Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location.

BACKGROUND: The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. PURPOSE: To identify predictors of revisits among patients with ureteral calculi in the ED. DESIGN, SETTING, AND PARTICIPANTS: Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. RESULTS: Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). CONCLUSIONS: Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.

Emergency department 30-Day emergency department revisits among people with sickle cell disease: Variations in characteristics.

People with sickle cell disease (SCD) often have emergency department (ED) revisits. The characteristics of people with SCD with ED revisits were assessed in this study using Medicaid administrative claims data from California and Georgia, representing 2794 and 3641 individuals with SCD, respectively. In both states, those with 6+ primary care provider (PCP) encounters had the highest percentage of ED revisits. In California, those with 6+ hematology encounters had the lowest percentage of individuals with an ED revisit; in Georgia, those with 1-2 hematology encounters. Increasing access to hematologic care may reduce ED revisits among people with SCD.

Chief complaints and computed tomography results in the emergency department: a three-year retrospective cohort study.

BACKGROUND: Computed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results. METHODS: This three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results. RESULTS: In total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98-4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings. CONCLUSION: Chief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.

The Impact of Integrated Patient Education on Short-Term Revisit Rates in Healthcare Settings: A Quality Improvement Project.

BACKGROUND: Patient education plays a critical role in healthcare, influencing outcomes and resource utilization. However, effectively integrating patient education into clinical practice remains challenging due to time constraints and inconsistencies in information delivery. Enhancements in Electronic Health Records (EHR) offer potential solutions by facilitating customized, quality education delivery. This study investigates the impact of an EHR-enhanced patient education intervention on short-term revisit rates to healthcare facilities. METHODS: A quasi-experimental, pre-test/post-test design without a control group was employed at the International Medical Center in Riffa, Bahrain. The intervention consisted of modifications to the EHR system to support patient education, along with staff training on effective education delivery. Patient revisit rates within seven days post-consultation were compared before and after the intervention using chi-square tests and logistic regression, adjusting for potential confounders. RESULTS: A total of 1,239 patients participated in the study, which was divided into two groups: 754 patients in the pre-intervention group and 485 patients in the post-intervention group. A significant change was observed in the patient revisit rates: in the pre-intervention group, 53.32% of patients (402 out of 754) returned within seven days, compared to 41.44% of patients (201 out of 485) in the post-intervention group, with a p-value < 0.01. CONCLUSION: Enhancements to EHR systems, combined with comprehensive staff education on patient education, can lead to significant reductions in short-term patient revisits. This underscores the importance of integrating technological and educational interventions in healthcare settings to improve patient outcomes and efficiency.

Measuring the impact of dental service quality on revisit intention using an extended SERVQUAL model.

Background: The pursuit of quality services can lead to both service enhancement and increased motivation to visit dental centers for oral health treatment. Aims: The purpose of this study is to investigate the effect of dental center service quality factors on revisit intention among adult patients by applying an extended service quality model (SERVQUAL). Methods: This cross-sectional study was conducted between September and November 2023 in the outpatient waiting areas and clinical settings of Umm Al-Qura University Dental Teaching Hospital (UQU-DTH). A sample of 355 patients was invited by the convenience sampling method. The data was collected through a validated Arabic version of the extended SERVQUAL questionnaire. A hierarchical regression analysis was used to assess the incremental effects of the extended SERVQUAL factors on the intention of patients to revisit the UQU-DTH while controlling for demographic variables. Cronbach alpha was used to examine the internal consistency of each model factor. Results: A total of 330 completed responses were received, with a 93% response rate. The findings indicated that demographic variables such as age and level of education contribute to some extent but become negligible when the extended SERVQUAL factors are included in the model. Moreover, the extended SERVQUAL model factors substantially improved the model. Three factors were found to positively and significantly affect the revisit intention, namely, "staff-related factors," "cost-effectiveness," and "responsiveness." Overall, the model explained 65.6% of the variance in the revisit intention (R2 = 0.656, p < 0.001). Conclusion: The findings present a unique model that may be used to better understand the factors that influence patients' intentions to revisit dental centers in an educational setting. Additionally, it identified elements that dental center quality management needs to prioritize and address.

Sport tourist perceptions of destination image and revisit intentions: An adaption of Mehrabian-Russell's environmental psychology model.

