Introduction: This study aims to assess follow-up behaviors of patients who leave without being seen (LWBS) from a hybrid point of service (POS) collection model Emergency Department (ED).

Methods: A cross-sectional survey was administered to patients who LWBS from a hybrid POS collection model ED, one-week post-ED visit, at an academic tertiary care medical center in Lebanon, between June 2016 and May 2017.

Results: LWBS patients were found to be young, males, and present with conditions of lower urgency and presenting mainly with a musculoskeletal chief complaint. Majority (66.8%) left because of third party payer denial of visit coverage followed by cost of visit (12.6%) and wait times (12.6%). A greater percentage of those who LWBS due to financial reasons were male (64.1% vs 33.3%, p <0.001) and waited less (23.4 min vs 30.8 min, p=0.08) compared to those who left for non-financial reasons. The majority of LWBS patients sought medical care within the week after leaving the ED (78.4%), primarily at ambulatory clinics (89.9%) with few at emergency departments (10.1%). Few required admission to hospital (4.2%) and no mortalities were reported. A greater percentage of those who left because of financial barriers, felt the same/better after leaving the ED (82.1% vs 66.7%, p=0.03), sought care at alternate sites (82.1% vs 66.7%, p=0.03), primarily ambulatory clinics (94.1%, p=0.003), with fewer requiring admission to the hospital within one well (1.4% vs 13.3%, p=003). Irrespective of the reason for LWBS, all patients who sought care at an ambulatory clinic, did so at a different institution (100.0%).

Conclusion: While the majority of patients who left without being seen from a hybrid POS collection ED left for financial reasons, a high percentage sought care at ambulatory clinics after leaving the ED.  Larger-scale studies are needed to adequately assess the outcomes of those patients, especially in areas with limited access to primary care ambulatory services.

Introduction: Unscheduled return visits are an important quality indicator in the emergency department. We aim to compare clinical characteristics and ED resource usage of pediatric high risk unscheduled return visits (HRURVs) between the index and return visit and explore root cause of HRURVs.

Methods: A retrospective chart-review study conducted between November 1, 2014 and October 31, 2015. All patients who returned to the ED within 72 hours of discharge and were admitted or died on re-presentation were considered.

Results: The incidence rate of HRURV in our study was 0.96% (95%, CI:0.81-1.13%). We found that significantly more patients were febrile on index visit than on the return visit. In contrast, HRURV patients had significantly more imaging, labs, IV fluids, ED consults and procedures on return visit. Also, the return visit length of stay (LOS) was significantly higher than on index visit (2.76±1.82 Vs. 5.88±0.44). Upon revisit, 2.2% of patients required ICU admission and 7.9% required surgery. The most common discharge diagnosis were digestive system disorders (29.5%) and infectious/parasitic diseases (27.3%). Only infectious/parasitic disease showed a high number of changes in diagnosis from first to second visit. The majority (73.4%) of HRURVs were classified as being “illness-related”. Digestive disorders accounted for the largest portion of “physician related” reasons for revisit (41%).

Conclusion: HRURV patients require more resources on return visits and have longer ED stays than the index visit. While the majority of re-visits do not lead to a change in diagnosis and are primarily related to progression of disease, specific attention should be paid to digestive disorders where physician related causes were high and which account for 18% of surgeries on return visit.

Introduction: Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

Methods: We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.

Results: Overall, E-prescriptions included fewer prescription errors as compared to HW- prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).

Conclusion: A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Introduction: Medication errors are common, with studies reporting at least one error perpatient encounter. At hospital discharge, medication errors vary from 15%-38%. However,studies assessing the effect of an internally developed electronic (E)-prescription systemat discharge from an emergency department (ED) are comparatively minimal. Additionally,commercially available electronic solutions are cost-prohibitive in many resource-limitedsettings. We assessed the impact of introducing an internally developed, low-cost E-prescriptionsystem, with a list of commonly prescribed medications, on prescription error rates at dischargefrom the ED, compared to handwritten prescriptions.

Methods: We conducted a pre- and post-intervention study comparing error rates in a randomlyselected sample of discharge prescriptions (handwritten versus electronic) five months pre andfour months post the introduction of the E-prescription. The internally developed, E-prescriptionsystem included a list of 166 commonly prescribed medications with the generic name, strength,dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 inthe pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase wereelectronic. We calculated rates of 14 different errors and compared them between the pre- andpost-intervention period.

Results: Overall, E-prescriptions included fewer prescription errors as compared to HWprescriptions.Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001),missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001)and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significantincrease in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).

Conclusion: A basic, internally developed E-prescription system, featuring commonly usedmedications, effectively reduced medication errors in a low-resource setting where the costs ofsophisticated commercial electronic solutions are prohibitive. [West J Emerg Med. 2017;18(5)943-950.]

Poisoning and envenomation are a global health problem for which the mortality burden is shouldered heavily by middle- and low-income countries that often lack poison prevention programs and medical toxicology expertise. Although telehealth or teleconsult services have been used to bridge the expertise gap between countries for multiple specialties, the use of medical toxicology teleconsult services across borders has been limited. We aim to describe the use of a United States-based medical toxicology teleconsult service to support patient care at a hospital in a middle-income country that lacks this expertise. This report outlines the logistics involved in setting up such a service, including the challenges and opportunities that emerged from establishing medical toxicology teleconsult service in a low-resource setting.