Dataset Information

Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?

ABSTRACT:

Objective

Determine the effects of a vertigo/dizziness emergency department (ED) clinical pathway incorporating vestibular physiotherapy on quality and efficiency of care.

Study design

A multisite retrospective study investigated differences between cohorts before and after a vertigo clinical pathway and cohorts who did and did not receive vestibular physiotherapy assessment.

Setting

Adults presenting to 2 Australian EDs with symptoms clinically consistent with vestibular disorder were captured via ED diagnostic code screening and subsequent medical record review.

Methods

Medical record audits obtained quality of care indicators: diagnosis, HINTS (head impulse-nystagmus-test of skew), and vestibular physiotherapy management. Linked hospital administrative data sets provided efficiency measures: time from ED presentation to assessments, hospital admission rates, and ED and total hospital length of stay.

Results

Postpathway cohorts (n = 329) showed greater use of HINTS (by 27%; 95% CI, 21%-33%), more frequent vestibular physiotherapy assessment (by 27%; 95% CI, 20%-33%), reduced wait time to assessment (25.0 to 4.6 hours; 95% CI, -27.1 to -14.1), and reduced ED length of stay (3.9 to 3.2 hours; 95% CI, -0.3 to -1.0) as compared with prepathway cohorts (n = 214). When compared with those not receiving vestibular physiotherapy assessment, patients assessed by a vestibular physiotherapist (n = 150) received a specific diagnosis more frequently (65% vs 34%; 95% CI, 22%-40%) but were admitted more often (79% vs 49%; 95% CI, 22%-38%) with longer total hospital length of stay (13.0 vs 5.0 hours; 95% CI, 6.1-10.6).

Conclusion

An ED vertigo clinical pathway was associated with improved quality and efficiency of care, including reduced ED time. Vestibular physiotherapist assessment was associated with greater diagnostic specificity but higher hospital admissions.

SUBMITTER: Stewart V

PROVIDER: S-EPMC9382073 | biostudies-literature | 2022 Jul-Sep

REPOSITORIES: biostudies-literature

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Publications

Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?

Stewart Vicky V Rosbergen Ingrid I Tsang Benjamin B Hoffman Aliese A Kwan Shelly S Grimley Rohan R

OTO open 20220701 3

<h4>Objective</h4>Determine the effects of a vertigo/dizziness emergency department (ED) clinical pathway incorporating vestibular physiotherapy on quality and efficiency of care.<h4>Study design</h4>A multisite retrospective study investigated differences between cohorts before and after a vertigo clinical pathway and cohorts who did and did not receive vestibular physiotherapy assessment.<h4>Setting</h4>Adults presenting to 2 Australian EDs with symptoms clinically consistent with vestibular d ...[more]

PMID: 35990816

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Project description:ObjectivesTo describe clinical characteristics and management of acute lymphadenitis and to identify risk factors for complications.MethodsHealth record review of children ≤17 years with acute lymphadenitis (≤2 weeks) in a tertiary paediatric emergency department (2009-2014); 10% of charts were reviewed by a blinded second reviewer. Multivariate logistic regression identified factors associated with intravenous antibiotic treatment, unplanned return visits warranting intervention, and surgical drainage.ResultsOf 1,023 health records, 567 participants with acute lymphadenitis were analyzed. The median age = 4 years (interquartile range [IQR]: 2 to 8 years), and median duration of symptoms = 1.0 day (IQR: 0.5 to 3.0 days). Cervical lymphadenitis was most common. Antibiotics were prescribed in 73.5% of initial visits; 86.9% of participants were discharged home. 29.0% received intravenous antibiotics, 19.3% had unplanned emergency department return visits, and 7.4% underwent surgical drainage. On multivariate analysis, factors associated with intravenous antibiotic use included history of fever (odds ratio [OR]=2.07, 95% confidence interval [CI]: 1.11 to 3.92), size (OR=1.74 per cm, 95% CI: 1.44 to 2.14), age (OR=0.84 per year, 95% CI: 0.76 to 0.92), and prior antibiotic use (OR=4.45, 95% CI: 2.03 to 9.88). The factors associated with unplanned return visit warranting intervention was size (OR=1.30 per cm, 95% CI: 1.06 to 1.59) and age (OR=0.89, 95% CI: 0.80 to 0.97). Factors associated with surgical drainage were age (OR=0.68 per year, 95% CI: 0.53 to 0.83) and size (OR=1.80 per cm, 95% CI: 1.41 to 2.36).ConclusionsThe vast majority of children with acute lymphadenitis were managed with outpatient oral antibiotics and did not require return emergency department visits or surgical drainage. Larger lymph node size and younger age were associated with increased intravenous antibiotic initiation, unplanned return visits warranting intervention and surgical drainage.

Project description:Leukostasis is a life-threatening complication of acute hyperleukocytic leukemia, and is associated with substantial mortality. Management of leukostasis requires time-sensitive diagnostics and therapeutics, and leukapheresis remains a mainstay of treatment in select patients. Leukapheresis requires coordination of multi-disciplinary resources, which can prove challenging in the emergency department setting, and delays in treatment due to the complexity and coordination required are common. The objective of this study was to assess the effect of utilization of an emergency department-ICU and a multidisciplinary care pathway on outcomes of critically ill leukostasis patients presenting to the emergency department.DesignRetrospective cohort study.SettingSingle large academic medical center in the United States.PatientsAdult emergency department patients with signs and symptoms of leukostasis requiring emergent leukapheresis from 2012-2019.InterventionsImplementation of a hybrid emergency department-ICU setting (emergency critical care center) and a multidisciplinary care pathway with members from Emergency Medicine, Hematology, Blood Bank, and Clinical Pathology.Measurements and main resultsA total of 70 patients were identified and included for analysis: 14 preemergency critical care center; 32 postemergency critical care center, premultidisciplinary care pathway; and 24 postemergency critical care center, postmultidisciplinary care pathway. A statistically significant reduction in the time from emergency department presentation to initiation of leukapheresis was observed from preemergency critical care center to postemergency critical care center, premultidisciplinary care pathway and postemergency critical care center, postmultidisciplinary care pathway (11.5 vs 7.9 vs 7.7 hr; p = 0.004). Statistically significant reductions in in-hospital mortality were observed from preemergency critical care center to postemergency critical care center, premultidisciplinary care pathway and postemergency critical care center, postmultidisciplinary care pathway (64.3% vs 21.9% vs 25.0%; p = 0.01). A trend toward decreased inpatient ICU utilization was observed, although was not statistically significant (35.7% vs 12.5% vs 25.0%; p = 0.14.).Conclusions and relevanceImplementation of a multidisciplinary care pathway via use of an emergency department-ICU for critically ill patients with leukostasis was associated with statistically significant reductions in time to leukapheresis and in-hospital mortality. These findings suggest an emergency department-ICU model may allow for maximal resource and care coordination at the point of contact with critically ill patients and improved clinical outcomes.

Dataset Information

Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?

Objective

Study design

Setting

Methods

Results

Conclusion

Publications

Do Vestibular Physiotherapy and a Clinical Pathway in the Emergency Department Improve Management of Vertigo?

Similar Datasets

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