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Osman AD, Yeak D, Ben-Meir M, Braitberg G. Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating thematic analysis. Emerg Med Australas 2024. [PMID: 39091123 DOI: 10.1111/1742-6723.14476] [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: 03/24/2024] [Revised: 06/26/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018-2019 and 2022-2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of 'front loading' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage. METHODS We conducted a cross-sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis. RESULTS The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). 'Valuable/vital resource' featured as a common response. Early decision-making, patient safety, staff and patient satisfaction emerged as consistent themes. CONCLUSIONS Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction.
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Affiliation(s)
- Abdi D Osman
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Nursing and Midwifery Discipline, College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Daryl Yeak
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Michael Ben-Meir
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - George Braitberg
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
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2
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Thyagaturu H, Taha A, Ali S, Roma N, Duhan S, Patel N, Sattar Y, Gonuguntla K, Sandhyavenu H, Badu I, Michos ED, Balla S. Disparities by sex, race, and region in acute myocardial infarction-related outcomes during the early COVID-19 pandemic: the national inpatient sample analysis. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:153-171. [PMID: 39021522 PMCID: PMC11249665 DOI: 10.62347/wkbj1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Disparities in acute myocardial infarction (AMI)-related outcomes have been reported before the COVID-19 pandemic. We studied in-hospital outcomes of AMI across demographic groups in the United States during the early COVID-19 pandemic. METHODS The National Inpatient Sample (NIS) database was queried for 2020 to identify AMI-related hospitalizations based on appropriate ICD-10-CM codes categorized by sex, race, and hospital region categories. The primary outcome was in-hospital mortality in females, racial and ethnic minority groups, and Northeast hospital region compared with males, White patients, and Midwest hospital region, respectively. Multivariable regression analysis was used to calculate the adjusted odds ratio and mean difference. RESULTS A total of 820,893 AMI-related hospitalizations were identified during the study period. On adjusted analysis, during the early COVID-19 pandemic, females had lower odds of in-hospital mortality [aOR 0.89 (0.85-0.92); P < 0.01] and revascularization [aOR 0.68 (0.66-0.69); P < 0.01] than males. Racial and ethnic based analysis showed that Asian/Pacific Islander patients had higher odds of in-hospital mortality [aOR 1.13 (1.03-1.25); P < 0.01] than White patients. During the early COVID-19 pandemic, Northeast and Western region hospitals had higher odds of in-hospital mortality, lower odds of revascularization, longer length of stay, and higher total hospitalization costs than Midwest region hospitals. CONCLUSIONS Our study disclosed disparities in AMI-related mortality and revascularization by sex, race and ethnic, and region during the early COVID-19 pandemic. Special attention should be given to at-risk populations. Whether these disparities continue in the post-vaccination era warrants further study.
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Affiliation(s)
| | - Amro Taha
- Department of Internal Medicine, Weiss Memorial HospitalChicago, IL, USA
| | - Shafaqat Ali
- Department of Medicine, Louisiana State UniversityShreveport, LA, USA
| | - Nicholas Roma
- Department of Internal Medicine, St Luke’s University HospitalBethlehem, PA, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of BaltimoreBaltimore, MD, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical CenterWoonsocket, RI, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia UniversityMorgantown, WV, USA
| | | | | | - Irisha Badu
- Department of Medicine, Onslow Memorial HospitalJacksonville, NC, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia UniversityMorgantown, WV, USA
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3
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Jones PM, Sweeny A, Branjerdporn G, Keijzers G, Marshall AP, Huang YL, Hall EJ, Ranse J, Palipana D, Teng YD, Crilly J. The impact of COVID-19 on emergency department presentations for mental health disorders in Queensland, Australia: A time series analysis. Asia Pac Psychiatry 2024; 16:e12553. [PMID: 38467558 DOI: 10.1111/appy.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with detrimental effects on mental health and psychological well-being. Although multiple studies have shown decreases in mental health-related Emergency Department (ED) presentations early in the COVID-19 pandemic, the medium-term effects on mental health-related ED presentations have remained less clear. This study aimed to evaluate the effect of the pandemic on mental health ED presentations by comparing observed presentation numbers to predictions from pre-pandemic data. METHODS This retrospective cohort study tallied weekly ED presentations associated with mental health disorders from a state-wide minimum dataset. Three time periods were identified: Pre-Pandemic (January 1, 2018-March 8, 2020), Statewide Lockdown (March 9, 2020-June 28, 2020), and Restrictions Easing (June 29, 2020-June 27, 2021). Time series analysis was used to generate weekly presentation forecasts using pre-pandemic data. Observed presentation numbers were compared to these forecasts. RESULTS Weekly presentation numbers were lower than predicted in 11 out of 16 weeks in the Statewide Lockdown period and 52 out of 52 weeks in the Restrictions Easing period. The largest decrease was seen for anxiety disorders (Statewide Lockdown: 76.8% of forecast; Restrictions Easing: 36.4% of forecast), while an increase was seen in presentations for eating disorders (Statewide Lockdown: 139.5% of forecast; Restrictions Easing: 194.4% of forecast). CONCLUSIONS Overall weekly mental health-related presentations across Queensland public EDs were lower than expected for the first 16 months of the COVID-19 pandemic. These findings underline the limitations of emergency department provision of mental health care and the importance of alternate care modalities in the pandemic context.
