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Garssen SH, Vernooij CA, Kant N, Koning MV, Bosch FH, Doggen CJM, Veldkamp BP, Verhaegh WFJ, Oude Wesselink SF. Predicting whether patients in an acute medical unit are physiologically fit-for-discharge using machine learning: A proof-of-concept. Int J Med Inform 2024; 191:105586. [PMID: 39167884 DOI: 10.1016/j.ijmedinf.2024.105586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Delays in discharging patients from Acute Medical Units hamper patient flows throughout the hospital. The decision to discharge a patient is mainly based on the patients' physiological condition, but may vary between physicians. An objective decision-support system based on patients' physiological data may help minimizing unnecessary delays in discharge. The aim of this proof-of-concept study is to assess the feasibility of predicting whether patients in an Acute Medical Unit are physiologically fit-for-discharge using machine learning with commonly available hospital data. Furthermore, this study investigated how long before actual time of discharge from the Acute Medical Unit we could predict discharge fitness. Also, the predictive importance of features extracted from these data was assessed. METHODS Electronic Medical Records of patients who participated in a Randomized Controlled Trial conducted in an Acute Medical Unit were used retrospectively (N = 199). Only commonly available hospital data were used. Logistic Regression and Random Forest models were applied to predict every hour whether patients were physiologically fit-for-discharge. Nested 5-fold cross-validation with 5 repeats was used to optimize the model hyperparameters and to estimate the predictive performances. RESULTS Physiological discharge fitness was predictable with reasonable performance for Logistic Regression (mean AUROC: 0.67) and Random Forest (mean AUROC: 0.69). For an intuitively chosen classification threshold of 0.8, mean specificity was 93.3 % and sensitivity 14.1 %. Models could predict physiological discharge fitness more than 24 h earlier than actual time of discharge for most patients who were correctly predicted to be fit-for-discharge. Patient characteristics, vital signs and laboratory results were shown to be important predictors. CONCLUSION This proof-of-concept study showed that it is feasible to predict with machine learning whether patients in an Acute Medical Unit are physiologically fit-for-discharge using commonly available hospital data.
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Affiliation(s)
- S H Garssen
- Health Technology and Services Research, Techmed Centre, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands; Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands; Department of Patient Care and Monitoring, Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
| | - C A Vernooij
- Department of Patient Care and Monitoring, Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - N Kant
- Health Technology and Services Research, Techmed Centre, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands; Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands; Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
| | - M V Koning
- Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
| | - F H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands; Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - C J M Doggen
- Health Technology and Services Research, Techmed Centre, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands; Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
| | - B P Veldkamp
- Department of Cognition, Data, and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, De zul 10, 7522 NJ Enschede, The Netherlands.
| | - W F J Verhaegh
- Department of Data Science & AI Engineering, Philips, High Tech Campus 33, 5656 AE Eindhoven, The Netherlands
| | - S F Oude Wesselink
- Department of Cognition, Data, and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, De zul 10, 7522 NJ Enschede, The Netherlands.
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Bartenschlager CC, Brunner JO, Kubiciel M, Heller AR. Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01162-8. [PMID: 39093430 DOI: 10.1007/s00063-024-01162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/20/2024] [Accepted: 06/11/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the "best for the most" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises. METHODS We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics. RESULTS Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU. CONCLUSION A SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or "first come, first served" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.
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Affiliation(s)
- Christina C Bartenschlager
- Applied Data Science in Healthcare, Nürnberg School of Health, Ohm University of Applied Sciences Nuremberg, 90489, Nürnberg, Germany.
- Anaesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Jens O Brunner
- Decision Science in Healthcare, Department of Technology, Management, and Economics, Technical University of Denmark, Akademivej, Kongens Lyngby, 2800, Denmark
| | - Michael Kubiciel
- Chair of German, European and International Criminal, Medical and Economic Law, University of Augsburg, Universitätsstraße 24, 86159, Augsburg, Germany
| | - Axel R Heller
- Anaesthesiology and Operative Intensive Care Medicine, Faculty of Medicine, University of Augsburg, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Pearce S, Marr E, Shannon T, Marchand T, Lang E. Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes. Intern Emerg Med 2024; 19:483-491. [PMID: 38041766 DOI: 10.1007/s11739-023-03477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments.
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Affiliation(s)
- Sabrina Pearce
- University of Calgary, Cumming School of Medicine, Calgary, Canada.
