title: Subspecialty emergency room as alternative model for otolaryngologic care: implications for emergency health care delivery.
abstract: OBJECTIVE
  A dedicated otolaryngology emergency room (ER) represents a specialized surgical evaluation and treatment setting that may be an alternative triage pathway for acute otolaryngologic complaints. We aim to characterize practice patterns in this setting and to provide insight into the epidemiology of all-comer, urgent otolaryngologic complaints in the United States.
  
  
  METHODS
  Electronic medical records were reviewed for all patients who registered for otolaryngologic care and received a diagnosis in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Predictors of inpatient admission were identified using multivariable regression. Geocoding analysis was performed to characterize catchment area.
  
  
  RESULTS
  A total of 12,234 patient visits were evaluated with a mean age of 44.7. Auditory and vestibular problems constituted the most frequent diagnoses (50.0%). The majority of patients were discharged home (92.3%). Forty-three percent of patients underwent a procedure in the ER; the most common procedure was diagnostic nasolaryngoscopy (52%). Predictors of inpatient admission were post-operative complaint (odds ratio [OR] 7.3, P<0.0001), arrival overnight (OR 3.3, P<0.0001), and laryngeal complaint (OR 2.4, P<0.0001). Patients traveled farther for evaluation of hearing loss (11 miles) and less for common diagnoses including impacted cerumen (7.1 miles) (P<0.0001).
  
  
  CONCLUSIONS
  In this report, we investigate practice patterns of a dedicated otolaryngology emergency room to explore an alternative to standard acute otolaryngologic health care delivery mechanisms. We identify key predictors of inpatient admission. This study has implications for emergency health care delivery models.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Rosh K V
authors.initials: RK
authors.lastname: Sethi
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. Electronic address: Elliott_kozin@meei.harvard.edu.
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lee
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Gliklich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D017146:Models, Organizational; D010038:Otorhinolaryngologic Diseases / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
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