What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources

Introduction: Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients.Methods: We collected definitions of FSEDs from 11 national data sources using their websites, email, and telephone communications. For each source, we asked how they define FSEDs, whether being open 24/7 is a requirement to be called an ED, and whether they maintain a dataset of FSEDs.Results: Definitions varied across the data sources. All sources recognize FSEDs in their definitions, regardless of type; only one (the National Health Intervew Survey) does not differentiate them from other EDs. Five of the 11 sources (45%) omit autonomous FSEDs from their definitions and do not separately identify satellite FSEDs from their affiliated hospitals. One source does separately identify satellite FSEDs from their affiliated hospitals, but also omits autonomous FSEDs. Furthermore, three of the 11 sources (27%) do not require being open 24/7, while all others (73%) employ this criterion. Six of the 11 (55%) maintain datasets of FSEDs using their definition.Conclusion: As FSEDs continue to change the landscape of emergency care, it is important that they also be represented in national ED data sources. The current differences in the definition of an FSED make it difficult to provide accurate and longitudinal analysis for these facilities and patients who receive services at these facilities. We propose a universal definition of FSEDs as described by both the American College of Emergency Physicians and the National Emergency Department Inventory. Implementing a standard definition would facilitate a more accurate representation of FSEDs in national data sources and enhance ongoing efforts to improve the quality of emergency care delivered in FSEDs

Estimated population access to acute stroke and telestroke centers in the US, 2019

This cross-sectional study assesses US population access to emergency departments with acute stroke capabilities and telestroke capacity in 2019

What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources

Introduction: Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients.Methods: We collected definitions of FSEDs from 11 national data sources using their websites, email, and telephone communications. For each source, we asked how they define FSEDs, whether being open 24/7 is a requirement to be called an ED, and whether they maintain a dataset of FSEDs.Results: Definitions varied across the data sources. All sources recognize FSEDs in their definitions, regardless of type; only one (the National Health Intervew Survey) does not differentiate them from other EDs. Five of the 11 sources (45%) omit autonomous FSEDs from their definitions and do not separately identify satellite FSEDs from their affiliated hospitals. One source does separately identify satellite FSEDs from their affiliated hospitals, but also omits autonomous FSEDs. Furthermore, three of the 11 sources (27%) do not require being open 24/7, while all others (73%) employ this criterion. Six of the 11 (55%) maintain datasets of FSEDs using their definition.Conclusion: As FSEDs continue to change the landscape of emergency care, it is important that they also be represented in national ED data sources. The current differences in the definition of an FSED make it difficult to provide accurate and longitudinal analysis for these facilities and patients who receive services at these facilities. We propose a universal definition of FSEDs as described by both the American College of Emergency Physicians and the National Emergency Department Inventory. Implementing a standard definition would facilitate a more accurate representation of FSEDs in national data sources and enhance ongoing efforts to improve the quality of emergency care delivered in FSEDs

Processed Meat Intake and Risk of Chronic Obstructive Pulmonary Disease among Middle-aged Women

International audienceBackground: Processed meat intake may increase the risk of chronic obstructive pulmonary disease (COPD). However, the magnitude of this association may depend on smoking and unhealthy diet. Our aims were to determine whether processed meat intake increased the risk of COPD among middle-aged women, and to estimate the combined impact of high processed meat intake, smoking and unhealthy diet on the risk of COPD.Methods: Analyses included 87,032 registered nurses from the Nurses' Health Study II (baseline mean age 36.8 years). Over 2,296,894 person-years (1991-2017), we documented 634 incident cases of COPD. Cumulative average of processed meat intake (every 4 years) was divided into never/almost never, < 1 or ≥ 1 servings/week. A score was created to study the impact of 3-risk lifestyle factors.Findings: In multivariable-adjusted Cox proportional hazards models, after careful adjustment for smoking and unhealthy diet, we observed a positive association between processed meat intake and the risk of COPD: Hazard Ratio (HR, 95%CI) for ≥ 1 servings/week vs. never/almost never = 1.29 (1.00-1.65). In analyses stratified according to smoking or unhealthy diet, processed meat intake was associated with increased risk of COPD only among ever smokers (HR 1.37 [1.01-1.86]), and among women with unhealthy diet (HR 1.39 [1.04-1.85]). The multivariable-adjusted HR for COPD in participants with all 3 high-risk lifestyle factors compared with none was 6.32 (3.67-10.87).Interpretation: Processed meat intake was associated with elevated risk of developing COPD in middle-aged women, especially in presence of other high-risk lifestyle factors (smoking, unhealthy diet).Fundings: US CDC and NIH