- Alberta Health Services, Calgary, Canada.
| | - Erica Marr
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tara Shannon
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tyara Marchand
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Eddy Lang
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
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Hasan MK, Nasrullah SM, Quattrocchi A, Arcos González P, Castro-Delgado R. Hospital surge capacity preparedness in disasters and emergencies: a systematic review. Public Health 2023; 225:12-21. [PMID: 37918172 DOI: 10.1016/j.puhe.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/21/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Adequate and effective emergency preparedness for hospital surge capacity is a prerequisite to ensuring standard healthcare services for disaster victims. This study aimed to identify, review, and synthesize the preparedness activities for and the barriers to hospital surge capacity in disasters and emergencies. METHODS We systematically searched seven databases (PubMed, MEDLINE, CINAHL, Scopus, Embase, Ovid, and PsycINFO). We included all English peer-reviewed studies published in January 2016 and July 2022 on surge capacity preparedness in hospital settings. Two independent researchers screened titles and abstracts, reviewed the full texts, and conducted data extractions using CADIMA software. We assessed the rigor of the included studies using the NIH quality assessment tools for quantitative studies, the Noyes et al. guidelines for qualitative studies, and the MMAT tool for mixed methods studies and summarized findings using the narrative synthesis method. We also used PRISMA reporting guidelines. RESULTS From the 2560 studies identified, we finally include 13 peer-reviewed studies: 10 quantitative, one qualitative, and two mixed methods. Five studies were done in the USA, three in Iran (n = 3), and the remaining in Australia, Pakistan, Sweden, Taiwan, and Tanzania. The study identified various ways to increase hospital surge capacity preparedness in all four domains (staff, stuff, space, and system); among them, the use of the Hospital Medical Surge Preparedness Index and the Surge Simulation Tool for surge planning was noteworthy. Moreover, nine studies (69%) recognized several barriers to hospital surge capacity preparedness. CONCLUSION The review provides synthesized evidence of contemporary literature on strategies for and barriers to hospital surge capacity preparedness. Despite the risk of selection bias due to the omission of gray literature, the study findings could help hospital authorities, public health workers, and policymakers to develop effective plans and programs for improving hospital surge capacity preparedness with actions, such as enhancing coordination, new or adapted flows of patients, disaster planning implementation, or the development of specific tools for surge capacity. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022360332.
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Affiliation(s)
- Md K Hasan
- Institute of Disaster Management and Vulnerability Studies, University of Dhaka, Dhaka, Bangladesh; Unit for Research in Emergency and Disaster, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
| | - S M Nasrullah
- Unit for Research in Emergency and Disaster, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain; Department of Global Public Health, Karolinska Institute, Solna, Sweden.
| | - A Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - P Arcos González
- Unit for Research in Emergency and Disaster, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - R Castro-Delgado
- Department of Medicine, University of Oviedo, Oviedo, Spain; Health Service of the Principality of Asturias (SAMU-Asturias), Health Research Institute of the Principality of Asturias (Research Group on Prehospital Care and Disasters, GIAPREDE), Oviedo, Spain
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Riedel HB, Espejo T, Bingisser R, Kellett J, Nickel CH. A fast emergency department triage score based on mobility, mental status and oxygen saturation compared with the emergency severity index: a prospective cohort study. QJM 2023; 116:774-780. [PMID: 37399089 PMCID: PMC10559338 DOI: 10.1093/qjmed/hcad160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Waiting for triage in overburdened emergency departments (ED) has become an increasing problem, which endangers patients. A fast triage system to rapidly identify low-acuity patients should divert care and resources to more urgent cases. AIM The objective of this study was to compare the performance of the Kitovu Hospital fast triage (KFT) score with the Emergency Severity Index (ESI), using mortality and hospital admission as proxies for the patients' acuity. DESIGN This is a prospective observational study of consecutive patients presenting to a Swiss academic ED. METHODS Patients were prospectively triaged into one of five ESI strata and retrospectively assessed by the KFT score, which awards one point each for altered mental status, impaired mobility and oxygen saturation <94%. RESULTS The KFT score had a lower discrimination than the ESI for hospital admission, but a higher discrimination for mortality from 24 h to 1 year after ED presentation. A total of 5544 (67%) patients were assigned to the lowest acuity by the KFT score compared with 2374 (28.7%) by the ESI; there was no significant difference in the 24-h mortality of patients who were deemed low acuity by either score. CONCLUSION Compared to the ESI, the KFT score identifies more than twice as many patients at low risk of early death. Therefore, this score might help to identify patients who could be managed through alternative pathways. This may be particularly helpful in situations of ED crowding and access block.
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Affiliation(s)
- H B Riedel
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Schweiz
| | - T Espejo
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Schweiz
| | - R Bingisser
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Schweiz
| | - J Kellett
- Department of Emergency Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - C H Nickel
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Schweiz
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Remondelli MH, Remick KN, Shackelford SA, Gurney JM, Pamplin JC, Polk TM, Potter BK, Holt DB. Casualty care implications of large-scale combat operations. J Trauma Acute Care Surg 2023; 95:S180-S184. [PMID: 37420334 PMCID: PMC10389308 DOI: 10.1097/ta.0000000000004063] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 07/09/2023]
Abstract
Analysis and review of combat casualty care challenges in future large-scale and medical multi-domain operations from the perspective of past, present, and potential future conflicts.
