Emergency department observation units (EDOUs) transition patients from the ED to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlations between demographic and clinical features and the likelihood of returning to the ED within 30 days following an initial EDOU assessment. Methods This retrospective, observational, cohort study of adult EDOU subjects was conducted between February 1, 2018, and January 31, 2023. Adult patients who were evaluated in an EDOU and returned to an ED within 30 days were compared with those who were assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables of sex, ethnicity, insurance status, primary diagnosis, and disposition using a generalized linear mixed model. Results A total of 14,910 EDOU encounters was analyzed, and 2,252 patients (15%) returned to the ED within 30 days. The analysis took into account several variables that indicated a significant association with the likelihood of returning to the ED within 30 days. These were sex (P<0.001), ethnicity (P=0.005), race (P<0.001), insurance status (P<0.001), primary diagnosis (P<0.001), and disposition (P<0.001). Emergency severity index and length of stay were not associated with ED return. Conclusion Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and the long-term intervention impacts on improved outcomes.

Emergency department observation units (EDOUs) transition patients from the ED to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlations between demographic and clinical features and the likelihood of returning to the ED within 30 days following an initial EDOU assessment. Methods This retrospective, observational, cohort study of adult EDOU subjects was conducted between February 1, 2018, and January 31, 2023. Adult patients who were evaluated in an EDOU and returned to an ED within 30 days were compared with those who were assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables of sex, ethnicity, insurance status, primary diagnosis, and disposition using a generalized linear mixed model. Results A total of 14,910 EDOU encounters was analyzed, and 2,252 patients (15%) returned to the ED within 30 days. The analysis took into account several variables that indicated a significant association with the likelihood of returning to the ED within 30 days. These were sex (P<0.001), ethnicity (P=0.005), race (P<0.001), insurance status (P<0.001), primary diagnosis (P<0.001), and disposition (P<0.001). Emergency severity index and length of stay were not associated with ED return. Conclusion Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and the long-term intervention impacts on improved outcomes.

Emergency department observation units (EDOUs) transition patients from the ED to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlations between demographic and clinical features and the likelihood of returning to the ED within 30 days following an initial EDOU assessment. Methods This retrospective, observational, cohort study of adult EDOU subjects was conducted between February 1, 2018, and January 31, 2023. Adult patients who were evaluated in an EDOU and returned to an ED within 30 days were compared with those who were assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables of sex, ethnicity, insurance status, primary diagnosis, and disposition using a generalized linear mixed model. Results A total of 14,910 EDOU encounters was analyzed, and 2,252 patients (15%) returned to the ED within 30 days. The analysis took into account several variables that indicated a significant association with the likelihood of returning to the ED within 30 days. These were sex (P<0.001), ethnicity (P=0.005), race (P<0.001), insurance status (P<0.001), primary diagnosis (P<0.001), and disposition (P<0.001). Emergency severity index and length of stay were not associated with ED return. Conclusion Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and the long-term intervention impacts on improved outcomes.

PURPOSE: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. METHODS: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. RESULTS: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the pre- and post-score difference between the training and control groups was not statistically significant. CONCLUSION: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the ED.
Cooperative Behavior ; Delivery of Health Care ; Emergencies ; Humans ; Medical Staff ; Patient Care ; Patient Satisfaction ; Quality Improvement ; Role Playing

Objective: Pain control for hip fractures is often achieved via intravenous opioids. However, opioids can have dangerous adverse effects, including respiratory depression and delirium. Peripheral nerve blockade is an alternative option for pain control that reduces the need for opioid analgesia. The purpose of this study was to compare the use of femoral nerve blocks versus standard pain control for patients with hip fractures. Methods: This retrospective study included adult patients presenting to the emergency department with isolated hip fractures between April 2021 and September 2022. The intervention group included all patients who received a femoral nerve block during this time. An equivalent number of patients who received standard pain control during that period was randomly selected to represent the control group. The primary outcome was preoperative opioid requirement, assessed by morphine milligram equivalents (MMEs). Results: During the study period, 90 patients were included in each group. Mean preoperative MME was 10.3 (95% confidence interval [CI], 7.4–13.2 MME) for the intervention group and 14.0 (95% CI, 10.2–17.8 MME) for the control group (P=0.13). Patients who received a femoral nerve block also had shorter time from emergency department triage to hospital discharge (7.2 days; 95% CI, 6.2–8.0 days) than patients who received standard care (8.6 days; 95% CI, 7.2–10.0 days). However, this difference was not statistically significant (P=0.09). Conclusion Femoral nerve blockade is a safe and effective alternative to opioids for pain control in patients with hip fractures.