Routine Emergency Department Screening to Decrease Subsequent Physical Abuse

1.113 Efficacy of Emergency Department (ED) Screening Tests for Children Admitted to an Inpatient Psychiatric Unit for Acute Mental Health Emergencies

The hope that death from suicide and injuries from suicidal behavior can be reduced from routine screening in emergency departments is a promising hypothesis. The most recent study by Goans et al casts renewed doubt on the promise and practicality of that approach.1 Ostensibly, the Columbia Suicide Severity Rating Scale (C-SSRS) has promise for use in emergency departments (EDs): it is simple to read, results in stratified categories of risk, and is a relatively brief tool.

Ready, willing and able? A survey of clinicians’ perceptions about domestic violence screening in a regional hospital emergency department

Comparison of Enhanced Targeted Rapid HIV Screening Using the Denver HIV Risk Score to Nontargeted Rapid HIV Screening in the Emergency Department

IntroductionThe novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began.MethodsThis was a retrospective, observational, cross-sectional study using billing data from January 1, 2017–April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories.ResultsED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively.ConclusionThere was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.

Universal suicide screening in emergency departments across a large healthcare system

Opt-out screening for blood-borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi-site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post-implementation. This was a cross-sectional electronic survey of HCWs. Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt-out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt-out consent process. Factors independently associated with acceptability of opt-out screening were identified using multivariable logistic regression. Free-text responses were analysed thematically. Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt-out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt-out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt-out screening with patients. Free-text answers suggested changes to test-ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing. There was substantial support from ED HCWs for routine opt-out ED BBV screening, including opt-out consent. Key areas suggested for improvement included changes to test-ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism.

Introduction: Identification of events preceding subarachnoid hemorrhage (SAH) could allow providers an opportunity to prevent SAH and improve outcomes for patients. Studies have suggested that SAH events are preceded by “warning bleeds” that produce symptoms such as migraines, however the results are contradictory and physicians have no indicators for warning bleeds. Hypothesis: We hypothesized that symptoms associated with an imminent SAH can be detected in emergency department (ED) visits preceding an SAH event. Methods: We studied 11,308 SAH visits that occurred at HCA hospitals between July 2011 and March 2016. A set of 10,000 ED encounters, matched by demographics (age, gender, race/ethnicity, location), was used as a control cohort. For each encounter, we pulled data for all ED or inpatient (IP) encounters within 30 days before the index SAH event. Data for each encounter include demographics, health history, diagnosis codes, and administered medications. Fisher Exact tests were used to study categorical variables; regression modeling was used to build models to assess patient risk. Results: 2,046 (18%) of all index SAH events were preceded with at least one ED or IP encounter within 30 days of the index event. 200 (9.8%) of the index SAH visits had a diagnosis of headache (including migraine), versus 2.7% in the controls (O.R. = 3.9; p < 0.01). Additionally, eye disorders, hereditary and degenerative nervous system conditions, coagulation and hemorrhagic disorders, and delirium/dementia/amnesia were all over-represented in the visits preceding SAH event (p < 0.01). Conclusions: Prior to SAH events, a proportion of patients present with ED or IP encounters associated with headaches, eye disorders, and dementia. It may be possible to use this information to develop a risk score for patients at imminent risk for an SAH and possibly reduce the incidence SAH.

220 The patient journey: Health-related encounters after hospital discharge in cardiac patients

Implementation of a violence risk assessment tool on a safety-net inpatient psychiatry unit.

Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed. The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies). Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.

Bouncing Back Elsewhere: Multilevel Analysis of Return Visits to the Same or a Different Hospital After Initial Emergency Department Presentation

HIV is a global public health issue. Routine testing for HIV should be performed on all 16–59 years old attending emergency departments (EDs) in high-prevalence areas in the UK.In August...

There are more than 140 million annual visits to emergency departments (EDs) in the US. The role of EDs in providing care at or near the end of life is not well characterized. To determine the frequency of death in the ED or within 1 month of an ED visit in an all-age, all-payer national database. The retrospective cohort study used patient-level data from the nationally representative Optum clinical electronic health record data set for 2010 to 2020. Data were analyzed from January to March 2022. Age, Charlson Comorbidity Index (CCI), and year of ED encounter. The primary outcome was death in the ED, overall and stratified by age, CCI, or year. A key secondary outcome was death within 1 month of an ED encounter. We extrapolated to make national estimates using US Census and Nationwide Emergency Department Sample data. Among a total of 104 113 518 individual patients with 96 239 939 ED encounters, 205 372 ED deaths were identified in Optum, for whom median (IQR) age was 72 (53 to >80) years, 114 582 (55.8%) were male, and 152 672 (74.3%) were White. ED death affected 0.20% of overall patients and accounted for 0.21% of ED encounters. An additional 603 273 patients died within 1 month of an ED encounter. Extrapolated nationally, ED deaths accounted for 11.3% of total deaths from 2010 to 2019, and 33.2% of all decedents nationally visited the ED within 1 month of their death. The proportion of total national deaths occurring in the ED decreased by 0.27% annually (P for trend = .003) but the proportion who died within 1 month of an ED visit increased by 1.2% annually (P for trend < .001). Compared with all ED encounters, patients with visits resulting in death were older, more likely to be White, male, and not Hispanic, and had higher CCI. Among ED encounters for patients aged older than 80 years, nearly 1 in 12 died within 1 month. This retrospective cohort study found deaths during or shortly after ED care were common, especially among patients who are older and with chronic comorbidities. EDs must identify patients for whom end-of-life care is necessary or preferred and be equipped to deliver this care excellently.

This study uses functional magnetic resonance imaging (fMRI) to address two important gaps in our knowledge of brain functioning and violence: (1) What are the brain correlates of adults in the community who have suffered severe physical abuse early in life and who go on to perpetrate serious violence in adulthood? (2) What characterizes those who experience severe physical abuse but who refrain from serious violence? Four groups of participants recruited from the community (controls, severe physical child abuse only, serious violence only, and severely abused, seriously violent offenders) underwent fMRI while performing a visual/verbal working memory task. Violent offenders who had suffered severe child abuse show reduced right hemisphere functioning, particularly in the right temporal cortex. Abused individuals who refrain from serious violence showed relatively lower left, but higher right, activation of the superior temporal gyrus. Abused individuals, irrespective of violence status, showed reduced cortical activation during the working memory task, especially in the left hemisphere. Brain deficits were independent of IQ, history of head injury, task performance, cognitive strategy, and mental activity during the control task. Findings constitute the first fMRI study of brain dysfunction in violent offenders, and indicate that initial right hemisphere dysfunction, when combined with the effects of severe early physical abuse, predisposes to serious violence but that relatively good right hemisphere functioning protects against violence in physically abused children. Aggr. Behav. 27:111–129, 2001. © 2001 Wiley‐Liss, Inc.