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Lubkowski P, Krygier J, Sondej T, Dobrowolski AP, Apiecionek L, Znaniecki W, Oskwarek P. Decision Support System Proposal for Medical Evacuations in Military Operations. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115144. [PMID: 37299871 DOI: 10.3390/s23115144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
The area of military operations is a big challenge for medical support. A particularly important factor that allows medical services to react quickly in the case of mass casualties is the ability to rapidly evacuation of wounded soldiers from a battlefield. To meet this requirement, an effective medical evacuation system is essential. The paper presented the architecture of the electronically supported decision support system for medical evacuation during military operations. The system can also be used by other services such as police or fire service. The system meets the requirements for tactical combat casualty care procedures and is composed of following elements: measurement subsystem, data transmission subsystem and analysis and inference subsystem. The system, based on the continuous monitoring of selected soldiers' vital signs and biomedical signals, automatically proposes a medical segregation of wounded soldiers (medical triage). The information on the triage was visualized using the Headquarters Management System for medical personnel (first responders, medical officers, medical evacuation groups) and for commanders, if required. All elements of the architecture were described in the paper.
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Affiliation(s)
- Piotr Lubkowski
- Faculty of Electronics, Military University of Technology, Gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
| | - Jaroslaw Krygier
- Faculty of Electronics, Military University of Technology, Gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
| | - Tadeusz Sondej
- Faculty of Electronics, Military University of Technology, Gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
| | - Andrzej P Dobrowolski
- Faculty of Electronics, Military University of Technology, Gen. Sylwestra Kaliskiego 2, 00-908 Warsaw, Poland
| | - Lukasz Apiecionek
- Institute of Computer Science, Kazimierz Wielki University, Jana Karola Chodkiewicza 30, 85-064 Bydgoszcz, Poland
- Teldat Sp. z o.o. sp.k, Cicha 19, 85-650 Bydgoszcz, Poland
| | | | - Pawel Oskwarek
- Military Institute of Medicine-National Research Institute, Szaserów 128, 04-141 Warsaw, Poland
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Yang J, Wan X, Yu P, Li X. Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey. Int Emerg Nurs 2023; 67:101264. [PMID: 36773513 DOI: 10.1016/j.ienj.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making. METHOD A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form. RESULT Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability. CONCLUSION Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.
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Affiliation(s)
- Jiayi Yang
- The First Hospital of China Medical University, Shenyang 110000, China
| | - Xinli Wan
- Fourth Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Pengyu Yu
- The People's Hospital Of Liaoning Province, Shenyang 110000, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang 110000, China.
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Phattharapornjaroen P, Carlström E, Holmqvist LD, Sittichanbuncha Y, Khorram-Manesh A. Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:52-63. [PMCID: PMC9930065 DOI: 10.1007/s13753-023-00468-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 08/16/2023]
Abstract
According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3603 Kongsberg, Norway
| | - Lina Dahlén Holmqvist
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 40530 Gothenburg, Sweden
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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Shortage of hospital bed capacity and overcrowding in emergency tertiary healthcare centers in Nigeria. Ann Med Surg (Lond) 2022; 82:104675. [PMID: 36268429 PMCID: PMC9577657 DOI: 10.1016/j.amsu.2022.104675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 12/03/2022] Open
Abstract
Shortage of hospital bed capacity and overcrowding remains a significant problem in Nigeria's healthcare system. The problem is even more conspicuous in emergency units in various health institutions. Despite Nigeria's already high morbidity burden, overcrowding remains a problem in these parts. The problem of overcrowding in tertiary health institutions can be traced back to a more specialized approach the institutions give as well as self-referrals that is common among community populations. The resultant effect is the referral of patients which can worsen already severe complications if not admitted immediately. Our study contributes to providing more information regarding the problems causing the shortage as well as recommends tenable solutions that could be enacted to solving this pressing problem.
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Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10091625. [PMID: 36141237 PMCID: PMC9498666 DOI: 10.3390/healthcare10091625] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Overcrowding in Emergency Departments (EDs) is a phenomenon that is now widespread globally and causes a significant negative impact that goes on to affect the entire hospital. This contributes to a number of consequences that can affect both the number of resources available and the quality of care. Overcrowding is due to a number of factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a decrease in the ability to provide critical services in a timely manner to patients suffering from medical emergencies. This phenomenon results in the Emergency Department reaching, and in some cases exceeding, its optimal capacity. In this review, the main causes and consequences involving this phenomenon were collected, including the effect caused by the SARS-CoV-2 virus in recent years. Finally, special attention was paid to the main operational strategies that have been developed over the years, strategies that can be applied both at the ED level (microlevel strategies) and at the hospital level (macrolevel strategies).
