Articles: emergency-department.
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Comparative Study
Evaluation of a hospital admission prediction model adding coded chief complaint data using neural network methodology.
Our objective was to apply neural network methodology to determine whether adding coded chief complaint (CCC) data to triage information would result in an improved hospital admission prediction model than one without CCC data. ⋯ Neural net methodology application resulted in the derivation and validation of a modestly stronger hospital admission prediction model after the addition of CCC data.
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Freestanding emergency departments (FEDs) have grown in popularity. They often provide emergent care in areas distant from other EDs. Investigations and research to characterize the operation and dynamics of FEDs are needed. This study characterizes the severity of illness seen at FEDs and compares it with a hospital-based urban tertiary care ED using the emergency severity index (ESI), a quantification of patient acuity. ⋯ The main ED demonstrated lower ESI levels and thus higher acuity than the 3 affiliated FEDs. There were significantly different acuity levels between the main ED and 3 FEDs as well as between individual FEDs.
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Health services research · Apr 2015
Do patient-centered medical homes reduce emergency department visits?
To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. ⋯ Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.
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To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types. ⋯ The application of observation charge codes to Michigan children with observation-prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.
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Eur Heart J Acute Cardiovasc Care · Apr 2015
Comparative StudyImpact of high-sensitivity Troponin T on hospital admission, resources utilization, and outcomes.
The use of high-sensitivity cardiac Troponin T (hs-cTnT) assay might lead to overdiagnosis and overtreatment of Acute Coronary Syndromes (ACS). This study assessed the epidemiological, clinical and prognostic impact of introducing hs-cTnT in the everyday clinical practice of an Emergency Department. ⋯ We did not observe overdiagnosis and overtreatment issues in presenters with suspected ACS managed by appropriate changes in hs-cTnT levels, despite the increase in the number of patients presenting with abnormal troponin levels. This occurred without a rise in short-term and mid-term mortality.