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Background: Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. Methods: We conducted a prospective observational cohort study including all in patients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. Results: We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. Conclusion: Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events. Contexte : Les taux de readmission a l'hopital apres une chirurgie peuvent servir d'indicateur de la qualite des soins. L'etude visait a determiner les taux et les causes de readmissions et de visites a l'urgence chez les patients ayant subi une chirurgie vasculaire et a etudier la facon dont ces patients etaient pris en charge. Methodes : Nous avons mene une etude de cohorte observationnelle prospective portant sur tous les patients qui ont ete hospitalises pour une importante chirurgie vasculaire entre septembre 2015 et juin 2016 dans un centre de soins tertiaires vasculaires a Toronto. Nous avons fait un suivi telephonique aupres de ces patients 30 jours apres leur conge. Resultats : Nous avons recrute 133 patients (94 hommes [70,7 %] et 39 femmes [29,3 %] dont l'age moyen etait de 65,3 ans). Le diagnostic le plus courant a l'admission initiale etait la maladie arterielle peripherique (67 patients [50,4 %]). A 30 jours, 19 patients (14,8 %) avaient ete rehospitalises ou s'etaient presentes a l'urgence; la plupart avaient initialement subi une revascularisation des membres inferieurs (19,4 %). Dix patients ont ete rehospitalises en moyenne 16,8 jours apres leur conge; l'infection du site operatoire etait la cause la plus courante de readmission (3 patients). Le traitement le plus courant chez les patients rehospitalises etait le traite ment antimicrobien (4 patients). La duree mediane des sejours a l'hopital etait de 14,4 jours. Neuf patients se sont presentes a l'urgence en moyenne 10,6 jours apres leur conge; 6 ont signale un probleme avec leur plaie, et la majorite (6 des 9 patients) ont recu une antibiotherapie orale. Conclusion : Les readmissions ou les visites a l'urgence de patients atteints d'une maladie arterielle peripherique peu apres une chirurgie de revascularisation des membres inferieurs sont courantes et souvent attribuables a une infection du site operatoire ou a des problemes associes a la plaie. Un suivi apres 7 a 10 jours ainsi que les services d'une equipe specialisee en soin des plaies pourraient contribuer a reduire la frequence de ce type d'evenement., Hospital readmission following major surgery is common and expensive and can serve as a marker for quality of care provided. In 2004, nearly 1 in 5 Medicare beneficiaries were readmitted [...]

We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children with ASD in rural areas were economically disadvantaged and concentrated in the South and Midwest regions. Rural children diagnosed with ASD and multiple comorbidities during emergency department visits were 1.6 times as that of urban children. Rural children with ASD, particularly those with multiple comorbidities, require more emergency department services when compared with urban children with ASD., Author(s): Wanqing Zhang [sup.1] , Ashley E. Mason [sup.1] , Brian Boyd [sup.1] , Linmarie Sikich [sup.2] , Grace Baranek [sup.1] Author Affiliations: (1) 0000000122483208grid.10698.36Department of Allied Health Sciences, School [...]

Objectives. We examined the relationship between intimate partner violence victimization among women in the general population and emergency department use. We sought to discern whether race/ethnicity moderates this relationship and to explore these relationships in race/ethnic--specific models. Methods. We used data on non-Hispanic White, Non-Hispanic Black, and Hispanic married or cohabiting women from the 2002 National Survey on Drug Use and Health. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using logistic regression. Results. Women who reported intimate partner violence victimization were 1.5 times more likely than were nonvictims to use the emergency department, after we accounted for race/ethnicity and substance use. In race/ethnic--specific analyses, only Hispanic victims were more likely than their nonvictim counterparts to use the emergency department (AOR = 3.68; 95% CI = 1.89, 7.18), whereas substance use factors varied among groups. Conclusions. Our findings suggest that the emergency department is an opportune setting to screen for intimate partner violence victimization, especially among Hispanic women. Future research should focus on why Hispanic victims are more likely to use the emergency department compared with nonvictims, with regard to socioeconomic and cultural determinants of health care utilization.

In addition to caring for patients with sudden illnesses or trauma, emergency departments provide primary care for other groups of individuals as well. For both trauma and primary care patients, the emergency room leads to admission to the hospital, with important reimbursement and public policy implications. During the past decade, the number of poor and uninsured patients admitted through emergency departments increased disproportionately. These patients are usually sicker and cost more to care for than patients with similar diagnoses who are admitted by their physicians. To determine whether emergency room admissions differ from other admissions, and to evaluate the resulting cost implications, 20,089 patients at 5 different hospitals were interviewed over a 6-month period. DRGSCALE, a system developed by SysteMetrics Inc., was used to judge severity of illness. At all five hospitals, patients admitted through the emergency department required substantially more resources than nonemergency patients, even after adjusting for age, diagnosis related group (DRG), severity of illness, and income. Uninsured persons were 3.1 times more likely, on average, to be admitted to the hospital through the emergency department than those with private health insurance. Single, nonwhite, lower-income patients were more likely to be admitted through the emergency department, and to require more care; however, hospital reimbursement for their care is based on the national Medicare DRG system of fixed payments based only on the admitting diagnosis. For this reason, hospitals with high occupancy rates are likely to limit emergency care, thus limiting access to medical care for the poor and the elderly. DRGSCALE was a strong predictor of length of hospital stay, and is an important addition to the DRG in predicting a patient's use of medical resources. (Consumer Summary produced by Reliance Medical Information, Inc.)

The increase in poverty levels in populations living in suburban communities is expected to over burden the suburban health professionals and social service providers. The impact of the demographic shift away from larger cities to the suburban areas on the already overloaded emergency departments is discussed.