Publications by authors named "Edward Wee Kwan Teo"

2 Publications

  • Page 1 of 1

Data-Driven Approach to Defining the Emergency Department Frequent Attender Using a Cohort of 10 Years.

J Acute Med 2018 Mar;8(1):6-16

Singapore General Hospital Department of Emergency Medicine Singapore.

Aims: To identify, based on the measure of resource utilization, the number of visits per calendar year that defines the emergency department (ED) frequent attender; and examine for significant trends in patient characteristics and outcomes which may support the use of our definition.

Materials And Methods: We conducted a retrospective observational study of electronic clinical records of all ED visits over a 10-year period from January 2005 to December 2014 to an urban tertiary general hospital. We defined the ED frequent attender based on the number of ED attendances per calendar year which would yield a patient group representing more than 20% of all patient visits. Chi-square tests were conducted on each categorical factor individually to assess if they were independent of time, and the Student's t-test was used to assess continuous variables on their association with being a frequent attender.

Results: 1.381 million attendance records were analyzed. Patients who attended three or more times per year accounted for about 22.1% of all attendances and were defined as frequent attenders. They were associated with higher triage acuity, complex chronic illnesses, greater 30-day mortality for patients with three to six visits, and increased markers of resource utilization, such as ambulance use (15.5% vs. 11.6%), time to disposition (180 vs. 155 minutes), admissions rate (47.4% vs. 30.7%) and inpatient length of stay (6 days vs. 4 days). All values were statistically significant ( < 0.001).

Conclusion: We have demonstrated a data-driven approach to defining an ED frequent attender. Frequent attenders are associated with increased resource utilization, more complex illness and may be associated with greater 30-day mortality rates.
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http://dx.doi.org/10.6705/j.jacme.201803_8(1).0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517909PMC
March 2018

Association between the elderly frequent attender to the emergency department and 30-day mortality: A retrospective study over 10 years.

World J Emerg Med 2018 ;9(1):20-25

Department of Emergency Medicine, Singapore General Hospital, Singapore.

Background: To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality.

Methods: Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student -test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender.

Results: 1.381 million attendance records were analyzed. Elderly patients accounted for 25.5% of all attendances, of which 31.3% are frequent attenders. Their 30-day mortality rate increased from 4.0% in the first visit, to 8.8% in the third visit, peaking at 10.2% in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year.

Conclusion: Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.
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http://dx.doi.org/10.5847/wjem.j.1920-8642.2018.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717371PMC
January 2018
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