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Affiliation(s)
- Philip M Jones
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Grace Branjerdporn
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Intensive Care Unit, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
| | - Emma J Hall
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Dinesh Palipana
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Yang D Teng
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Centre for Mental Health, Griffith University, Gold Coast, Queensland, Australia
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4
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [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: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Hudson C, Branjerdporn G, Hughes I, Todd J, Bowman C, Randall M, Stapelberg NJC. Using machine learning to mine mental health diagnostic groups from emergency department presentations before and during the COVID-19 pandemic. DISCOVER MENTAL HEALTH 2023; 3:22. [PMID: 37930489 PMCID: PMC10628018 DOI: 10.1007/s44192-023-00047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The COVID-19 pandemic had a profound negative effect on mental health worldwide. The hospital emergency department plays a pivotal role in responding to mental health crises. Understanding data trends relating to hospital emergency department usage is beneficial for service planning, particularly around preparing for future pandemics. Machine learning has been used to mine large volumes of unstructured data to extract meaningful data in relation to mental health presentations. This study aims to analyse trends in five mental health-related presentations to an emergency department before and during, the COVID-19 pandemic. METHODS Data from 690,514 presentations to two Australian, public hospital emergency departments between April 2019 to February 2022 were assessed. A machine learning-based framework, Mining Emergency Department Records, Evolutionary Algorithm Data Search (MEDREADS), was used to identify suicidality, psychosis, mania, eating disorder, and substance use. RESULTS While the mental health-related presentations to the emergency department increased during the COVID-19 pandemic compared to pre-pandemic levels, the proportion of mental health presentations relative to the total emergency department presentations decreased. Several troughs in presentation frequency were identified across the pandemic period, which occurred consistently during the public health lockdown and restriction periods. CONCLUSION This study implemented novel machine learning techniques to analyse mental health presentations to an emergency department during the COVID-19 pandemic. Results inform understanding of the use of emergency mental health services during the pandemic, and highlight opportunities to further investigate patterns in presentation.
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Affiliation(s)
- Carly Hudson
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia.