Association of Emergency Department Payer Mix with ED Receipt of Telehealth Services: An Observational Analysis

Introduction: Telehealth is commonly used to connect emergency department (ED) patients with specialists or resources required for their care. Its infrastructure requires substantial upfront and ongoing investment from an ED or hospital and may be more difficult to implement in lower-resourced settings. Our aim was to examine for an association between ED payer mix and receipt of telehealth services. Methods: Using data from the National Emergency Department Inventory (NEDI)-USA 2016 survey, we categorized EDs based on receipt of telehealth services (yes/no). The NEDI-USA data for EDs in New York state was linked with data from state ED datasets (SEDD) and state inpatient data (SID) to determine EDs’ payer mix (percent self-pay or Medicaid). Other ED characteristics of interest were rural location, academic status, and annual ED visit volume. We compared EDs with and without telehealth receipt, and used a logistic regression model to examine the relationship between ED payer mix and telehealth receipt after accounting for other ED characteristics. Results: Of the 162 New York EDs in the SEDD-SID dataset, 160 (99%) were linked to the NEDI-USA dataset and 133 of those responded (83%) to the survey. Telehealth receipt was reported by 48 EDs (36%, 95% confidence interval [CI], 28-44%). Emergency departments with and without telehealth receipt were similar (all P &gt;0.40) with respect to rurality (6% vs 9%, respectively), academic status (13% vs 8%), and annual volume (median 36,728 vs 43,000). By contrast, median percent of Medicaid or self-pay patients was lower in telehealth EDs (36%) vs non-telehealth EDs (45%, P = 0.02). In adjusted analysis, increasing proportion of Medicaid and self-pay patients was associated with decreased odds of telehealth receipt (odds ratio 0.87 per 5% increase; 95% CI, 0.77-0.99). Rural location, academic status, and ED volume were not significantly associated with odds of ED telehealth receipt in the adjusted model. Conclusion: Among EDs in the state of New York, increasing proportion of self-pay and Medicaid patients was associated with decreased odds of ED telehealth receipt, even after accounting for rural location, academic status, and ED volume. The findings support the need for additional infrastructural investment in EDs serving a greater proportion of disadvantaged patients to ensure equitable access

Consolidating Emergency Department-specific Data to Enable Linkage with Large Administrative Datasets

Introduction: The American Hospital Association (AHA) has hospital-level data, while the Centers for Medicare &amp; Medicaid Services (CMS) has patient-level data. Merging these with other distinct databases would permit analyses of hospital-based specialties, units, or departments, and patient outcomes. One distinct database is the National Emergency Department Inventory (NEDI), which contains information about all EDs in the United States. However, a challenge with merging these databases is that NEDI lists all US EDs individually, while the AHA and CMS group some EDs by hospital network. Consolidating data for this merge may be preferential to excluding grouped EDs. Our objectives were to consolidate ED data to enable linkage with administrative datasets and to determine the effect of excluding grouped EDs on ED-level summary results.Methods: Using the 2014 NEDI-USA database, we surveyed all New England EDs. We individually matched NEDI EDs with corresponding EDs in the AHA and CMS. A “group match” was assigned when more than one NEDI ED was matched to a single AHA or CMS facility identification number. Within each group, we consolidated individual ED data to create a single observation based on sums or weighted averages of responses as appropriate.Results: Of the 195 EDs in New England, 169 (87%) completed the NEDI survey. Among these, 130 (77%) EDs were individually listed in AHA and CMS, while 39 were part of groups consisting of 2-3 EDs but represented by one facility ID. Compared to the individually listed EDs, the 39 EDs included in a “group match” had a larger number of annual visits and beds, were more likely to be freestanding, and were less likely to be rural (all P&lt;0.05). Two grouped EDs were excluded because the listed ED did not respond to the NEDI survey; the remaining 37 EDs were consolidated into 19 observations. Thus, the consolidated dataset contained 149 observations representing 171 EDs; this consolidated dataset yielded summary results that were similar to those of the 169 responding EDs.Conclusion: Excluding grouped EDs would have resulted in a non-representative dataset. The original vs consolidated NEDI datasets yielded similar results and enabled linkage with large administrative datasets. This approach presents a novel opportunity to use characteristics of hospital-based specialties, units, and departments in studies of patient-level outcomes, to advance health services research

