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Noor Azhar AM, Zambri SNA, Bustam A, Abdul Rahim SJ, Ramli AA, Poh K. Impact of Spatial Separation for Respiratory Patients on Emergency Department Flow Process Intervals and Length of Stay. J Hosp Infect 2024:S0195-6701(24)00216-0. [PMID: 38908754 DOI: 10.1016/j.jhin.2024.06.001] [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: 04/19/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Spatial separation in emergency departments (ED) is empirically practised as part of transmission-based precaution. Despite its potential benefits in segregating potentially infectious patients, the effects of spatial separation on patient flow remains uncertain. AIM To explore the impact of spatial separation on ED patient flow and identify specific clinical factors and flow process intervals (FPI) influencing ED length-of-stay (EDLOS). METHODS This was a retrospective study of data extracted from patients' electronic medical records from January 1 to March 31, 2022 conducted at the ED of a tertiary hospital in Kuala Lumpur, Malaysia. During this period, patients were separated into respiratory areas (RA) and non-respiratory areas (NRA) based on Centers for Disease Control and Prevention recommendations. The study obtained ethics approval from the institution's ethics board. FINDINGS A total of 1,054 patients were included in the study, 275 allocated to RA and 779 to NRA. Patients in RA had a significantly longer median EDLOS compared to in NRA (9 hours 29 minutes versus 7 hours 6 minutes, p<0.001, d=0.41). A lower proportion of patients in RA achieved an EDLOS ≤8 hours compared to NRA (41.8% versus 58.3%, p<0.001). Independent factors affecting EDLOS were triage category, re-triaging, hypertension, performing biomedical imaging, medical, surgical, and critical care consultations, and disposition plan. Bottlenecks significantly prolonging EDLOS were decision-to-departure, ultrasound interval and referral-to-consultation. CONCLUSION Spatial separation prolongs FPI and EDLOS. Addressing inpatient access block and streamlining specialty review and biomedical imaging processes may reduce RA EDLOS.
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Affiliation(s)
| | - Siti Nur Aliyah Zambri
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Aida Bustam
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | | | | | - Khadijah Poh
- Department of Emergency Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Lee KS, Sung HK, Choi YY, Han C, Min HS. Impact of the Early COVID-19 Pandemic on Emergency Department Visits of Adult Cancer Patients With Fever or Respiratory Symptoms: A Korean Nationwide Population-Based Study, 2016-2020. J Korean Med Sci 2024; 39:e187. [PMID: 38887201 PMCID: PMC11182695 DOI: 10.3346/jkms.2024.39.e187] [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: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer patients having COVID-like symptoms. METHODS We analyzed the National Emergency Department Information System (NEDIS) data on ED visits by adult cancer patients who presented with chief complaints of fever or respiratory symptoms (FRS) indicative of COVID-19, from 2016 to 2020. An interrupted time series analysis with a quasi-Poisson regression model was performed, adjusting for seasonality and time, to evaluate whether underlying trends for monthly ED visits and the in-hospital mortality rate (%) per month changed with the pandemic among these patients. We also estimated the adjusted odds ratio (aOR) of in-hospital deaths among cancer patients using multivariable logistic regression analysis. RESULTS ED visits by cancer patients with FRS decreased during the COVID-19 pandemic (relative risk [RR] with 95% confidence interval [CI]: slope change, 0.99 [0.98-1.00] and step change, 0.84 [0.76-0.92]). However, the in-hospital mortality rate (%) for these patients was increased (slope change, 1.14 [1.04-1.25] and step change, 0.99 [0.98-1.01]). Factors such as urgent triage status, ambulance use, and treatment in hospitals with fewer than 300 staffed beds significantly contributed to increased aOR of in-hospital deaths during the COVID-19 pandemic compared to the pre-pandemic period. CONCLUSION Further studies are needed to highlight the importance of ED service preparation in planning and managing resources for cancer patients during future pandemics.