| | - Grace Branjerdporn
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Ian Hughes
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - James Todd
- Centre for Data Analytics, Bond Business School, Bond University, Gold Coast, Queensland, Australia
| | - Candice Bowman
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Marcus Randall
- Centre for Data Analytics, Bond Business School, Bond University, Gold Coast, Queensland, Australia
| | - Nicolas J C Stapelberg
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Eccleston C, Marsden E, Craswell A, Sweeny A, Howell N, Wallis M, Crilly J. Impact of COVID-19 state-wide lockdown on older adult presentations to Queensland emergency departments. Emerg Med Australas 2023; 35:799-808. [PMID: 37160322 DOI: 10.1111/1742-6723.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/25/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To determine the impact of the COVID-19 state-wide lockdown on ED presentations for older adults in Queensland, Australia. METHODS A retrospective cohort study pertaining to adults aged 70+ years who presented to Queensland public hospital EDs across three separate time periods; 11 March to 30 June 2018 and 2019 (pre-pandemic average), 2020 (COVID-19 state-wide lockdown) and 2021 (post-state-wide lockdown). The primary outcome was change in presentation rates to ED. Secondary outcomes included change in triage category rates, length of stay (LOS), diagnosis and disposition. RESULTS There was 380 854 older adult presentations. During the COVID-19 state-wide lockdown, ED presentation rates decreased by 12.5% (incidence rate ratio 0.875 [95% confidence interval 0.867-0.883]). All triage category presentation rates decreased, as did ED LOS and reasons for presentation, except sepsis and disorders of the nervous system. In the post-state-wide lockdown period a 22% (incidence rate ratio 1.22 [95% confidence interval 1.21-1.23]) increase in the presentation rate was observed and presentations in all triage categories increased. ED LOS increased to longer than pre-pandemic (P < 0.001). Respiratory presentations increased by 346%. Patients who 'did not wait' increased by 212% and ED mortality rose by 42% compared to during the lockdown. CONCLUSION There was a significant decrease in presentation rates to EDs during the COVID-19 state-wide lockdown for the older population, followed by an increase in presentation rates, longer ED LOS, and an increased ED mortality rate, in the post-state-wide lockdown period. It is important to ensure older adults continue to seek appropriate, timely medical care, during a pandemic.
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Affiliation(s)
- Cassanne Eccleston
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Elizabeth Marsden
- RADAR Metro North, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Craswell
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Amy Sweeny
- Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Faculty of Medicine, Griffith University, Brisbane, Queensland, Australia
- School of Dentistry and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Naomi Howell
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Marianne Wallis
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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7
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Dickson K, Aboltins C, Pelly J, Jessup RL. Effective communication of COVID-19 vaccine information to recently-arrived culturally and linguistically diverse communities from the perspective of community engagement and partnership organisations: a qualitative study. BMC Health Serv Res 2023; 23:877. [PMID: 37605184 PMCID: PMC10440864 DOI: 10.1186/s12913-023-09836-3] [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: 02/08/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND In many high-income countries, COVID-19 has disproportionately impacted Culturally and Linguistically Diverse (CALD) communities. Barriers to engaging with essential health messaging has contributed to difficulties in following public health advice and exacerbated existing inequity in Australia. Research suggests that recently-arrived CALD populations are particularly vulnerable to misinformation and are more likely to experience vaccine hesitancy. The aim of this study was to explore the barriers and enablers to COVID-19 vaccination among recently-arrived CALD communities in Melbourne's outer north and identify strategies to reduce hesitancy in this population. METHODS Semi-structured interviews were conducted with representatives from community organisations working with recently-arrived CALD communities in Melbourne's north. This included a mix of peer (from the community) and health care workers. RESULTS Fifteen participants from community organisations participated in interviews. Thematic analysis identified four themes; (1) trusted sources, (2) accurate and culturally sensitive information, (3) supported pathways and (4) enablers to vaccination. CONCLUSIONS Participants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities' strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities.
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Affiliation(s)
- Kara Dickson
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Craig Aboltins
- Department of Infectious Diseases, Northern Health, Epping, VIC, 3076, Australia
- Adjunct Associate Professor, Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Janet Pelly
- Northern Health, Epping, VIC, 3076, Australia
| | - Rebecca Leigh Jessup
- Director of Research and Evaluation, Staying Well. Northern Health, Epping, VIC, 3076, Australia.
- Adjunct Research Fellow, School of Allied Health, Human Services and Sport, La Tobe University, Bundoora, Australia.
- Adjunct Research Fellow, School of Rural Health, Monash University, Warragul, Australia.
