Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability.

BACKGROUND: This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). METHODS: This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5-64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. RESULTS: Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41-3.29). CONCLUSIONS: Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors.

Clinical Presentations of Adolescents Aged 16-18 Years in the Adult Emergency Department.

BACKGROUND: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16-18 years of age when compared to adults and focuses on their principle complaints. METHODS: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16-18 years of age in this time period and compares their consultation characteristics to those of adult patients. RESULTS: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year; +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p < 0.001), as walk-ins (54.2% vs. 44.9%, p < 0.001), or with less highly acute complaints at triage (21% vs. 31%, p < 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p < 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. CONCLUSIONS: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.

Association between potential primary care emergency service and general practitioner care utilisation in New South Wales.

OBJECTIVE: To examine patterns of potential primary care (PPC) ED presentations and any association between PPC ED presentations and frequency of general practitioner (GP) care utilisation in New South Wales, Australia. METHODS: Retrospective cross-sectional study of 6 221 762 New South Wales patients who had at least one service in public hospitals, EDs or Medical Benefit Schedule claimable for GP service between 2013/2014 and 2014/2015 is conducted to examine association between PPC ED presentations and GP care utilisation using logistic regression adjusting for comorbidity index and a number of other covariates. Data over 2010/2011 to 2014/2015 are included for analyses of trends and patterns in PPC ED and GP care utilisation. RESULTS: Forty-one percent of the ED presentations were PPC ED presentations over the 5 years 2010/2011 to 2014/2015. Population rates of PPC ED presentations and GP care both increased over the period, with higher PPC ED presentation rates in regional areas, and higher GP care rates in major cities. GP care utilisation was associated with reduced odds for PPC ED presentations, with the adjusted odds ratios ranging from 0.28 for patients with one GP care service to 0.48 for patients with five or more GP care services compared with patients with none. Increased comorbidity index was also associated with increased risk of PPC ED presentations. CONCLUSION: GP care utilisation was associated with reduced risk for any PPC ED presentations after adjusting for comorbidity index and the other factors.

Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia.

OBJECTIVE: To explore the patterns of low acuity patient (LAP) presentations to EDs in New South Wales (NSW), Australia. METHODS: Retrospective study of NSW public hospital ED presentations between January 2013 and December 2014 that were registered in the NSW Emergency Department Data Collection (n = 409 035). LAPs were defined according to the Australian Institute of Health and Welfare (AIHW), Sprivulis and multiple ACEM methods. Multivariable logistic regression was used to assess the adjusted odds of LAP ED presentation by a suite of sociodemographic factors. RESULTS: The percentage of LAPs varied considerably by definition, being as high as 54.7% (inner regional areas) and as low as 3.2% (major cities) using revised ACEM methods modified to contain unlimited consultation times or consultation times of 15 min or less, respectively. For each method, higher proportions of LAPs were observed in inner regional and remote/very remote areas relative to major cities. LAP ED presentations, based on ACEM definition with 1 h or 15 min consultation times, were greater in younger patients, increased during out of business hours and weekends, and decreased with increasing general practitioner (GP) density. CONCLUSION: The percentage of LAPs varied substantially by definition, and further work is required to validate the methods, particularly around the appropriateness of length of consultation time with ACEM, between different hospitals and remoteness areas. Age was strongly associated with low acuity, with substantial effects also observed for GP density, and attendances during out of hours and weekends.