Faculty Bibliography

Patients presenting to the emergency department with certain traumatic conditions can be managed in observation units. The evidence base supporting the use of observation units to manage injured patients is smaller than the evidence base supporting the management of medical conditions in observation units. The conditions that are eligible for management in an observation unit are not limited to those described in this article, and investigators should continue to identify types of conditions that may benefit from this type of health care delivery.

Background: In our ED Observation Unit (OU), chest pain patients comprise 16.4% of 72-hour unscheduled revisits among patients with specific diagnosis protocols. Given that most returning chest pain patients are discharged, these patients' complaints could potentially be addressed by a primary care provider or cardiologist. We aimed to reduce ED re-presentations and improve rates of post-discharge evaluation and follow up by scheduling primary care or cardiology follow up appointments. Methods: All consecutive patients admitted to the ED OU during July 2016 under the 'chest pain' protocol were offered the services of a medical staff facilitator (MSF) to schedule a follow up appointment within 72 hours of discharge from the observation unit. The rate of return to the ED was evaluated by chart review. Results: 49 chest pain protocol patients were placed in the OU. 15 patients were excluded due to incomplete charting (n=1), lack of chest pain noted in patient's initial history (n=11) and inpatient admission from the observation unit (n=3). 34 patient charts were reviewed for follow up instructions and rate of return to the ED. 38% of patients overall had a follow up appointment within 72 hours of discharge. For patients using a MSF the rate of scheduled follow up was 78% (n=7/9). For patients not using a MSF, the rate of scheduled follow up was 24% (n=6/25). There was no unexpected return to the ED within 72 hours for any patient (n=0/34). Since the conclusion of the pilot, by-phone follow up with patients who participated in this study was conducted. Of those patients, four reported they followed up with a cardiologist of PCP within 72 hours of being discharged, while two reported they did not. Conclusion: Patients using a MSF had a higher rate of 72-hour follow up (78% vs. 24%). Further study regarding effect of timely follow up care is being designed, as this pilot indicated that scheduled follow-up prior to discharge can result in more timely follow up which may decrease rates of unscheduled ED return. Education of all care providers regarding this resource would help optimize overall follow-up care, as patients are more likely to arrange an outpatient reassessment visit when utilizing a medical staff facilitator

Early palliative care consultation ha the potential to provide comfort to patients and families, and decrease costs and length of stay.

OBJECTIVE: The emergency department (ED) of NYU Langone Medical Center was destroyed by Hurricane Sandy, contributing to a public health disaster in New York City. We evaluated hospital-based acute care provided through the establishment of an urgent care center with an associated ED-run observation service (EDOS) that operated in the absence of an ED during this disaster. METHODS: We conducted a retrospective cohort study of all patients placed in an EDOS following a visit to an urgent care center during the 18 months of ED closure. We reviewed diagnoses, clinical protocols, selection criteria, and performance metrics. RESULTS: Of 55,723 urgent care center visits, 15,498 patients were hospitalized, and 3167 of all hospitalized patients (20.4%) were placed in the EDOS. A total of 2660 EDOS patients (84%) were discharged from the EDOS. The 8 most frequently utilized clinical protocols accounted for 76% of the EDOS volume. CONCLUSIONS: A diverse group of patients presenting to an urgent care center following the destruction of an ED by natural disaster can be cared for in an EDOS, regardless of association with a physical ED. An urgent care center with an associated EDOS can be implemented to provide patient care in a disaster situation. This may be useful when existing ED or hospital resources are compromised. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).