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8
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Jessup RL, Bramston C, Putrik P, Haywood C, Tacey M, Copnell B, Cvetanovska N, Cao Y, Gust A, Campbell D, Oldenburg B, Mehdi H, Kirk M, Zucchi E, Semciw AI, Beauchamp A. Frequent hospital presenters' use of health information during COVID-19: results of a cross-sectional survey. BMC Health Serv Res 2023; 23:616. [PMID: 37308996 DOI: 10.1186/s12913-023-09504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND High-frequency hospital users often present with chronic and complex health conditions and are at increased risk of serious morbidity and mortality if they contract COVID-19. Understanding where high-frequency hospital users are sourcing their information, whether they understand what they find, and how they apply the information to prevent the spread of COVID-19 is essential for health authorities to be able to target communication approaches. METHODS Cross-sectional survey of 200 frequent hospital users (115 with limited English proficiency) informed by the WHO's "Rapid, simple, flexible behavioral insights on COVID-19". Outcome measures were source of, and trust in information, and knowledge of symptoms, preventive strategies, restrictions, and identification of misinformation. RESULTS The most frequently cited source of information was television (n = 144, 72%) followed by the internet (n = 84, 42%). One in four television users sought their information from overseas news outlets from their country of origin, while for those using the internet, 56% relied on Facebook and other forms of social media including YouTube and WeChat. Overall, 41.2% of those surveyed had inadequate knowledge about symptoms, 35.8% had inadequate knowledge about preventative strategies, 30.2% had inadequate knowledge about government-imposed restrictions, and 69% believed in misinformation. Half of the respondents (50%) trusted all information, and only one in five (20%) were uncertain or untrusting. English-speaking participants were almost three times more likely to have adequate knowledge about symptoms (OR 2.69, 95%CI 1.47;4.91) and imposed restrictions (OR 2.10 95%CI 1.06; 4.19), and 11 times more likely to recognize misinformation (OR 11.52 95%CI 5.39; 24.60) than those with limited English. CONCLUSION Within this population of high-frequency hospital users with complex and chronic conditions, many were sourcing their information from less trustworthy or locally relevant sources, including social media and overseas news outlets. Despite this, at least half were trusting all the information that they found. Speaking a language other than English was a much greater risk factor for having inadequate knowledge about COVID-19 and believing in misinformation. Health authorities must look for methods to engage diverse communities, and tailor health messaging and education in order to reduce disparities in health outcomes.
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Affiliation(s)
- Rebecca L Jessup
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia.
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
- School of Rural Health, Monash University, Warragul, Australia.
| | - Cassandra Bramston
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Polina Putrik
- Department of Family Medicine, Care and Public Health Research Institute, Maastrich University, Maastricht, Netherlands
| | - Cilla Haywood
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Mark Tacey
- Department of Medicine, University of Melbourne, Parkville, Australia
- Office of Research, Northern Health, Epping, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Natali Cvetanovska
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
- School of Rural Health, Monash University, Warragul, Australia
| | - Yingting Cao
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Anthony Gust
- Digital Health, Northern Health, Epping, Australia
| | - Donald Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, LaTrobe University, Melbourne, Bundoora, Australia
- Baker Heart and Diabetes Institute, Prahran, Australia
| | - Hala Mehdi
- Office of Research, Northern Health, Epping, Australia
| | - Michael Kirk
- Division of Medicine, Rockhampton Hospital, Rockhampton, Australia
| | | | - Adam I Semciw
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Alison Beauchamp
- School of Rural Health, Monash University, Clayton, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Australia
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9
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Islam MI, Bagnulo S, Wang Y, Ramsden R, Wrightson T, Masset A, Colbran R, Edwards M, Martiniuk A. Job Satisfaction of Health Practitioners Providing Outreach Health Services during COVID-19 in Rural New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. Healthcare (Basel) 2022; 11:healthcare11010003. [PMID: 36611463 PMCID: PMC9819187 DOI: 10.3390/healthcare11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Outreach health practitioners play a key role in enhancing access to healthcare for remote, rural, regional, and Aboriginal and Torres Strait Islander communities in Australia. Outreach health practitioners are those providing ongoing and integrated health services in communities that would otherwise have limited access. In the context of the COVID-19 pandemic, it is important to understand the job satisfaction of health workers as it correlates with long-term retention of the workforce, as well as effectiveness in the role and clinical outcomes for patients. Method: The study analysed data from 258 outreach health practitioners who responded to two cross-sectional surveys conducted by the NSW Rural Doctors Network during the COVID-19 pandemic in 2020/21 and 2021/22 in NSW and the ACT, Australia. Both bivariate and multivariate analyses were employed to assess the associations between the outcome variable (outreach health practitioners' job satisfaction) and independent variables (sociodemographic factors, motivation, self-confidence, communication, capability). Results: Overall, the study showed that 92.2% of health practitioners were satisfied in their role providing outreach health services during the COVID-19 pandemic. In the multivariable model, factors significantly associated with higher satisfaction included good communication with other local health practitioners, using telehealth along with in-person care, and having high self-rated capability compared to those health practitioners who said they had lower job satisfaction. Conclusions: Outreach health practitioners' job satisfaction is important because poor satisfaction may lead to suboptimal healthcare delivery, poor clinical outcomes, and poor retention of staff in rural settings. These findings should be taken into consideration when developing future strategies to improve job satisfaction among rural outreach health practitioners and to enhance attraction, recruitment and retention and may be applicable to the broader health workforce.