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Xie F, Liu N, Yan L, Ning Y, Lim KK, Gong C, Kwan YH, Ho AFW, Low LL, Chakraborty B, Ong MEH. Development and validation of an interpretable machine learning scoring tool for estimating time to emergency readmissions. EClinicalMedicine 2022; 45:101315. [PMID: 35284804 PMCID: PMC8904223 DOI: 10.1016/j.eclinm.2022.101315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Emergency readmission poses an additional burden on both patients and healthcare systems. Risk stratification is the first step of transitional care interventions targeted at reducing readmission. To accurately predict the short- and intermediate-term risks of readmission and provide information for further temporal risk stratification, we developed and validated an interpretable machine learning risk scoring system. METHODS In this retrospective study, all emergency admission episodes from January 1st 2009 to December 31st 2016 at a tertiary hospital in Singapore were assessed. The primary outcome was time to emergency readmission within 90 days post discharge. The Score for Emergency ReAdmission Prediction (SERAP) tool was derived via an interpretable machine learning-based system for time-to-event outcomes. SERAP is six-variable survival score, and takes the number of emergency admissions last year, age, history of malignancy, history of renal diseases, serum creatinine level, and serum albumin level during index admission into consideration. FINDINGS A total of 293,589 ED admission episodes were finally included in the whole cohort. Among them, 203,748 episodes were included in the training cohort, 50,937 episodes in the validation cohort, and 38,904 in the testing cohort. Readmission within 90 days was documented in 80,213 (27.3%) episodes, with a median time to emergency readmission of 22 days (Interquartile range: 8-47). For different time points, the readmission rates observed in the whole cohort were 6.7% at 7 days, 10.6% at 14 days, 13.6% at 21 days, 16.4% at 30 days, and 23.0% at 60 days. In the testing cohort, the SERAP achieved an integrated area under the curve of 0.737 (95% confidence interval: 0.730-0.743). For a specific 30-day readmission prediction, SERAP outperformed the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, and Emergency department visits in past six months) and the HOSPITAL score (Hemoglobin at discharge, discharge from an Oncology service, Sodium level at discharge, Procedure during the index admission, Index Type of admission, number of Admissions during the last 12 months, and Length of stay). Besides 30-day readmission, SERAP can predict readmission rates at any time point during the 90-day period. INTERPRETATION Better performance in risk prediction was achieved by the SERAP than other existing scores, and accurate information about time to emergency readmission was generated for further temporal risk stratification and clinical decision-making. In the future, external validation studies are needed to evaluate the SERAP at different settings and assess their real-world performance. FUNDING This study was supported by the Singapore National Medical Research Council under the PULSES Center Grant, and Duke-NUS Medical School.
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Affiliation(s)
- Feng Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Institute of Data Science, National University of Singapore, Singapore
- Corresponding author at: Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Linxuan Yan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Yilin Ning
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Ka Keat Lim
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Changlin Gong
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Andrew Fu Wah Ho
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
- Department of Post-Acute and Continuing Care, Outram Community Hospital, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bibhas Chakraborty
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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14
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Savioli G, Ceresa IF, Gri N, Bavestrello Piccini G, Longhitano Y, Zanza C, Piccioni A, Esposito C, Ricevuti G, Bressan MA. Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J Pers Med 2022; 12:279. [PMID: 35207769 PMCID: PMC8877301 DOI: 10.3390/jpm12020279] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions that can put an end to hospital overcrowding, this review aims, through a review of the literature, to summarize the triggering factors, as well as the possible solutions that can be proposed.
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Affiliation(s)
- Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (G.S.); (M.A.B.)
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Nicole Gri
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (N.G.); (G.B.P.)
| | - Gaia Bavestrello Piccini
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (N.G.); (G.B.P.)
- School of Master in Emergency Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Yaroslava Longhitano
- Foundation “Ospedale Alba-Bra Onlus”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Christian Zanza
- Foundation “Ospedale Alba-Bra Onlus”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Giovanni Ricevuti
- School of Pharmacy, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Maria Antonietta Bressan
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (G.S.); (M.A.B.)
