Emergency Response in the Ambulatory Surgery Center
As more surgeries are moving out of the hospital setting, effective emergency response in freestanding ambulatory surgery centers requires organized preparedness. Rapid, consistent emergency response can be challenged by their rarity of occurrence, fast-paced environment, and relative lack of resources. Anesthesiologists who practice in these settings must be aware of the differences between the management of an anesthetic emergency in the hospital with virtually unlimited resources and staff, versus an ambulatory surgery center with limited resources and slightly different goal: stabilization and transfer of care. Regular simulation-based training schedules are effective for ambulatory surgery center preparedness for emergency response.
Keywords: Airway fire; Ambulatory surgery center; Anaphylaxis; Delayed emergence; Emergencies; Local anesthetic systemic toxicity; Malignant hyperthermia; Myocardial infarction.
Emergency department visits in older patients: a population-based survey
Background: Given the higher incidence of emergency conditions in older inhabitants, the global increase in aged population will pose a challenge for emergency services. In this study we examined the burden caused to emergency health care by the aged population.
Methods: Consecutive patients aged 80 years or over visiting a high-volume, collaborative emergency department (ED) between 2015 and 2016 were included. The key factors under analysis were the incidence of emergency conditions and costs associated with emergency care.
Results: A total of 6944 patients (median age 85 years, range 80-104 years; 67% female) aged ≥80 years representing 1.5% of the local population, made 17,769 ED visits during the two-year observation period accounting for 15% of all ED visits. Forty-two percent (n = 2884) of patients had a single ED visit, whereas 8.2% (n = 570) made ≥5 ED visits/year for a total of 1400 visits (7.9%). Thirty-two percent of those aged ≥80 years required ED services each year. The number of ED visits increased with age (p < 0.001); and was 768/1000 person-years among octogenarians and 1007/1000 among nonagenarians, in comparison to 233/1000 among those aged < 80 years. One in five of the study population were discharged with non-specific diagnoses. Typical diagnoses included pneumonia (4.8%), malaise and fatigue (4.5%) and heart failure (4.3%). Non-specific diagnoses were frequent, and examination of patients with non-specific diagnoses incurred costs similar to or higher than those of other patients. The mean cost per ED visit in older patients was 422 €.
Conclusions: We demonstrated a high incidence of emergency department visits in older patients. While our aim was not to solve how the growing demand should be met, it seems unlikely that increasing ED resources is feasible. Instead, the focus should be on chronic care of the aged and prevention of potentially avoidable ED visits.
Keywords: Aged; Emergencies; Epidemiology; Health care costs.
Bansal VK, Dobie KH, Brock EJ. Emergency Response in the Ambulatory Surgery Center. Anesthesiol Clin. 2019 Jun;37(2):239-250. doi: 10.1016/j.anclin.2019.01.012. Epub 2019 Mar 16. PMID: 31047127.
Ukkonen M, Jämsen E, Zeitlin R, Pauniaho SL. Emergency department visits in older patients: a population-based survey. BMC Emerg Med. 2019 Feb 27;19(1):20. doi: 10.1186/s12873-019-0236-3. PMID: 30813898; PMCID: PMC6391758.