Clinical Correlates of Visit Disposition in Emergency Department Patients with Chronic Obstructive Pulmonary Disease

2.50
Hdl Handle:
http://hdl.handle.net/10755/162758
Type:
Presentation
Title:
Clinical Correlates of Visit Disposition in Emergency Department Patients with Chronic Obstructive Pulmonary Disease
Abstract:
Clinical Correlates of Visit Disposition in Emergency Department Patients with Chronic Obstructive Pulmonary Disease
Conference Sponsor:Emergency Nurses Association
Conference Year:2000
Author:Parshall, Mark B., PhD, RN, CEN
P.I. Institution Name:University of New Mexico
Contact Address:College of Nursing, Albuquerque, NM, 87131, USA
Purpose: The purpose of this study was to determine if any clinical findings predict visit disposition for emergency department (ED) patients with chronic obstructive pulmonary disease (COPD). ED visits for COPD are time-consuming, and, except in respiratory failure, there are no objective criteria for admission. Early identification of likely admissions could expedite disposition.

Design, Sample, and Setting: In this exploratory study, 104 ED patients with COPD were recruited from a Department of Veterans Affairs hospital (ED 1; n=62; all male) and a university hospital (ED2; n=42; 26 [62%] female).

Methods: Subjects were interviewed and records reviewed during an ED visit. Clinical data such as age, vital signs (VS), and laboratory results were analyzed for association with admission.

Results: Mean age was ~65 years. Mean duration of dyspnea (as severe as at presentation) was 3 days. Approximately 46% were triaged as emergent, 49% urgent, and 5% non-urgent. On average, subjects were afebrile, normotensive, mildly tachypneic (M=27/min), borderline tachycardic (M=97/min), mildly hypercapnic (M=44mmHg), and moderately hypoxemic (M=74mmHg). Mean Hct, Hgb, and pH were normal. Approximately 90% received at least one, and 55% at least two, nebulized bronchodilator treatments. The admission rate, 46%, was similar to the national average for COPD. Mean visit length was 4.hours, and unrelated to triage classification or disposition. Only 31 % of subjects in ED 1 were admitted compared to 69% in ED2 (p<.00l), despite no differences between departments in triage ratings, laboratory findings, and most vital signs, and only minor differences in age and initial HR. Age, triage ratings, dyspnea duration, blood results, and VS other than HR were unrelated to admission. Approximately 77% of females were admitted, compared to 36% for all males (p<.001), and 56% of males in ED2 (p=.19). Clinical features predicting disposition were: Initial HR (equal to or greater than 101 vs. equal to or less than 100; Sensitivity=62%, Specificity=64%, OR=3.0, 95%CI 1.4, 6.7); and the number of nebulizer treatments (equal to or greater than 2 vs.equal to or less than 1; Sensitivity=71%, Specificity =59%, OR =3.5, 95%CI 1.5, 7.9).

Conclusions: Only two clinical indicators, initial heart rate and the number of nebulizer treatments predicted visit disposition adequately. In contrast, age, triage ratings, symptom duration, and laboratory results were not associated with disposition. Admission rate differences by sex may reflect departmental differences. Findings may help expedite disposition of visits for ED patients with COPD. [Research Paper Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleClinical Correlates of Visit Disposition in Emergency Department Patients with Chronic Obstructive Pulmonary Diseaseen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162758-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Clinical Correlates of Visit Disposition in Emergency Department Patients with Chronic Obstructive Pulmonary Disease</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2000</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Parshall, Mark B., PhD, RN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of New Mexico</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">College of Nursing, Albuquerque, NM, 87131, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">mparshall@salud.unm.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The purpose of this study was to determine if any clinical findings predict visit disposition for emergency department (ED) patients with chronic obstructive pulmonary disease (COPD). ED visits for COPD are time-consuming, and, except in respiratory failure, there are no objective criteria for admission. Early identification of likely admissions could expedite disposition.<br/><br/>Design, Sample, and Setting: In this exploratory study, 104 ED patients with COPD were recruited from a Department of Veterans Affairs hospital (ED 1; n=62; all male) and a university hospital (ED2; n=42; 26 [62%] female).<br/><br/>Methods: Subjects were interviewed and records reviewed during an ED visit. Clinical data such as age, vital signs (VS), and laboratory results were analyzed for association with admission.<br/><br/>Results: Mean age was ~65 years. Mean duration of dyspnea (as severe as at presentation) was 3 days. Approximately 46% were triaged as emergent, 49% urgent, and 5% non-urgent. On average, subjects were afebrile, normotensive, mildly tachypneic (M=27/min), borderline tachycardic (M=97/min), mildly hypercapnic (M=44mmHg), and moderately hypoxemic (M=74mmHg). Mean Hct, Hgb, and pH were normal. Approximately 90% received at least one, and 55% at least two, nebulized bronchodilator treatments. The admission rate, 46%, was similar to the national average for COPD. Mean visit length was 4.hours, and unrelated to triage classification or disposition. Only 31 % of subjects in ED 1 were admitted compared to 69% in ED2 (p&lt;.00l), despite no differences between departments in triage ratings, laboratory findings, and most vital signs, and only minor differences in age and initial HR. Age, triage ratings, dyspnea duration, blood results, and VS other than HR were unrelated to admission. Approximately 77% of females were admitted, compared to 36% for all males (p&lt;.001), and 56% of males in ED2 (p=.19). Clinical features predicting disposition were: Initial HR (equal to or greater than 101 vs. equal to or less than 100; Sensitivity=62%, Specificity=64%, OR=3.0, 95%CI 1.4, 6.7); and the number of nebulizer treatments (equal to or greater than 2 vs.equal to or less than 1; Sensitivity=71%, Specificity =59%, OR =3.5, 95%CI 1.5, 7.9).<br/><br/>Conclusions: Only two clinical indicators, initial heart rate and the number of nebulizer treatments predicted visit disposition adequately. In contrast, age, triage ratings, symptom duration, and laboratory results were not associated with disposition. Admission rate differences by sex may reflect departmental differences. Findings may help expedite disposition of visits for ED patients with COPD. [Research Paper Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:33:38Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:33:38Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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