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Affiliation(s)
- Md Irteja Islam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
- Centre for Health Research and Faculty of Health, Engineering and Sciences, The University of Southern Queensland, West Street, Darling Heights, Toowoomba, QLD 4350, Australia
- Correspondence:
| | - Sharif Bagnulo
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
- Australasian College of Health Service Management, 11/41-43 Higginbotham Rd., Gladesville, Sydney, NSW 2111, Australia
| | - Yiwen Wang
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Robyn Ramsden
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
- School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, Melbourne, VIC 3220, Australia
| | - Trent Wrightson
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
| | - Amanda Masset
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
| | - Richard Colbran
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
| | - Mike Edwards
- NSW Rural Doctors Network, Suite 1, 53 Cleary Street, Hamilton, Sydney, NSW 2303, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
- Office of the Chief Scientist, The George Institute for Global Health, Level 5/1 King Street, Newtown, Sydney, NSW 2042, Australia
- Dalla Lana School of Public Health, The University of Toronto, 155 College Street Room 500, Toronto, ON M5T 3M7, Canada
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10
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Sher L, Semciw A, Jessup RL, Carrodus A, Boyd J. Structured evaluation of a virtual emergency department triage model of care: A study protocol. Emerg Med Australas 2022; 34:907-912. [PMID: 35570401 PMCID: PMC9790376 DOI: 10.1111/1742-6723.14010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A new virtual ED service was introduced into a hospital network in the northern suburbs of Melbourne in response to changing needs during the COVID-19 pandemic. The 'virtual ED' utilises a telehealth model as a means of assessment for appropriately selected patients to facilitate either complete care or navigation into streamlined pathways for ongoing care, in some cases bypassing the ED entirely where appropriate. The proposed study aims to evaluate the implementation of the model and identify future improvement opportunities, assess the impact on traditional health service delivery processes and patient experience, and determine the acceptability of the 'virtual ED' model of care. METHODS The present study will consist of a pre-post- implementation evaluation using the RE-AIM framework. Routine health service data will be collected for 6 months post-implementation of the virtual ED model and compared to 24 months prior to implementation. Prospective data will be collected using routinely collected and survey data. Interviews and focus groups will be conducted to understand consumer and clinician perspectives on barriers and enablers to implementation and adoption of the virtual ED. RESULTS Descriptive statistics will be used to describe the study population and key outcomes, including changes in ED presentations and length of stay. Thematic analysis will be conducted on transcribed interviews and focus group data. This will be triangulated with data collected from patient feedback surveys. CONCLUSION This project will support the delivery of care to ED patients by evaluating the 'virtual ED' model of care.
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Affiliation(s)
- Loren Sher
- Emergency DepartmentNorthern Hospital EppingMelbourneVictoriaAustralia,School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Adam Semciw
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia,Allied Health Research, Northern Hospital EppingMelbourneVictoriaAustralia
| | - Rebecca L Jessup
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia,Allied Health Research, Northern Hospital EppingMelbourneVictoriaAustralia
| | - Ariana Carrodus
- Project Management Office, Northern Hospital EppingMelbourneVictoriaAustralia
| | - James Boyd
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
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11
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Frankcombe D, Gauri N, Satchithanandha V, Liang Y, Bak S, Suri T, Loxley D, Merrett N, Kaushal D. Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study. BMC Surg 2022; 22:393. [PMID: 36397052 PMCID: PMC9670068 DOI: 10.1186/s12893-022-01851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis. Methods A retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019–2020. Patients managed operatively or conservatively were included. Results 1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044). Conclusion We identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.