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15
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Limbani F, Kapumba BM, Mzinganjira H, Phiri T, Mwandumba HC, Rylance J, Morton B, Desmond N. “An increase in COVID-19 patients would be overwhelming”: A qualitative description of healthcare workers’ experiences during the first wave of COVID-19 (March 2020 to October 2020) at Malawi’s largest referral hospital. Wellcome Open Res 2022; 7:40. [PMID: 36969720 PMCID: PMC10036953 DOI: 10.12688/wellcomeopenres.17368.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background COVID-19 is currently a global health threat. Healthcare workers are on the front-line of the COVID-19 outbreak response and therefore at heightened risk of infection. There is a dearth of evidence from Sub-Saharan Africa about healthcare worker experiences in managing COVID-19. We have reported on healthcare worker responses, experiences, and perspectives on epidemic response strategies at Queen Elizabeth Central Hospital, Malawi’s largest referral hospital. Methods We conducted 39 face-to-face in-depth interviews with a purposively selected sample of healthcare workers during the first wave of COVID-19 in Malawi (March 2020 to October 2020). The study included healthcare workers who provided direct and indirect patient care. Results During the early phase of the first wave (March to May 2020), healthcare workers expressed concerns with inadequate working space, unconducive infrastructure, delayed and rushed training on the management of COVID-19, and lack of incentives. Additionally, the hospital had staff shortages and limited essential resources such as piped oxygen and personal protective equipment. This increased healthcare worker fears of contracting COVID-19 and they were less willing to volunteer at COVID-19 isolation units. Resource constraints and limited preparedness compromised the care pathway particularly with increased numbers of COVID-19 patients. By the peak of the first wave (June to August 2020) many of these issues had been resolved. The hospital provided refresher training courses, personal protective equipment became available, incentives were offered to healthcare workers working in COVID-19 units and piped oxygen was installed. Staff morale was boosted, and more staff were willing to work at the COVID-19 isolation centres. Conclusion Experiences of healthcare workers during the first wave of COVID-19 are critical for improving care in future COVID-19 waves. Response strategies in resource-constrained areas should prioritise timely training of staff, creation of adequate isolation areas, provision of adequate medical supplies and strengthening leadership.
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Affiliation(s)
- Felix Limbani
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, PO Box 30096, Chichiri, Blantyre, BT3, Malawi
| | - Blessings M Kapumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, PO Box 30096, Chichiri, Blantyre, BT3, Malawi
| | | | - Tamara Phiri
- Queen Elizabeth Central Hospital, Blantyre, BT3, Malawi
| | - Henry C Mwandumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, PO Box 30096, Chichiri, Blantyre, BT3, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, PO Box 30096, Chichiri, Blantyre, BT3, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Ben Morton
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, PO Box 30096, Chichiri, Blantyre, BT3, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Nicola Desmond
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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16
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De Bondt F, Pollaris G, Sabbe MB. Can a reverse triage clinical decision support tool create sufficient surge capacity and reduce emergency department crowding? Eur J Emerg Med 2022; 29:16-17. [PMID: 34285173 DOI: 10.1097/mej.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Frieda De Bondt
- Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium
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17
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Saleh H, Monsoori ZA, Serour A, Oniya O, Konje JC. Improving Emergency Care Through a Dedicated Redesigned Obstetrics and Gynecology Emergency Unit at the Women's Hospital, Doha, Qatar. AJOG GLOBAL REPORTS 2022; 2:100053. [PMID: 36275495 PMCID: PMC9563527 DOI: 10.1016/j.xagr.2022.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RESULTS CONCLUSION
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Affiliation(s)
- Huda Saleh
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - Zeena Al Monsoori
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - A. Serour
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar (Dr Saleh, Dr Al Monsoori and Dr Serour)
| | - Olubunmi Oniya
- Women's Clinical Services Management Group, Sidra Medical and Research Centre, Weill Cornell Medicine-Qatar, Doha, Qatar (Ms Oniya)
| | - Justin C. Konje
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom and Weill Cornell Medicine, Qatar (Dr Konje)
- Corresponding author: Justin C. Konje, MD.
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18
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Iacorossi L, Fauci AJ, Napoletano A, D'Angelo D, Salomone K, Latina R, Coclite D, Iannone P. Triage protocol for allocation of critical health resources during Covid-19 pandemic and public health emergencies. A narrative review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020162. [PMID: 33525236 PMCID: PMC7927504 DOI: 10.23750/abm.v91i4.10393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023]
Abstract
Background and aim of the work. Triage during the Covid-19 pandemic can impose difficult allocation decisions when demand for mechanical ventilation or intensive care beds greatly exceeds available resources. Triage criteria should be objective, ethical, transparent, applied equitably and publically disclosed. The aim of this review is to describe the triage tools and process for critical care resources in a pandemic health emergency. Methods. A narrative review was conducted of the literature on five electronic databases, namely PubMed, CINHAL, Web of Science, Cochrane and Embase, searching for studies published from January 2006 to July 2020. Results. The results describe different triage tools. A gold standard of triage does not exist for the adult or paediatric population. Using probability of short-term survival as the sole allocation principle is problematic. In general, each triage protocol should be applied with a specific ethical justification, including transparency, duty to care, duty to steward resources, duty to plan, and distributive justice. Conclusions. Clinical triage decisions based on clinical judgment alone are prone to inconsistent application by triage officers in a pandemic. An ethical framework can inform decision-making and improve accountability. It remains difficult to connect clinical criteria and ethical criteria, because of the models on offer for health services. (www.actabiomedica.it)
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Affiliation(s)
- Laura Iacorossi
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | - Alice J Fauci
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | - Antonello Napoletano
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | - Daniela D'Angelo
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | - Katia Salomone
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | | | - Daniela Coclite
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
| | - Primiano Iannone
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Istituto Superiore di Sanità, Via Giano della Bella, 34, 00162 Rome, Italy.