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Affiliation(s)
- Kyung Shin Lee
- Public Health Research Institute, National Medical Center, Seoul, Korea.
| | - Ho Kyung Sung
- Public Health Research Institute, National Medical Center, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Youn Young Choi
- Public Health Research Institute, National Medical Center, Seoul, Korea
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hye Sook Min
- Public Health Research Institute, National Medical Center, Seoul, Korea
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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Lopes J, Faria M, Santos MF. Exploring trends and autonomy levels of adaptive business intelligence in healthcare: A systematic review. PLoS One 2024; 19:e0302697. [PMID: 38728308 PMCID: PMC11086907 DOI: 10.1371/journal.pone.0302697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE In order to comprehensively understand the characteristics of Adaptive Business Intelligence (ABI) in Healthcare, this study is structured to provide insights into the common features and evolving patterns within this domain. Applying the Sheridan's Classification as a framework, we aim to assess the degree of autonomy exhibited by various ABI components. Together, these objectives will contribute to a deeper understanding of ABI implementation and its implications within the Healthcare context. METHODS A comprehensive search of academic databases was conducted to identify relevant studies, selecting AIS e-library (AISel), Decision Support Systems Journal (DSSJ), Nature, The Lancet Digital Health (TLDH), PubMed, Expert Systems with Application (ESWA) and npj Digital Medicine as information sources. Studies from 2006 to 2022 were included based on predefined eligibility criteria. PRISMA statements were used to report this study. RESULTS The outcomes showed that ABI systems present distinct levels of development, autonomy and practical deployment. The high levels of autonomy were essentially associated with predictive components. However, the possibility of completely autonomous decisions by these systems is totally excluded. Lower levels of autonomy are also observed, particularly in connection with prescriptive components, granting users responsibility in the generation of decisions. CONCLUSION The study presented emphasizes the vital connection between desired outcomes and the inherent autonomy of these solutions, highlighting the critical need for additional research on the consequences of ABI systems and their constituent elements. Organizations should deploy these systems in a way consistent with their objectives and values, while also being mindful of potential adverse effects. Providing valuable insights for researchers, practitioners, and policymakers aiming to comprehend the diverse levels of ABI systems implementation, it contributes to well-informed decision-making in this dynamic field.
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Affiliation(s)
- João Lopes
- ALGORITMI Research Center, University of Minho, Braga, Portugal
| | - Mariana Faria
- ALGORITMI Research Center, University of Minho, Braga, Portugal
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Farimani RM, Karim H, Atashi A, Tohidinezhad F, Bahaadini K, Abu-Hanna A, Eslami S. Models to predict length of stay in the emergency department: a systematic literature review and appraisal. BMC Emerg Med 2024; 24:54. [PMID: 38575857 PMCID: PMC10996208 DOI: 10.1186/s12873-024-00965-4] [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: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Prolonged Length of Stay (LOS) in ED (Emergency Department) has been associated with poor clinical outcomes. Prediction of ED LOS may help optimize resource utilization, clinical management, and benchmarking. This study aims to systematically review models for predicting ED LOS and to assess the reporting and methodological quality about these models. METHODS The online database PubMed, Scopus, and Web of Science (10 Sep 2023) was searched for English language articles that reported prediction models of LOS in ED. Identified titles and abstracts were independently screened by two reviewers. All original papers describing either development (with or without internal validation) or external validation of a prediction model for LOS in ED were included. RESULTS Of 12,193 uniquely identified articles, 34 studies were included (29 describe the development of new models and five describe the validation of existing models). Different statistical and machine learning methods were applied to the papers. On the 39-point reporting score and 11-point methodological quality score, the highest reporting scores for development and validation studies were 39 and 8, respectively. CONCLUSION Various studies on prediction models for ED LOS were published but they are fairly heterogeneous and suffer from methodological and reporting issues. Model development studies were associated with a poor to a fair level of methodological quality in terms of the predictor selection approach, the sample size, reproducibility of the results, missing imputation technique, and avoiding dichotomizing continuous variables. Moreover, it is recommended that future investigators use the confirmed checklist to improve the quality of reporting.
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Affiliation(s)
| | - Hesam Karim
- Department of Health Information Management, Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Atashi
- E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kambiz Bahaadini
- Department of Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Ameen Abu-Hanna
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands.
