Patients Discharged From the Emergency Department After Referral for Hospitalist Admission

From The American Journal of Managed Care:

Objectives: To describe the characteristics and outcomes of patients discharged from the emergency department (ED) by hospitalist physicians.

Study Design: Retrospective cohort study at a tertiary academic medical center.

Methods: We used consultation Current Procedural Technology codes to identify patients discharged from the ED after referral for hospitalist admission from April 2011 to April 2014. We report patient demographics and primary diagnoses. Main outcome measures included return to the ED, hospitalization, or mortality, all within 30 days.

Results: There were 710 discharges from the ED for 670 patients referred for hospitalist admission; 21.7% returned to the ED, 12.3% were hospitalized, and 0.4% died within 30 days. Chest pain was the most common diagnosis (38.2%); 18.1% of these patients returned to the ED within 30 days. Patients with the following 3 diagnoses returned to the ED most frequently: sickle cell disease (82.4%), alcohol-related diagnoses (43.5%), and abdominal pain (35.7%). In multivariate analysis, abdominal pain (odds ratio [OR], 3.2; <.001) and alcohol dependence (OR, 3.1; = .003) increased the odds of ED revisits, whereas syncope (OR, 0.23; = .049) reduced the odds. Chest pain reduced the odds of hospitalization (OR, 0.37; = .005).

Conclusions: A majority of patients discharged from the ED after referral for hospitalist admission did not return to the ED within 30 days, and the 30-day hospitalization rate was low. Our data suggest that hospitalists can safely aid patients by reducing the costs and adverse outcomes associated with unnecessary hospitalization.

Pharmacotherapy for Primary Headache Disorders in the Emergency Department

From US Pharmacist:

Headache disorders are one of the most common reasons that patients present to the emergency department (ED). For proper patient care, it is vital for the headache to be differentiated as a primary or secondary headache disorder. Primary headaches are more common than secondary headaches; however, secondary headaches are potentially life-threatening, whereas primary headaches possess straightforward treatment regimens and benign long-term outcomes. Classifying primary headaches as tension-type, cluster, or migraine headache with or without aura will guide pharmacotherapy selection in the ED setting. The pharmacist can impact the clinical management of headache disorders by providing effective medication counseling, ensuring that the medication regimen has the appropriate indication and route, and monitoring for adverse effects of treatment.