Reciprocal Abstracts

Abstract

Background: Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. Methods: This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0 to 14 years of age seen in the 12-month period from August 2018 to July 2019 were included. Descriptive statistical analyses were performed. Results: Data from 346 days and 64,966 patient encounters were analysed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/ day). The most common diagnoses were upper respiratory infections (URIs), gastroenteritis, asthma and dermatologic problems. The highest acuity diagnoses were neurologic prob-lems (59%), asthma (57%) and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. Conclusion: This epidemiologic profile of illness seen in the HCM PED for improved resource utilization. opportunities for evidence-based care algo-rithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis. Study objective: Reducing excessive opioid prescribing in emergency departments (EDs) may prevent opioid addic-tion. We evaluated the largest personalized feedback and peer comparison intervention to date on emergency clinician opioid prescription rates in a national emergency clinician group. Methods: This interrupted time-series analysis of a quality improvement intervention included data from adults discharged from 102 EDs in 17 states from 1 January 2019 to 31 July 2021. From 16 June 2020 to 30 November 2020, site-level ED directors received emails on local opioid prescription rates. From 1 December 2020 to 31 July 2021, all clinicians were granted electronic dashboard access, which showed prescription rates compared with peers, and national ED leaders sent emails to high-pre-scribing clinicians and engaged in one-on-one conversa-tions. The primary outcome was opioid prescriptions per 100 discharges. Results: The study included 5,328,288 ED discharges from 924 physicians and 472 advanced practice providers. Opioid prescription rates did not change meaning-fully in the site-level director feedback period (mean difference = –0.3, 95% confidence interval (CI) = –0.6 to –0.1). During the direct clinician feedback period, opioid prescription rates declined from 10.4 per 100 discharges to 8.4 per 100 discharges (mean difference = –2.0, 95% CI = –2.4 to –1.5), Study objective: Challenges in transitioning from obstetric to primary care in the postpartum period may increase emergency department (ED) visits. This study described the frequency, characteristics and predictors of maternal ED visits in the postpartum period. five We in the and used negative regression models to assess the outcome of any ED visit in the period associated with relevant soci-odemographic and clinical Results were reported using rate ratios (RRs) and 95% confidence intervals (95% CIs). on from the study 44.7% one or more visits; 29.7% of with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study. with prior dependence in activities of daily living in the multivariate analysis (odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.11 to 5.27) and a low–moderate score on the Simplified Acute Physiology Score II (SAPS II) ver-sus a high–very high one (OR = 2.69, 95% CI = 1.26 to 5.77). Mortality after OHEMS ventilation was associated with dis-continuance of NIV during transfer (OR = 8.57, 95% CI = 2.19 to 33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV; OR = 3.24, 95% CI = 2.62 to 6.45) and prior dependence (OR = 2.08, 95% CI = 1.02 to 4.22). Conclusion: Patients treated in the hospital ED and OHEMS setting have similar baseline characteristics, although acute episodes were more serious in the OHEMS group. No significant differences were found related to in-hospital mortality. Higher mortality was associated with dependence, a SAPS II score greater than 52 and discon-tinuance of NIV. Readmission was associated with dependence and NIV treatment in the hospital ED setting.