In environmental psychology literature, an individual's perception of the surroundings leads to subsequent behaviors. In this regard, small-scale sport events (SSE) have been used as a marketing tool for tourism development. However, how SSEs are leveraged to improve destination image (DI) for tourists has not been fully understood. Building on Mehrabian-Russell's environmental psychology model, this study examined the relationship between the SSE environmental stimuli and revisit intentions through the sequential mediation of cognitive and affective DI. Data from the 423 respondents were collected from 2023 Wuxi Marathon held in Wuxi, China. Structural equation modeling was employed to analyze the hypothesized framework. The results indicated that the SSE environmental stimuli were positively associated with both cognitive and affective DI, which were positively correlated with revisit intentions. The applicability of the serial mediation of cognitive and affective DI within the relationship was confirmed. This study contributes to the sport and tourism literature by extending the applicability of Mehrabian and Russell's model to SSE settings and identifying the serial mediating effects of cognitive and affective DI.

Understanding the influencing factors of tourists' revisit intention in traditional villages.

The intention of tourists to revisit traditional villages plays a significant role in their sustainable development. This study utilizes a cross-sectional survey design and collects 373 valid responses from Chinese tourists via a questionnaire. The questionnaire, based on a Likert 5-point scale, encompasses key constructs such as space Atmosphere, place attachment, perceived interest, experiential marketing, recreation perception, environmental image perception, well-being, information richness, and revisit intention. To ensure the quality of data, reliability and validity assessments were performed, followed by the verification of research hypotheses using Structural Equation Modeling (SEM). The findings indicate that perceived interest and experiential marketing are pivotal variables influencing tourists' revisit intentions. well-being emerges as a crucial driver that enhancing the likelihood of tourists' return visits. Additionally, recreation perception and perceived interest significantly impact well-being, while information richness positively moderates the effects of space atmosphere, place attachment, perceived interest, and environmental image perception on well-being. These findings can be utilized to formulate strategies that influence tourists' intentions to revisit traditional villages.

How Do Tourists' Value Perceptions of Food Experiences Influence Their Perceived Destination Image and Revisit Intention? A Moderated Mediation Model.

The food experience is an important part of the tourism experience. Although it is crucial to comprehend the significance of tourists' perception of food experiences, there is a scarcity of research investigating the impact of tasting local food on tourists' perceptions and behaviors. This study employs structural equation modeling to empirically examine the relationship between tourists' value perceptions of food experiences, their perceived destination image, and their revisit intention. In addition, the moderating effects of tourists' genders on the aforementioned relationships are also explored. A renowned restaurant brand, Nanjing Impressions, which specializes in offering the unique cuisine of the city of Nanjing, China, is chosen as the research case. A grand total of 500 questionnaires were distributed, and, out of these, 458 questionnaires were deemed legitimate and kept for further analysis. The results indicate that the functional, social, emotional, cultural, and health values of local food experienced by tourists have significant positive impacts on their perceived destination image and revisit intention. Moreover, perceived destination image partially mediates the relationships between tourists' value perceptions of food experiences and their revisit intention. Gender is found to partially moderate the relationships between the proposed constructs. The current study offers noteworthy theoretical contributions and provides valuable practical suggestions for tourism destination managers.

The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults.

BACKGROUND: Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. OBJECTIVE: We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. METHODS: The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. RESULTS: REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. CONCLUSIONS: REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences.

Effect of Comorbid Diseases on Hospitalization and In-Hospital Mortality of Elderly Patients Who Reapplied to the Emergency Department Within 72 Hours.

OBJECTIVE: This study aimed to determine the effects of comorbidities on hospitalization and in-hospital mortality in patients aged 65 years and older who returned to the emergency department within 24, 48, and 72 hours of an initial visit. METHODS: This study was conducted at the Department of Emergency Medicine, Firat University Faculty of Medicine, Elâzig, Turkey. It has a retrospective design and received local ethics committee approval from the university. Patients aged 65 years and older who presented to the emergency department within a one-year period (2022) were examined to identify those who returned to the emergency department within 24, 48, and 72 hours of an initial visit. RESULTS: A total of 763 (3.2%) patients >65 years of age returned to the emergency department within the first three days of their initial visit. Of these returning patients, 349 returned within 24 hours (Group 1), 227 within 48 hours (Group 2), and 187 within 72 hours (Group 3). Being female, polypharmacy, the presence of at least one comorbidity, cancer, and chronic renal failure were found to be independent predictors of hospitalization, whereas polypharmacy was found to be an independent predictor of in-hospital mortality. CONCLUSION: Patients returning to the emergency department shortly after an initial visit should be assessed more diligently due to the risk of mortality.