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19
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Bruni T, Lalvani A, Richeldi L. Telemedicine-enabled Accelerated Discharge of Patients Hospitalized with COVID-19 to Isolation in Repurposed Hotel Rooms. Am J Respir Crit Care Med 2020; 202:508-510. [PMID: 32543906 PMCID: PMC7427391 DOI: 10.1164/rccm.202004-1238oe] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Teresa Bruni
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli-Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Roma, Italy; and.,National Institute for Health Research Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ajit Lalvani
- National Institute for Health Research Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli-Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Roma, Italy; and
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20
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Abstract
Emergency department crowding is a multifactorial issue with causes intrinsic to the emergency department and to the health care system. Understanding that the causes of emergency department crowding span this continuum allows for a more accurate analysis of its effects and a more global consideration of potential solutions. Within the emergency department, boarding of inpatients is the most appreciable effect of hospital-wide crowding, and leads to further emergency department crowding. We explore the concept of emergency department crowding, and its causes, effects, and potential strategies to overcome this problem.
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Affiliation(s)
- James F Kenny
- Milstein Adult Emergency Department, NewYork-Presbyterian Hospital, Department of Emergency Medicine, Columbia University Irving Medical Center, 622 West 168th Street, Suite VC2-260, New York, NY 10032, USA.
| | - Betty C Chang
- Milstein Adult Emergency Department, NewYork-Presbyterian Hospital, Department of Emergency Medicine, Columbia University Irving Medical Center, 622 West 168th Street, Suite VC2-260, New York, NY 10032, USA
| | - Keith C Hemmert
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Ground Floor Ravdin, Philadelphia PA 19104, USA
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21
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Pattison N. End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Intensive Crit Care Nurs 2020; 58:102862. [PMID: 32280052 PMCID: PMC7132475 DOI: 10.1016/j.iccn.2020.102862] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Natalie Pattison
- Florence Nightingale Foundation Clinical Professor of Nursing: University of Hertfordshire, East & North Herts NHS Trust, United Kingdom.
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22
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Mathew R, Sinha TP, Sahu AK, Bhoi S, Galwankar S. Coronavirus-19 Pandemic: A Two-step Triage Protocol for Emergency Department. J Emerg Trauma Shock 2020; 13:169-171. [PMID: 33013100 PMCID: PMC7472809 DOI: 10.4103/jets.jets_33_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/15/2020] [Accepted: 03/29/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Sarasota, FL, USA
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23
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Caramello V, Marulli G, Reimondo G, Fanto' F, Boccuzzi A. Comparison of Reverse Triage with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index to classify medical inpatients of an Italian II level hospital according to their resource's need. Intern Emerg Med 2019; 14:1073-1082. [PMID: 30778758 DOI: 10.1007/s11739-019-02049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/09/2019] [Indexed: 10/27/2022]
Abstract
Resource allocation in our overcrowded hospitals would require classification of inpatients according to the severity of illness, the evolving risk and the clinical complexity. Reverse triage (RT) is a method used in disasters to identify inpatients according to their use of hospital resources. The aim of this observational prospective study is to evaluate the use of RT in medical inpatients of an Italian Hospital and to compare the RT score with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index. Cluster sampling was performed on high dependency unit (HDU), geriatrics (Ger) and internal medicine (IM) wards. We calculate RT, NEWS, SOFA and CCI from inpatient charts. Length of stay (LOS), transfer to a higher level of care, death and discharge date were collected after 30 days. We obtained demographics, comorbidities, severity and clinical complexity of 260 inpatients. We highlighted differences in NEWS, SOFA and CCI in the three divisions. On the contrary RT score was uniformly high (median 7), with 85% of patients with RT = 8. NEWS, SOFA and CCI were higher in patients with higher RT score. We used the sum of the interventions listed by RT (RT sum) as a proxy of the level of care needed. RT-sum showed moderate correlation with NEWS (r = 0.52 Spearman, p < 0.001). RT-sum was the highest in HDU, related to the evolving severity of HDU patients. Ger patients that showed the highest CCI score (with all patients in the CCI ≥ 3 category) had the second highest RT-sum. RT score showed similar values in the majority of the inpatients regardless of differences in NEWS, SOFA and CCI in different ward subgroups. RT-sum is related both to evolving severity (NEWS) and to clinical complexity (CCI). RT and NEWS could predict inpatient level of care and resource need associated with CCI.