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lee KS, Han C, Min HS, Lee J, Youn SH, Kim Y, Moon JY, Lee YS, Kim SJ, Sung HK. Impact of the early phase of the COVID-19 pandemic on emergency department-to-intensive care unit admissions in Korea: an interrupted time-series analysis. BMC Emerg Med 2024; 24:51. [PMID: 38561666 PMCID: PMC10985913 DOI: 10.1186/s12873-024-00968-1] [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: 01/07/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in significant disruptions to critical care systems globally. However, research on the impact of the COVID-19 pandemic on intensive care unit (ICU) admissions via the emergency department (ED) is limited. Therefore, this study evaluated the changes in the number of ED-to-ICU admissions and clinical outcomes in the periods before and during the pandemic. METHODS We identified all adult patients admitted to the ICU through level 1 or 2 EDs in Korea between February 2018 and January 2021. February 2020 was considered the onset point of the COVID-19 pandemic. The monthly changes in the number of ED-to-ICU admissions and the in-hospital mortality rates before and during the COVID-19 pandemic were evaluated using interrupted time-series analysis. RESULTS Among the 555,793 adult ED-to-ICU admissions, the number of ED-to-ICU admissions during the pandemic decreased compared to that before the pandemic (step change, 0.916; 95% confidence interval [CI] 0.869-0.966], although the trend did not attain statistical significance (slope change, 0.997; 95% CI 0.991-1.003). The proportion of patients who arrived by emergency medical services, those transferred from other hospitals, and those with injuries declined significantly among the number of ED-to-ICU admissions during the pandemic. The proportion of in-hospital deaths significantly increased during the pandemic (step change, 1.054; 95% CI 1.003-1.108); however, the trend did not attain statistical significance (slope change, 1.001; 95% CI 0.996-1.007). Mortality rates in patients with an ED length of stay of ≥ 6 h until admission to the ICU rose abruptly following the onset of the pandemic (step change, 1.169; 95% CI 1.021-1.339). CONCLUSIONS The COVID-19 pandemic significantly affected ED-to-ICU admission and in-hospital mortality rates in Korea. This study's findings have important implications for healthcare providers and policymakers planning the management of future outbreaks of infectious diseases. Strategies are needed to address the challenges posed by pandemics and improve the outcomes in critically ill patients.
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Affiliation(s)
- Kyung-Shin Lee
- Public Health Research Institute, National Medical Center, 245 Eulgi-ro, Jung-gu, 04564, Seoul, Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hye Sook Min
- Public Health Research Institute, National Medical Center, 245 Eulgi-ro, Jung-gu, 04564, Seoul, Korea
| | - Jeehye Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Chungju-si, Korea
| | - Seok Hwa Youn
- Department of Trauma Surgery, National Medical Center, Seoul, Korea
| | - Younghwan Kim
- Department of Trauma Surgery, National Medical Center, Seoul, Korea
| | - Jae Young Moon
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Young Seok Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ho Kyung Sung
- Public Health Research Institute, National Medical Center, 245 Eulgi-ro, Jung-gu, 04564, Seoul, Korea.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Kim S, Sung HK, Lee J, Ko E, Kim SJ. Trends in emergency department visits for emergency care-sensitive conditions before and during the COVID-19 pandemic: a nationwide study in Korea, 2019-2021. Clin Exp Emerg Med 2024; 11:88-93. [PMID: 38204160 PMCID: PMC11009707 DOI: 10.15441/ceem.23.087] [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: 07/04/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Emergency care systems worldwide have been significantly affected by the COVID-19 pandemic. This study investigated the trend of emergency department (ED) visits for emergency care-sensitive conditions (ECSCs) in Korea before and during the pandemic. METHODS We performed a longitudinal study using the national ED database in Korea from January 2019 to December 2021. We calculated the number and incidence rate of visits for ECSCs per 100,000 ED visits, and the incidence rate ratio of 2021 relative to the value in 2019. The selected ECSCs were intracranial injury, ischemic heart disease, stroke, and cardiac arrest. RESULTS The number of ED visits for all causes decreased by about 23% during the pandemic. The number of ED visits for intracranial injuries decreased from 166,695 in 2019 to 133,226 in 2020 and then increased to 145,165 in 2021. The number of ED visits for ischemic heart disease and stroke decreased in 2020 but increased to 2019 levels in 2021. In contrast, the number of ED visits for cardiac arrest increased from 23,903 in 2019 to 24,344 in 2020 and to 27,027 in 2021. The incidence rate and incidence rate ratio of these four ECSCs increased from 2019 to 2021, suggesting increasing relative proportions of ECSCs in total ED visits. CONCLUSION During the COVID-19 pandemic, the number of cardiac arrests seen in the EDs increased, but that of other ECSCs decreased. The decrease in ED visits for ECSCs was not as pronounced as the decrease in ED visits for all causes during the pandemic. Further studies are needed to determine clinical outcomes in patients with ECSC during the pandemic.