A cross-sectional study on exploring the antecedents of patient's revisit intention: Mediating role of trust in the hospital among patients in India.

BACKGROUND: In the healthcare domain, patients' trust in the hospital plays an instrumental role in determining the behavioral intention of the patient. This article attempts to investigate the impact of service quality perception on behavioral intention with the mediating effect of trust in the hospital and patient satisfaction. METHODS: This research was carried out in multispecialty hospitals located in Bangalore Urban and Mysore districts of Karnataka during August 2021. This was a questionnaire-based study and the sample size was 242. Statistical Package for the Social Science (SPSS) 27.0 and SmartPLS 3.0 software was used to analyze the data. RESULTS: The findings revealed that perceived service quality significantly influences trust through patient satisfaction (observed partial mediation) and patient satisfaction significantly impacts behavioral intention through trust (observed partial mediation). CONCLUSION: This study empowers hospital managers to understand the factors influencing behavioral intention. Healthcare professionals must ensure that good quality service is delivered to enhance patient satisfaction and trust in adverse services, which influence behavioral intention among the patients.

Antecedents of patient health engagement in the radiotherapy service (evidence from Indonesia).

Background: Private radiotherapy (RT) facilities in emerging countries are growing with cancer incidence. Private healthcare providers must provide better care based on patient perspectives to reach more patients. Aim: This study investigated the relationship between antecedents of patient health engagement (PHE) with revisit intention (RVI) and intent to recommend (ITR) in private RT facilities. Setting: The survey was conducted in a private hospital with a RT service in Central Java province, Indonesia. Methods: A quantitative, cross-sectional design with a purposive sampling method was used. Patient questionnaire survey modified from validated self-administered radiotherapy experience (RTEQ) and PHE questionnaire were used to collect data. Partial least squares-structural equation modelling was used to analyse the data. Results: In this study, 173 respondents consented to participate, which demonstrated that seven of the eight experience antecedents of PHE measured by reliable and valid RTEQ and were significantly related to PHE (p-value <0.05). At the same time, the degree of PHE has a significant relationship with RVI and ITR (p-value <0.05). Conclusion: Patient informational needs elements from the patient experience, followed by situational repose, were shown to have a prominent relation to PHE. The management of private RT facilities needs to focus more on these elements to encourage PHE to establish hospital performance. Contribution: The findings denote that six elements of RTEQ relate to PHE and further hospital outcomes. Hospital management could utilise this approach to improve the quality of care in RT facilities, specifically in private hospitals in emerging countries.

Prediction of COVID-19 Patients' Emergency Room Revisit using Multi-Source Transfer Learning.

The coronavirus disease 2019 (COVID-19) has led to a global pandemic of significant severity. In addition to its high level of contagiousness, COVID-19 can have a heterogeneous clinical course, ranging from asymptomatic carriers to severe and potentially life-threatening health complications. Many patients have to revisit the emergency room (ER) within a short time after discharge, which significantly increases the workload for medical staff. Early identification of such patients is crucial for helping physicians focus on treating life-threatening cases. In this study, we obtained Electronic Health Records (EHRs) of 3,210 encounters from 13 affiliated ERs within the University of Pittsburgh Medical Center between March 2020 and January 2021. We leveraged a Natural Language Processing technique, ScispaCy, to extract clinical concepts and used the 1001 most frequent concepts to develop 7-day revisit models for COVID-19 patients in ERs. The research data we collected were obtained from 13 ERs, which may have distributional differences that could affect the model development. To address this issue, we employed a classic deep transfer learning method called the Domain Adversarial Neural Network (DANN) and evaluated different modeling strategies, including the Multi-DANN algorithm (which considers the source differences), the Single-DANN algorithm (which doesn't consider the source differences), and three baseline methods: using only source data, using only target data, and using a mixture of source and target data. Results showed that the Multi-DANN models outperformed the Single-DANN models and baseline models in predicting revisits of COVID-19 patients to the ER within 7 days after discharge (median AUROC = 0.8 vs. 0.5). Notably, the Multi-DANN strategy effectively addressed the heterogeneity among multiple source domains and improved the adaptation of source data to the target domain. Moreover, the high performance of Multi-DANN models indicates that EHRs are informative for developing a prediction model to identify COVID-19 patients who are very likely to revisit an ER within 7 days after discharge.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.