For Immediate Release Contact: LAURA GORE October 30, 1998 (202) 728-0610, ext 3009 (202) 728-0610, EXT. 3006
Annals of Emergency Meicine Presents New Studies About Frequent Users of the Emergency Department and Systematic Immunization of Patients
WASHINGTON, D.C. - Patients who go to the emergency department more frequently than the general population often have chronic complaints and are more likely to be admitted to the hospital, according to a new study in the November issue of Annals of Emergency Medicine. Other studies in this issue found that immunizing people against influenza and pneumococcus in a public emergency department is both needed and feasible and that dehydration is the diagnosis with the highest risk for both early return and subsequent admission to the hospital.
AN ANALYSIS OF FREQUENT USERS OF EMERGENCY CARE AT AN URBAN UNIVERSITY HOSPITAL
A study of frequent users of emergency care found that people who come to the emergency department more frequently than the general population often have chronic complaints and are more likely to be admitted to the hospital. The study identified 134 patients as frequent users of the emergency department and found that although 84 percent of the patients (113) had some form of medical insurance, they used the emergency department for complaints they believed were serious and needed immediate attention. Seventy-three percent of these patients also indicated they had a doctor or clinic where they received care.
"Sixty percent of visits by those in the study group were for existing or recurrent medical problems, and 72 percent believed their chief complaints were moderately or very serious," said Raymond H. Lucas, M.D., of George Washington University Department of Emergency Medicine in Washington, DC. "Efforts to cut medical costs should not limit access to the emergency department, which often becomes an important source of medical care for these patients."
The study found that people who frequently used the emergency department had a 28-percent admission rate to the hospital, significantly higher than 16-percent admission rate for the general emergency population. While it is widely recognized that a small subset of emergency patients visit the emergency department for nonurgent care, there are very few studies that focus on why these patients choose the emergency department over other sources of medical care.
DEMONSTRATION OF THE FEASIBILITY OF EMERGENCY DEPARTMENT IMMUNIZATION AGAINST INFLUENZA AND PNEUMOCOCCUS
A new study found it to be feasible to systematically immunize people against influenza and pneumococcus in a public emergency department, but that increased staffing alone may not improve immunization rates.
In the study, nurses offered immunization against influenza and pneumococcus to all nonemergency adult patients meeting Centers for Disease Control and Prevention criteria for high-risk immunization. Of the 2,631 patients (24 percent of patients) who were screened, 716 patients were identified as high risk, 1,234 were immunized against influenza, and 241 patients were immunized against pneumococcus. Only 3 percent of high-risk patients had been previously immunized for pneumococcus.
Study authors indicated that each year tens of thousands of deaths and hundreds of thousands of hospitalizations occur among adults in the United States from vaccine-preventable influenza and pneumococcal disease. They estimated the economic costs to be tens of billions of dollars annually and that 50 percent of the burden of influenza could be prevented by full immunization.
INITIAL EMERGENCY DEPARTMENT DIAGNOSIS AND RETURN VISITS: RISK VERSUS PERCEPTION
A study of patients making two or more visits to a hospital within a 3-day period found that dehydration was the most common diagnosis among three categories of study patients: general emergency department, early-return (within a 3-day period), and return-admit (within a 3-day period and then hospitalized) Of the 52,533 general emergency department, 1,422 early-return, and 313 return-admit populations, dehydration was the most prevalent reason for return in the three groups (7 percent, 15 percent, and 25 percent, respectively). Surveys were distributed to all emergency health professionals to assess their perceptions of the diagnoses most likely to return. Nearly two- thirds of the health professionals did not identify dehydration as a diagnosis at high risk for return. Study authors suggest that screening a return emergency department population for high-frequency diagnoses may reveal under-recognized target groups for specific prevention strategies.
OTHER STUDIES
∑ New Vision for the Role of Emergency Medical Services. The article, by Ricardo Martinez, MD, Administrator of the National Highway Traffic Safety Administration, outlines the vision contained in EMS: Agenda for the Future, which charts the future course of emergency medical services.
∑ Case Report: Pulmonary Injury After Ski Wax Inhalation Exposure. The article discusses a rare case of a 60-year old man who had prolonged exposure to ski wax (considered nontoxic and no reported side effects) and experienced severe respiratory failure.
∑ Change of Shift: Silent Night. This article presents a heart-rending story about the death of a Los Angeles police officer in a southern California emergency department three days before Christmas.
For copies of the articles, contact the Washington Office of the American College of Emergency Physicians.
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Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical society representing nearly 20,000 physicians who specialize in emergency medicine. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia, and a Government Services Chapter representing emergency physicians employed by military branches and other government agencies.
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