Differences of disease characteristics between genders in emergency department elderly of a community hospital in Taiwan.

BACKGROUND: The purpose of this study was to catalog the chief complaints and diagnoses of elderly patients visiting to a Taiwanese emergency department (ED), and to compare gender differences. METHODS: ED computer log data of patients 65 years and older, who visited the ED from July 1995 to June 1996, were retrospectively reviewed. The computer log data for each patient was entered prospectively by the doctor providing the ED care. All patient data were separated by gender, and then subdivided into trauma and non-trauma groups for analysis. RESULTS: There were 8038 elderly patients treated during the study period. The most common male chief complaint was dyspnea, and for females, it was abdominal pain, followed by injuries for both genders. Falls were the most common mechanism of injury for both genders, but they were more common among females (63.2% vs. 46.1%, p < 0.001). Motorbike accidents, however, were 3 times as frequent among males (16.05% vs. 5.45%, p < 0.001). Males presented most commonly with COPD (12.2%), compared to only 4.16% for females (p < 0.001), with urinary retention the second most common diagnosis (5.04% vs. 0.72%, p < 0.001). Females suffered a greater number of urinary tract infections (5.42% vs. 2.03%, p < 0.001), presentations for renal failure (2.98% vs. 1.56% p < 0.001), and diabetes-associated problems (4.58% vs. 2.48%, p < 0.001). CONCLUSION: Elderly females presented to the ED more frequently with urinary tract and diabetic problems; while their male counterparts presented with complications of COPD, urinary retention, and motorbike accidents.

Clinical presentations of elderly patients at emergency departments: a comparison between a medical center and a community hospital.

BACKGROUND: The utilization of emergency services is expected to increase in parallel with an increase of the elderly population. This article compares the elderly patient Emergency Department (ED) utilization at a 3500-bed medical center with that of a 600-bed community hospital serviced by the same group of emergency physicians. METHODS: We retrospectively reviewed all patients over 64 years old who presented to Linkou Chang Gung Memorial Hospital (CGMH) and Keelung CGMH between July 1, 1995 and June 30, 1996 by using the 2 ED's real-time computer logs. Data comparisons included age, gender, mode of arrival, arriving source, triage category, chief complaint, impression, and final disposition. RESULTS: There were 18,285 patients in the Linkou ED and 8038 in Keelung. Significant differences in arrival mode, arriving source, triage category, disease pattern, and final disposition were observed between the Linkou and Keelung CGMH EDs. CONCLUSION: Significant differences reflected the different roles between the Linkou and Keelung CGMH EDs. Hospital EDs should be prepared to adapt to meet the needs of the elderly based on their roles in the medical care system, at the elderly population grows in the 21st century.

Rates and causes of emergency department revisits within 72 hours.

The purpose of this study was to determine the rates and causes of revisits to the emergency department (ED) of a 3,500-bed referral hospital, to identify areas for improvement, and to generate baseline data for the development of a computerized, automatic monthly audit system. We identified all patients returning within 72 hours of their initial ED visits, from 1 July 1995 to 30 June 1997, and monthly revisit rates were calculated. To determine the reasons for revisits, two independent reviewers examined the charts of revisit cases from 1 July 1996 to 30 June 1997. A one-in-three sampling method was used to select charts. A total of 485 revisit charts were reviewed. The monthly revisit rates ranged from 1.32% to 2.38%, with no particular seasonal or event-specific pattern. Most revisits were attributed to disease factors (79.0%). Those felt to be medical errors only accounted for 7.8% of the revisits but led to a higher hospital admission rate (73.7%) subsequently. By contrast, the overall hospital admission rates for revisit patients (36.5%) and all ED patients (36.2%) were similar. We suggest setting baseline monthly ED revisit rates at 2% for future computer-programmed audit filters. While this study indicates that most revisits are disease-related, further prospective studies are needed to evaluate the most common and serious causes of revisits to see if improvements can be made.

Compliance with the law and appropriate medical standards during interhospital transfers.

Interhospital transfer patients constitute a significant proportion of medical center emergency department (ED) patients in Taiwan. Many such transfers are poorly planned and put the patient at risk. We wished to evaluate the safety and compliance with the Taiwan Medical Law among patients transferred to the Linkou Chang Gung Memorial Hospital ED from other health care centers. We performed a prospective, cross-sectional, observational study on 1,056 patients transferred from August 15 to September 30, 1997. Of these patients, 357 were critically ill or injured and only 160 received adequate pretransfer stabilization. The major omissions included: 1) failure to intubate in 121 (55%) of the 220 patients in severe respiratory distress or unprotected patent airways; 2) no intravenous line in 74 (20.7%) of the 357; and 3) inadequate IV lines in 36 (63.2%) of the 57 severely hypotensive patients. Overall, 894 patients were sent with transfer notes, but few indicated whether the referral was to the ED or outpatient department. This added an unnecessary burden for patients with stable longstanding problems who claimed they had been referred to the ED. While the majority of patients (49.4%) were transferred at the request of physicians for further treatment, 28% of the critically ill patients were transferred because of family requests. Physicians accompanied these patients only on seven occasions and nurses on 84 occasions. Despite the 1993 Department of Health policy of pretransfer phone contact with the receiving hospital for critically ill patients, such contact occurred only 10.6% of the time. While the Taiwan emergency medical system, Emergency Medicine, and Critical Care Medicine are all in their developmental stages, a medical and legal noncompliance rate of above 55% for critically ill transfer patients is unacceptably high. The appropriate medical societies and the Department of Health should work in concert to upgrade existing transfer practices.