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Affiliation(s)
- Valeria Caramello
- Emergency Department, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Giulia Marulli
- Emergency Department, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine Department, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Fausto Fanto'
- Geriatric Department, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Adriana Boccuzzi
- Emergency Department, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
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24
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Gupta P, Goyal K, Kanta P, Ghosh A, Singh MP. Novel 2019-coronavirus on new year's Eve. Indian J Med Microbiol 2019; 37:459-477. [PMID: 32436867 PMCID: PMC7836853 DOI: 10.4103/ijmm.ijmm_20_54] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/09/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
An ongoing apocalyptic outbreak of a new virus causing pneumonia-like clusters in Wuhan city, China, has gleamed the world. The outbreak, confirmed on the New Year's Eve 2020, has known no boundaries since then. The number has surpassed that of Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS), and is uninterruptedly escalating. Being an RNA virus, it has a propensity to mutate due to the low proofreading capacity of RNA-dependent RNA polymerase. Step-wise mutations have led to the gradual spillover of virus and after crossing the inter-species interface, the virus has adapted itself for a stable human-to-human transmission. The disease caused by severe acute respiratory syndrome coronavirus (CoV)-2 (SARS-CoV-2) can prove deadlier if the so-called 'super-spreading events' emerge with time. Recent research has shown the maximum homology of 99% of SARS-CoV-2 to pangolins associated coronavirus, owing to which these can serve as potential intermediate host. India is responding swiftly to the emergency situation, and the whole of the country is under lockdown since 25 March 2020, to ensure social distancing. All the international flights are padlocked and the travellers are being screened at airports and seaports via thermal sensors, and quarantine for a period of 14 days is recommended. Three hundred and forty-five patients across the country tested positive with six fatalities as of 22 March 2020. No specific anti-CoV drugs are currently available. Patients are being treated with protease drugs are inhibitors, remdesivir, chloroquine, angiotensin-converting enzyme 2 inhibitors, ivermectin, sarilumab and tocilizumab, though none of these is Food and Drug Administration approved and are undergoing trials. Preventive measures such as social distancing, quarantine, cough etiquettes, proper hand washing, cleaning and decontaminating the surfaces are the mainstay for curbing the transmission of this virus. The present review highlights the update of novel SARS-CoV-2 in context to the Indian scenario.
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Affiliation(s)
- Parakriti Gupta
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Poonam Kanta
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P. Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Feizolahzadeh S, Vaezi A, Taheriniya A, Mirzaei M, Vafaeenasab M, Khorasani-Zavareh D. The Feasibility of Increasing Hospital Surge Capacity in Disasters through Early Patient Discharge. Bull Emerg Trauma 2019; 7:105-111. [PMID: 31198797 PMCID: PMC6555210 DOI: 10.29252/beat-070203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Hospitals are expected to be able to provide quality services during disasters. However, hospital capacity is limited and most hospital beds are almost always occupied. The aim of this study was to determine the feasibility of increasing hospital surge capacity during disasters through identification of patients suitable for safe early discharge. Methods: This cross-sectional study was conducted from May 2017 to February 2018 in two phases. In phase I, the Early Discharge Checklist was developed by a multidisciplinary panel of experts. Then in phase II, the checklist was used to assess the dischargeability of 396 in-patients in general wards of hospitals in Alborz province, Iran. Data were analyzed through the SPSS software (v. 22.0) and the results were presented by descriptive and analytical statics at a significance level of less than 0.05. Results: Of 396 patients, (64.65%) were male, (68.9%) were married, and (38.6%) aged more than 54. Moreover, (34.6%) patients were dischargeable. Patients in cardiology wards were more dischargeable. At follow-up assessment, 33.3% of patients had been discharged after 48 hours. There was a significant relationship between patient dischargeability and 48-hour hospitalization status (p=0.001). Dischargeability had no significant relationships with patients’ demographic characteristics (p>0.05). Conclusion: A considerable percentage of in-patients are dischargeable during disasters. The Early Discharge Assessment Checklist, developed in this study, is an appropriate tool to provide reliable data about early dischargeability in disasters.
