them to use emergency departments (ED) for HD. Consequently, these patients can receive "emergency-only" HD after presenting to the ED with critical illness due to untimely dialysis. Our objective was to describe the impact of emergency-only HD on hospital cost and resource utilization in a large academic health system that includes public and private hospitals.

The Impact of Virtual Care in an Emergency Department Observation Unit.

Study Objective(s): We report the impact of telemedicine virtual rounding in emergency department observation units (EDOU) on the effectiveness, safety, and cost relative to traditional observation care.

Methods: In this retrospective diff-in-diff study, we compared observation visit outcomes from 2 EDOUs before (pre) and after (post) full adoption of telemedicine rounding tele-observation (tele-obs) with usual care in control EDOU and care in a hospital bed in an integrated health system without tele-obs. Tele-obs physicians did not work at the control hospital.

The impact of emergency department observation units on a health system.

Importance: Protocol driven ED observation units (EDOU) have been shown to improve outcomes for patients and payers, however their impact on an entire health system is unknown. Two thirds of US hospitals do not have such units.

Objective: To determine the impact of a protocol-driven EDOU on health system length of stay, cost, and resource utilization.

A Method for Grouping Emergency Department Visits by Severity and Complexity.

Introduction: Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements.

Racial and Ethnic Differences in Diagnostic Imaging Utilization During Adult Emergency Department Visits in the United States, 2005 to 2014.

Objective: To compare the use of medical imaging (x-ray [XR], CT, ultrasound, and MRI) in the emergency department (ED) for adult patients of different racial and ethnic groups in the United States from 2005 to 2014.

Methods: We performed a multilevel stratified regression analysis of the National Hospital Ambulatory Medical Care Survey ED Subfile, a nationally representative database of hospital-based ED visits. We examined race (white, black, Asian, other) and ethnicity (Hispanic versus non-Hispanic) as the primary exposures for the outcomes of ED medical imaging use (XR, CT, ultrasound, MRI, and any imaging).

Advanced diagnostic imaging utilization during emergency department visits in the United States: A predictive modeling study for emergency department triage.

Background: Emergency department (ED) crowding is associated with negative health outcomes, patient dissatisfaction, and longer length of stay (LOS). The addition of advanced diagnostic imaging (ADI), namely CT, ultrasound (U/S), and MRI to ED encounter work up is a predictor of longer length of stay. Earlier and improved prediction of patients' need for advanced imaging may improve overall ED efficiency.

Primary Care Office Visits For Acute Care Dropped Sharply In 2002-15, While ED Visits Increased Modestly.

The traditional model of primary care practices as the main provider of care for acute illnesses is rapidly changing. Over the past two decades the growth in emergency department (ED) visits has spurred efforts to reduce "inappropriate" ED use. We examined a nationally representative sample of office and ED visits in the period 2002-15.

Homelessness and Emergency Medicine: A Review of the Literature.

Objectives: We aimed to synthesize the available evidence on the demographics, prevalence, clinical characteristics, and evidence-based management of homeless persons in the emergency department (ED). Where appropriate, we highlight knowledge gaps and suggest directions for future research.

Methods: We conducted a systematic literature search following databases: PubMed, Ovid, and Google Scholar for articles published between January 1, 1990, and December 31, 2016.

Prediction of Emergency Department Hospital Admission Based on Natural Language Processing and Neural Networks.

Objective: To describe and compare logistic regression and neural network modeling strategies to predict hospital admission or transfer following initial presentation to Emergency Department (ED) triage with and without the addition of natural language processing elements.

Methods: Using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a cross-sectional probability sample of United States EDs from 2012 and 2013 survey years, we developed several predictive models with the outcome being admission to the hospital or transfer vs. discharge home.

A "Patch" to the NYU Emergency Department Visit Algorithm.

Objective: To document erosion in the New York University Emergency Department (ED) visit algorithm's capability to classify ED visits and to provide a "patch" to the algorithm.

Data Sources: The Nationwide Emergency Department Sample.

Study Design: We used bivariate models to assess whether the percentage of visits unclassifiable by the algorithm increased due to annual changes to ICD-9 diagnosis codes.

Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits.

Background: Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed.

Characteristics of United States Emergency Department Visits for Traumatic Amputations in the Elderly Adult from 2010 to 2013.

Background: Elderly adults (65 years of age and older) are of particular concern for traumatic amputations due to age-related changes in vision and coordination, making them more susceptible to injury.

Objectives: The objective of this study is to describe the epidemiology of traumatic amputations in the elderly adults treated in United States emergency departments (ED).

Design: A retrospective analysis using data from the National Electronic Injury Surveillance System from 2010 to 2013.

Tricycle Injuries Presenting to US Emergency Departments, 2012-2013.

Objective: To investigate the characteristics of tricycle-related injuries in children presenting to US emergency departments (EDs).

Methods: Data regarding tricycle injuries in children younger than 18 years of age were obtained from the National Electronic Injury Surveillance System for calendar years 2012 and 2013. Data included body regions injured, ED disposition, and demographics.

Emergency department resource use by supervised residents vs attending physicians alone.

Importance: Few studies have evaluated the common assumption that graduate medical education is associated with increased resource use.

Objective: To compare resources used in supervised vs attending-only visits in a nationally representative sample of patient visits to US emergency departments (EDs).

Design, Setting, And Participants: Cross-sectional study of the National Hospital Ambulatory Medical Care Survey (2010), a probability sample of US EDs and ED visits.

A cross-sectional study of emergency department boarding practices in the United States.

Objectives: The median emergency department (ED) boarding time for admitted patients has been a nationally reportable core measure that now also affects ED accreditation and reimbursement. However, no direct national probability samples of ED boarding data have been available to guide this policy until now. The authors studied new National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items to establish baseline values, to generate hypotheses for future research, and to help improve survey quality in the future.

Protocol-driven emergency department observation units offer savings, shorter stays, and reduced admissions.

Many patients who seek emergency department (ED) treatment are not well enough for immediate discharge but are not clearly sick enough to warrant full inpatient admission. These patients are increasingly treated as outpatients using observation services. Hospitals employ four basic approaches to observation services, which can be categorized by the presence or absence of a dedicated observation unit and of defined protocols.