Characterizing New England Emergency Departments by Telemedicine Use

Introduction: Telemedicine connects emergency departments (ED) with resources necessaryfor patient care; its use has not been characterized nationally, or even regionally. Our primaryobjective was to describe the prevalence of telemedicine use in New England EDs and theclinical applications of use. Secondarily, we aimed to determine if telemedicine use wasassociated with consultant availability and to identify ED characteristics associated withtelemedicine use.Methods: We analyzed data from the National Emergency Department Inventory-New Englandsurvey, which assessed basic ED characteristics in 2014. The survey queried directors of everyED (n=195) in the six New England states (excluding federal hospitals and college infirmaries).Descriptive statistics characterized ED telemedicine use; multivariable logistic regressionidentified independent predictors of use.Results: Of the 169 responding EDs (87% response rate), 82 (49%) reported usingtelemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of nonusers,p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); andless likely to have 24/7 access to neurology (p&lt;0.001), neurosurgery (p&lt;0.001), orthopedics(p=0.01), plastic surgery (p=0.01), psychiatry (p&lt;0.001), and hand surgery (p&lt;0.001)consultants. Neuro/stroke (68%), pediatrics (11%), psychiatry (11%), and trauma (10%) were themost commonly reported applications. On multivariable analysis, telemedicine was more likely inrural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1. 30-14.86), and less likely in EDswith 24/7 neurologist availability (OR 0.21, 95% CI [0.09-0.49] ), and annual volume &lt;20,000 (OR0.24, 95% CI [0.08-0.68]).Conclusion: Telemedicine is commonly used in New England EDs. In 2014, use was morecommon among rural EDs and EDs with limited neurology consultant availability. In contrast,telemedicine use was less common among very low-volume EDs

Characterizing New England Emergency Departments by Telemedicine Use

Introduction: Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use. Methods: We analyzed data from the National Emergency Department Inventory-New England survey, which assessed basic ED characteristics in 2014. The survey queried directors of every ED (n=195) in the six New England states (excluding federal hospitals and college infirmaries). Descriptive statistics characterized ED telemedicine use; multivariable logistic regression identified independent predictors of use. Results: Of the 169 responding EDs (87% response rate), 82 (49%) reported using telemedicine. Telemedicine EDs were more likely to be rural (18% of users vs. 7% of non-users, p=0.03); less likely to be academic (1% of users vs. 11% of non-users, p=0.01); and less likely to have 24/7 access to neurology (p<0.001), neurosurgery (p<0.001), orthopedics (p=0.01), plastic surgery (p=0.01), psychiatry (p<0.001), and hand surgery (p<0.001) consultants. Neuro/stroke (68%), pediatrics (11%), psychiatry (11%), and trauma (10%) were the most commonly reported applications. On multivariable analysis, telemedicine was more likely in rural EDs (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.30–14.86), and less likely in EDs with 24/7 neurologist availability (OR 0.21, 95% CI [0.09–0.49]), and annual volume <20,000 (OR 0.24, 95% CI [0.08–0.68]). Conclusion: Telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

International audienceBackground: Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses. Methods: The Nurses’ Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index. Results: Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence. Conclusions: In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect

Healthful and Unhealthful Plant-Based Diets and Chronic Obstructive Pulmonary Disease in U.S. Adults: Prospective Study

Background: Despite the potential protective effect of a plant-based diet against chronic obstructive pulmonary disease (COPD), it remains unknown whether intake of different types of plant foods is beneficial for COPD. Our aims were to determine whether adherence to the healthful version of a plant-based diet (healthful Plant-based Diet Index (hPDI)) is associated with a lower COPD risk, whereas adherence to the unhealthful version (unhealthful Plant-based Diet Index (uPDI)) is associated with a higher COPD risk. Methods: 46,948 men from the Health Professionals Follow-up Study, 73,592 women from the Nurses&rsquo; Health Study, and 85,515 women from the Nurses&rsquo; Health Study II who completed biennial questionnaires from 1984&ndash;2018. We derived diet scores from repeated validated food frequency questionnaires. Among 5,661,994 person-years of follow-up, we documented 2605 validated COPD cases between 1984&ndash;2018. Results: After tight control for smoking and other potential confounders, COPD risk was 46% lower among participants with the highest hPDI score compared to those with the lowest score. Conversely, COPD risk was 39% higher among participants with the highest uPDI. Further adjustment for processed meat intake led to similar results. Conclusions: These findings provide further evidence for consuming a diet that emphasizes healthful plant foods to optimize lung health