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Admission rates in emergency departments in Geneva during tennis broadcasting: a retrospective study.

ABSTRACT: BACKGROUND:Literature provides mixed results regarding the influence of large-scale sporting events on emergency department attendance. To contribute to the research on the subject, we sought to evaluate whether the broadcasting of major tennis tournaments, one of the most popular sports in Switzerland, has an impact on patient admission rates in emergency units in Geneva including 1) type of match 2) the role of a Swiss player, 3) degree of triage, 4) reason of attendance and 5) age of patients. METHODS:Admission rates between periods with tennis matches regarding the semi-finals and finals of 3 major tennis tournaments were compared to equivalent periods without matches from May 2013 to August 2017. Patient admission data was retrieved retrospectively from administrative databases of two Outpatient Emergency Units in Geneva. Patients' admission rates in periods with and without a tennis match were investigated using a negative binomial regression model with mixed effects. RESULTS:We observed a statistically significant decrease (-?10%, 95% CI -17 to -?2, p?=?0.015) in admission rates in periods with a tennis match compared to periods without a tennis match, more pronounced during finals (-?15%, 95% CI -26 to -?3, p?=?0.017) than during semi-finals (-?7%, -?16 to 2, p?=?0.13). In addition, this effect was more pronounced in patients aged between 26 to 64?years of age, a category representing professionnally active people. No modification in the admission rates was detected in the hours preceding and following the matches, nor in type of consultations (traumatology vs non traumatology related admissions). CONCLUSION:Although modest, the results support the hypothesis that the broadcasting of large-scale sporting events such as tennis matches decreases admission rates in emergency units. Further research is required to explore for a potential causal relationship.

SUBMITTER: Correia JC

PROVIDER: S-EPMC6293595 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Project description:BackgroundPrevious studies examining sex-related differences in the treatment of coronary artery disease have focused on patients in hospital. We sought to examine sex-related differences at an earlier point in care--presentation to the emergency department.MethodsWe collected data on ambulatory care and hospital admissions for 54,134 patients (44% women) who presented to an emergency department in Alberta between July 1998 and March 2001 because of acute myocardial infarction, unstable angina, stable angina or chest pain. We used logistic regression and Cox regression analyses to determine sex-specific associations between the likelihood of discharge from the emergency department or coronary revascularization within 1 year and 1-year mortality after adjusting for age, comorbidities and socioeconomic factors.ResultsFollowing the emergency department visit, 91.3% of patients with acute myocardial infarction, 87.4% of those with unstable angina, 40.7% of those with stable angina and 19.8% of those with chest pain were admitted to hospital. Women were more likely than men to be discharged from the emergency department: adjusted odds ratio (and 95% confidence interval [CI]) 2.25 (1.75-2.90) for acute myocardial infarction, 1.71 (1.45-2.01) for unstable angina, 1.33 (1.15-1.53) for stable angina and 1.46 (1.36-1.57) for chest pain. Women were less likely than men to undergo coronary revascularization within 1 year: adjusted odds ratio (and 95% CI) 0.65 (0.57-0.73) for myocardial infarction, 0.39 (0.35-0.44) for unstable angina, 0.35 (0.29-0.42) for stable angina and 0.32 (0.27-0.37) for chest pain. Female sex had no impact on 1-year mortality among patients with acute myocardial infarction; it was associated with a decreased 1-year mortality among patients with unstable angina, stable angina and chest pain: adjusted hazard ratio (and 95% CI) 0.60 (0.46-0.78), 0.60 (0.46-0.78) and 0.74 (0.63-0.87) respectively.InterpretationWomen presenting to the emergency department with coronary syndromes are less likely than men to be admitted to an acute care hospital and to receive coronary revascularization procedures. These differences do not translate into worse outcomes for women in terms of 1-year mortality.

Project description:BackgroundApproximately 2 million children are hospitalized each year in the United States, with more than three-quarters of non-elective hospitalizations admitted through emergency departments (EDs). Direct admission, defined as admission to hospital without first receiving care in the hospital's ED, may offer benefits for patients and healthcare systems in quality, timeliness, and experience of care. While ED utilization patterns are well studied, there is a paucity of research comparing the effectiveness of direct and ED admissions. The overall aim of this project is to compare the effectiveness of a standardized direct admission approach to admission beginning in the ED for hospitalized children.Methods/designWe will conduct a stepped wedge cluster randomized controlled trial at 3 structurally and geographically diverse hospitals. A total of 70 primary and urgent care practice sites in the hospitals' catchment areas will be randomized to a time point when they will begin participation in the multi-stakeholder informed direct admission program. This crossover will be unidirectional and occur at 4 time points, 6 months apart, over a 24-month implementation period. Our primary outcome will be the timeliness of clinical care provision. Secondary outcomes include (i) parent-reported experience of care, (ii) unanticipated transfer to the intensive care unit within 6?h of hospital admission, and (iii) rapid response calls within 6?h of hospital admission. We anticipate that 190 children and adolescents will be directly admitted, with 1506 admitted through EDs. Analyses will compare the effectiveness of direct admission to admission through the ED and will evaluate the causal effect of implementing a direct admission program using linear regression with random effects for referring practice clusters and time period fixed effects. We will further examine the heterogeneity of treatment effects based on hypotheses specified a priori. In addition, we will conduct a mixed-methods process evaluation to assess reach, effectiveness, adoption, implementation, and maintenance of our direct admission intervention.DiscussionOur study represents the first randomized controlled trial to compare the effectiveness of direct admission to admission through the ED for pediatric patients. Our scientific approach, pairing a stepped wedge design with a multi-level assessment of barriers to and facilitators of implementation, will generate valuable data about how positive findings can be reproduced across other healthcare systems.Trial registrationClinicalTrials.gov NCT04192799 . Registered on December 10, 2019).

Project description:BackgroundMedication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness.MethodsMedication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness.ResultsAdmission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness.ConclusionsMedication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.

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Admission rates in emergency departments in Geneva during tennis broadcasting: a retrospective study.

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