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12
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Jessup RL, Awad N, Beauchamp A, Bramston C, Campbell D, Semciw A, Tully N, Fabri AM, Hayes J, Hull S, Clarke AC. Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia. BMC Health Serv Res 2022; 22:911. [PMID: 35831887 PMCID: PMC9277602 DOI: 10.1186/s12913-022-08173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.
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Affiliation(s)
- R. L. Jessup
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086 Australia
- School of Rural Health, Monash University, Sargeant St, Warragul, 3820 Australia
| | - N. Awad
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
| | - A. Beauchamp
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- School of Rural Health, Monash University, Sargeant St, Warragul, 3820 Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria Australia
| | - C. Bramston
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086 Australia
| | - D. Campbell
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria Australia
| | - Al Semciw
- Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086 Australia
| | - N. Tully
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
| | - A. M. Fabri
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
| | - J. Hayes
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
| | - S. Hull
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
| | - A. C. Clarke
- Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075 Australia
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13
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Islam MI, Freeman J, Chadwick V, Martiniuk A. Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study. Healthcare (Basel) 2022; 10:1261. [PMID: 35885788 PMCID: PMC9324364 DOI: 10.3390/healthcare10071261] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Access to healthcare for young people is essential to ensure they can build a foundation for a healthy life. However, during the COVID-19 pandemic, many people avoided seeking healthcare, adversely affecting population health. We investigated the factors associated with the avoidance of healthcare for Australian young people when they reported that they needed healthcare. We were able to compare healthcare avoidance during the COVID-19 pandemic with healthcare avoidance prior to COVID-19. METHODS We used two recent data collection waves from the Longitudinal Study of Australian Children (LSAC)-Wave 9C1 during the COVID-19 pandemic in 2020, and Wave 8 data which were collected in 2018. The primary outcome of this study revealed the avoidance of healthcare among those who perceived the need for care. Bivariate analyses and multiple logistic regression models were employed to identify the factors associated with the avoidance of healthcare during the COVID-19 and pre-COVID-19 periods. RESULTS In the sample of 1110 young people, 39.6% avoided healthcare during the first year of the COVID-19 pandemic even though they perceived that they had a health problem that required healthcare. This healthcare avoidance was similar to the healthcare avoidance in the pre-COVID-19 pandemic period (41.4%). The factors most strongly associated with healthcare avoidance during the COVID-19 pandemic were female gender, an ongoing medical condition, and moderately high psychological distress. In comparison, prior to the pandemic, the factor associated with healthcare avoidance was only psychological distress. The most common reason for not seeking healthcare was thinking that the problem would spontaneously resolve itself (55.9% during COVID-19 vs. 35.7% pre-COVID-19 pandemic). CONCLUSIONS A large proportion of youths avoided healthcare when they felt they needed to seek care, both during and before the COVID-19 pandemic.
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Affiliation(s)
- Md Irteja Islam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, A27 Fisher Road, Sydney, NSW 2006, Australia; (M.I.I.); (J.F.)
- Centre for Health Research and School of Sciences, The University of Southern Queensland, West Street, Toowoomba, QLD 4350, Australia
| | - Joseph Freeman
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, A27 Fisher Road, Sydney, NSW 2006, Australia; (M.I.I.); (J.F.)
| | - Verity Chadwick
- Royal North Shore Hospital, Reserve Rd., St. Leonard’s, Sydney, NSW 2065, Australia;
| | - Alexandra Martiniuk
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, A27 Fisher Road, Sydney, NSW 2006, Australia; (M.I.I.); (J.F.)
- Office of the Chief Scientist, The George Institute for Global Health, Level 5/1 King Street, Newtown, Sydney, NSW 2042, Australia
- Dalla Lana School of Public Health, The University of Toronto, 155 College St. Room 500, Toronto, ON M5T 3M7, Canada
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