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Subspecialty emergency room as alternative model for otolaryngologic care: implications for emergency health care delivery.
- Source :
-
American journal of otolaryngology [Am J Otolaryngol] 2014 Nov-Dec; Vol. 35 (6), pp. 758-65. Date of Electronic Publication: 2014 Jul 10. - Publication Year :
- 2014
-
Abstract
- Purpose: A dedicated otolaryngology emergency room (ER) represents a specialized surgical evaluation and treatment setting that may be an alternative triage pathway for acute otolaryngologic complaints. We aim to characterize practice patterns in this setting and to provide insight into the epidemiology of all-comer, urgent otolaryngologic complaints in the United States.<br />Methods and Methods: Electronic medical records were reviewed for all patients who registered for otolaryngologic care and received a diagnosis in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Predictors of inpatient admission were identified using multivariable regression. Geocoding analysis was performed to characterize catchment area.<br />Results: A total of 12,234 patient visits were evaluated with a mean age of 44.7. Auditory and vestibular problems constituted the most frequent diagnoses (50.0%). The majority of patients were discharged home (92.3%). Forty-three percent of patients underwent a procedure in the ER; the most common procedure was diagnostic nasolaryngoscopy (52%). Predictors of inpatient admission were post-operative complaint (odds ratio [OR] 7.3, P<0.0001), arrival overnight (OR 3.3, P<0.0001), and laryngeal complaint (OR 2.4, P<0.0001). Patients traveled farther for evaluation of hearing loss (11 miles) and less for common diagnoses including impacted cerumen (7.1 miles) (P<0.0001).<br />Conclusion: In this report, we investigate practice patterns of a dedicated otolaryngology emergency room to explore an alternative to standard acute otolaryngologic health care delivery mechanisms. We identify key predictors of inpatient admission. This study has implications for emergency health care delivery models.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Humans
Male
Massachusetts
Middle Aged
Models, Organizational
Otorhinolaryngologic Diseases surgery
Young Adult
Emergency Medical Services organization & administration
Emergency Service, Hospital organization & administration
Otorhinolaryngologic Diseases therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1532-818X
- Volume :
- 35
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of otolaryngology
- Publication Type :
- Academic Journal
- Accession number :
- 25106951
- Full Text :
- https://doi.org/10.1016/j.amjoto.2014.06.013