Clinical Research Directory

Study of Hospital-at-Home Program Failure for Infections Started in the Emergency Department

This is a retrospective, multicenter, non-interventional cohort study based on data derived from existing electronic medical records. The study collects data on patient demographic and clinical characteristics, infection diagnosis, triage vital signs, laboratory values, and comorbidities in adults enrolled in the Emergency Department-initiated Hospital-at-Home (ED/HaH) model under Taiwan's National Health Insurance Administration (NHIA) Acute Care at Home (ACAH) Pilot Program. For patient selection, enrollment in the NHIA ACAH Model C pathway was used as the index event. The patient selection period extends from August 1, 2024 to January 1, 2026. All adult patients (aged ≥18 years) with a primary diagnosis of pneumonia, urinary tract infection (UTI), or skin and soft tissue infection (SSTI) - confirmed by ICD-10 codes - who were enrolled directly from the emergency department at one of three participating tertiary medical centers (Chi-Mei Medical Center, Wan-Fang Hospital, and Taipei Medical University Hospital) during that period were considered for inclusion. Patients were identified through electronic medical record queries, and data were abstracted using a standardized case record form applied uniformly across all sites. The primary outcome is HaH program failure, defined as any unanticipated care escalation (emergency department transfer, inpatient admission, or ICU admission within 48 hours of ED transfer) or death occurring during the HaH episode prior to planned completion. The program failure rate and characteristics of failure events - including failure type, clinical disposition, and time from HaH initiation to failure - will be described. As a secondary objective, exploratory multivariable analysis will examine whether demographic and clinical variables measured at ED enrollment show potential associations with program failure. A total of 472 HaH episodes from 420 unique patients were analyzed. Statistical analyses will be performed for the overall cohort.

Effect of Aromatherapy on Anxiety in Relatives of Emergency Patients.

This study aims to determine the effect of aromatherapy (lavender oil) application on the anxiety level of relatives of patients admitted to the emergency department. The hypotheses of the study are as follows: H1: Aromatherapy (lavender oil) application has an effect on the anxiety level of relatives of patients presenting to the emergency department. H0: Aromatherapy (lavender oil) application has no effect on the anxiety level of relatives of patients presenting to the emergency department.

Home-based Acute Care for Older Persons Initiated by the Emergency Medical and Ambulance Services - a Retrospective Observation of Effects on Healthcare Utilisation and Mortality

This observational study aims to examine outcomes of home-based acute care delivered by a mobile healthcare team in persons aged 75 years and older following an episode of acute illness. The study will assess whether home-based acute care initiated by the emergency medical dispatch centre or ambulance services is non-inferior to emergency department care with regard to care needs and mortality.

Informing Low-acuity Emergency Department Patients of Non-emergent Resources (2)

The goal of this campaign is to reduce unnecessary visits to a Geisinger emergency department (ED). In this campaign, patients will be assigned to receive or not receive outreach following ED discharge with a low-acuity visit designation. Outreach will occur via a text message the day after discharge from the ED as well as information added to the patient's after visit summary (AVS). Depending on the assigned condition, it will include calls to see their primary care provider (PCP) or use an Intelligent Triage tool. The study will assess whether ED use within the following 120 days differs across patients in different outreach conditions (current standard practice vs contact your PCP vs use Intelligent Triage). It will also examine whether patients follow through on the message-specific calls to action differently across conditions.

Evaluation of the Access to Healthcare Service

The Healthcare Access Service (SAS) of the Emergency Department of the CHG du Havre is a telephone regulation (i.e., orientation) service for users of Le Havre. Access to this service, during a call, gives access to a Medical Regulation Assistant (ARM) (first contact) who determines, in less than 30 seconds, the degree of urgency applicable to the "caller" in order to direct the latter to the "primary care" channel or the "urgent medical assistance" channel. Thus, in the context of a non-life-threatening emergency, this service allows access during the day to a consultation with a healthcare professional. When their primary care physician is not available, the "caller" is directed by a Medical Regulation Assistant (ARM) to an Unscheduled Care Operator (OSNP) who can provide medical advice, offer a teleconsultation, or direct them, depending on the situation, to an unscheduled care consultation in an office, at home, or at a health center. This service therefore allows for patient referrals and gives patients direct access to healthcare professionals known as "performers" of primary care (doctor, midwife, dentist) within very short timeframes (most often during the day, and 48 hours at the latest). This medical regulation is made possible through the use of a shared calendar between independent healthcare professionals and the healthcare access service (SAS). In the event of a life-threatening emergency, the "caller" is directed by the Medical Regulation Assistant (ARM) to an emergency Medical Regulation Assistant (ARM) who assesses the actual degree of urgency, the medical needs and the possibility of triggering the SAMU intervention. Before its implementation, the patient journey was complicated by the lack of a link between regulation and so-called "field" medical professionals, now called "performers" of primary care. Indeed, the initial so-called "standard" regulation system did not have a "primary care" referral system (with very rapid appointments to primary care for semi-emergencies (unscheduled community care)), potentially saving recourse to emergency services or medical time in situations not requiring medical advice (request for contact details of on-call pharmacy).

Eligibility of Patients Referred to Emergency Departments by Their General Practitioners for Care in Walk-in Clinics: A Single-Center Study in Île-de-France

This study aims to find out how many patients sent to the emergency department by their general practitioner could instead be treated in a walk-in clinic. Walk-in clinics provide quick, basic medical care without an appointment and can perform simple tests like blood work and X-rays. By identifying patients who don't need full hospital emergency care, this study hopes to improve patient flow and reduce overcrowding in emergency rooms in the Île-de-France region.

Modelling of Correlation Between Emergency Department Admissions and Location-specific Air Quality and Weather in the Florence Urban Area

The goal of this observational study is to evaluate the impact of primary air pollutants and weather parameters on emergency department (ED) visits in the metropolitan area of Florence.

Appropriate Use of Blood Cultures in the Emergency Department Through Machine Learning

The goal of this clinical trial is to study whether the use of our blood culture prediction tool is non-inferior to current practice and if it can improve certain outcomes in all adult patients presenting to the emergency department with a clinical indication for a blood culture analysis (according to the treating physician). The primary endpoint is 30-day mortality. Key secondary outcomes are: * hospital admission rates * in-hospital mortality * hospital length-of-stay. In the intervention group, the physician will follow the advice of our blood culture prediction tool. In the comparison group all patients will undergo a blood culture analysis.