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Affiliation(s)
- Sima Feizolahzadeh
- Department of Emergency and Disaster Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Aliakbar Vaezi
- Department of Nursing, School of Nursing and Midwifery, Research Center for Nursing and Midwifery Care in Family Health, Shahid Sadughi University of Medical Science, Yazd Iran
| | - Ali Taheriniya
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Masoud Mirzaei
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bazyar J, Farrokhi M, Khankeh H. Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach. Open Access Maced J Med Sci 2019; 7:482-494. [PMID: 30834023 PMCID: PMC6390156 DOI: 10.3889/oamjms.2019.119] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: Injuries caused by emergencies and accidents are increasing in the world. To prioritise patients to provide them with proper services and to optimally use the resources and facilities of the medical centres during accidents, the use of triage systems, which are one of the key principles of accident management, seems essential. AIM: This study is an attempt to identify available triage systems and compare the differences and similarities of the standards of these systems during emergencies and disasters through a review study. METHODS: This study was conducted through a review of the triage systems used in emergencies and disasters throughout the world. Accordingly, all articles published between 1990 and 2018 in both English and Persian journals were searched based on several keywords including Triage, Disaster, Mass Casualty Incidents, in the Medlib, Scopus, Web of Science, PubMed, Cochrane Library, Science Direct, Google scholar, Irandoc, Magiran, Iranmedex, and SID databases in isolation and in combination using both and/ or conjunctions. RESULTS: Based on the search done in these databases, twenty different systems were identified in the primary adult triage field including START, Homebush triage Standard, Sieve, CareFlight, STM, Military, CESIRA Protocol, MASS, Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT, TEWS Triage, Medical Triage, SALT, mSTART and ASAV. There were two primary triage systems including Jump START and PTT for children, and also two secondary triage systems encompassing SAVE and Sort identified in this respect. ESI and CRAMS were two other cases distinguished for hospital triage systems. CONCLUSION: There are divergent triage systems in the world, but there is no general and universal agreement on how patients and injured people should be triaged. Accordingly, these systems may be designed based on such criteria as vital signs, patient’s major problems, or the resources and facilities needed to respond to patients’ needs. To date, no triage system has been known as superior, specifically about the patients’ clinical outcomes, improvement of the scene management or allocation of the resources compared to other systems. Thus, it is recommended that different countries such as Iran design their triage model for emergencies and disasters by their native conditions, resources and relief forces.
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Affiliation(s)
- Jafar Bazyar
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Caramello V, Marulli G, Reimondo G, Fanto' F, Boccuzzi A. Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital. Int J Clin Pract 2018; 73:e13281. [PMID: 30288861 DOI: 10.1111/ijcp.13281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. MATERIAL AND METHODS We prospectively assessed every 4 days (t0 ) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. RESULTS Twenty-five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty-four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. CONCLUSIONS Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.
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Affiliation(s)
- Valeria Caramello
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Giulia Marulli
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Giuseppe Reimondo
- Internal Medicine Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Fausto Fanto'
- Geriatric Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Adriana Boccuzzi
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Reverse Triage to Increase the Hospital Surge Capacity in Disaster Response. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e17. [PMID: 31172080 PMCID: PMC6549049 DOI: 10.22114/ajem.v0i0.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Successful and effective management of large-scale disasters and epidemics requires pre-established systematic plans to minimize the damage and control the situation. With an increasing number of people in need of urgent medical care, hospitals must improve their response capacity, being at the forefront of responding to disasters and incidents. One way to develop the hospital capacity in disaster response is by reverse triage (RT). Objective The current study was conducted to investigate the role of RT to create additional hospital surge capacity in one of the major referral academic hospitals of Isfahan, Iran. Method This cross-sectional study was conducted in 2015 at Al-Zahra Subspecialty Hospital, Isfahan, Iran. The ten most common diseases leading to hospitalization in each ward of the hospital in 2014 were reviewed and, based on the prevalence, sorted and listed. Academic instructions for making a decision and possibility of early discharge was written and approved by an expert panel. On a day that was not set previously, the pre-selected in-charge person of each department was asked to run the RT following the instructions, and the number and percentage of those who were eligible for discharge via RT were determined. Results The total BOR in Al-Zahra Hospital in 2014 was about 80%, so it was estimated that almost 140 out of 700 beds are vacant. The results showed that by using RT, 108 (20%) hospitalized cases could be discharged, and considering the bed occupancy rate of about 80% and 140 vacant beds, a total of 248 beds could be provided following RT. Conclusion Running RT in 41 wards and units of Isfahan Al-Zahra Hospital, on average, added 108 beds to the hospital capacity. This increment is not the same in all wards, as the role of intensive care units in RT for surge capacity is insignificant.
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Abstract
OBJECTIVE The objective of this study was to develop and evaluate an evidence-based information technology (IT) application that guides clinical decision-making during the reverse-triage selection process in mass casualty incidents. METHODS Based upon 28 validated critical interventions (CI) relevant for determining whether a patient qualifies for early discharge, we developed the Reverse Triage Tool of Leuven (RTTL). The RTTL is compatible with the health electronic record (HER) of UZ Leuven, a tertiary hospital in Belgium. During a 3-week period in March 2015, we registered data from 2 groups of patients: a random group (no RTTL usage) and a filtered group (RTTL usage). RESULTS When applying the original 28 CIs, we were able to select almost twice as many patients in the filtered group who qualified for early discharge compared with patients in the random group. The predictive validity was highly satisfactory. CONCLUSIONS The RTTL saves time in 2 ways. First, it reduces the patient population that needs to be evaluated for potential early discharge to one-third. Second, it doubles the probability of selecting an actual dischargeable patient. Each selected patient, however, still must undergo multidisciplinary reassessment in order to qualify for early discharge. Thus, further research is required to optimize the IT application.(Disaster Med Public Health Preparedness. 2018;12:599-605).
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