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Affiliation(s)
- Seonji Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Kyung Sung
- Public Health Research Institute, National Medical Center, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jeehye Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Seong Jung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
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O'Guinn ML, Martino AM, Ourshalimian S, Holliday-Carroll MC, Chaudhari PP, Spurrier R. Association Between Hospital Arrival Time and Avoidable Transfer in Pediatric Trauma. J Pediatr Surg 2024; 59:310-315. [PMID: 37973422 DOI: 10.1016/j.jpedsurg.2023.10.023] [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: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Avoidable transfers (AT) in pediatric trauma can increase strain on healthcare resources and families. We sought to identify characteristics of patients and their injuries that are associated with AT. METHODS A multicenter retrospective cross-sectional study of the regional Trauma Registry was conducted from 1/1/10-12/31/21 of children <18 years-old who experienced an interfacility transfer. AT was defined as receiving hospital length of stay (LOS) < 48 hrs without procedure or intervention performed. Patient demographics, mechanism of injury, and arrival time were analyzed with descriptive statistics. A multivariable logistic regression was performed to analyze demographic and clinical factors associated with AT. RESULTS We included 5438 trauma transfers, of which 2187 (40.2%) were AT. Patients experiencing AT had a median [IQR] age of 5 years [1-12] and most were male (67%) and Hispanic/Latino (46.3%). The odds of experiencing AT decreased as age increased and were less likely in females and Non-Hispanic Black children. Injuries from falls (ground level (OR = 2.48; 95%CI = 1.89-3.28) and >10 ft (OR = 3.20; 95%CI = 2.35-4.39)), sports/recreational activities (OR = 2.36; 95%CI = 1.78-3.16), MVCs (OR = 1.44; 95%CI = 1.05-1.98), and firearms (OR = 1.74; 95%CI = 1.15-2.62) were associated with an increased odds of AT. Time of arrival at the receiving facility in early hours (00:00-07:59) (OR = 1.48; 95%CI = 1.24-1.76) and evening hours (17:00-23:59) (OR = 1.75; 95%CI = 1.47-2.07) were associated with an increased odds of AT. CONCLUSION Younger patients, injuries from falls, sports/recreational activities, MVCs, and firearms as well as arrival time outside of standard work hours are more likely to result in AT. Knowing these results, we can begin working with our referral centers to improve communication and strengthen institutional transfer criteria for pediatric trauma patients. Further investigation will then be needed to determine if the changes implemented have influenced care and lowered rates of avoidable transfer. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- MaKayla L O'Guinn
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Alice M Martino
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Shadassa Ourshalimian
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Mary C Holliday-Carroll
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA
| | - Pradip P Chaudhari
- Children's Hospital Los Angeles, Division of Emergency Medicine &Transport Medicine, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA; Keck School of Medicine of University of Southern California, Department of Pediatrics, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Ryan Spurrier
- Children's Hospital Los Angeles, Division of Pediatric Surgery, 4650 W Sunset Blvd, Los Angeles, CA 90027, USA; Keck School of Medicine of University of Southern California, Department of Surgery, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
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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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10
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Grosman-Rimon L, Rivlin L, Spataro R, Zhu Z, Casey J, Tory S, Solanki J, Wegier P. Trend of mortality and length of stay in the emergency department following implementation of a centralized sepsis alert system. Digit Health 2024; 10:20552076241250255. [PMID: 38680733 PMCID: PMC11055486 DOI: 10.1177/20552076241250255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Sepsis alerts based on laboratory and vital sign criteria were found insufficient to improve patient outcomes. While most early sepsis alerts were implemented into smaller scale operating systems, a centralized new approach may provide more benefits, overcoming alert fatigue, improving deployment of staff and resources, and optimizing the overall management of sepsis. The objective of the study was to assess mortality and length of stay (LOS) trends in emergency department (ED) patients, following the implementation of a centralized and automated sepsis alert system. Methods The automated sepsis alert system was implemented in 2021 as part of a hospital-wide command and control center. Administrative data from the years 2018 to 2021 were collected. Data included ED visits, in-hospital mortality, triage levels, LOS, and the Canadian Triage and Acuity Scale (CTAS). Results Mortality rate for patients classified as CTAS I triage level was the lowest in 2021, after the implementation of the automated sepsis alert system, compared to 2020, 2019, and 2018 (p < 0.001). The Kaplan-Meier survival curve revealed that for patients classified as CTAS I triage level, the probability of survival was the highest in 2021, after implementation of the sepsis alert algorithm, compared to previous years (Log Rank, Mantel-Cox, χ²=29.742, p < 0.001). No significant differences in survival rate were observed for other triage levels. Conclusion Implementing an automated sepsis alert system as part of a command center operation significantly improves mortality rate associated with LOS in the ED for patients in the highest triage level. These findings suggest that a centralized early sepsis alert system has the potential to improve patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Pete Wegier
- Humber River Health, Toronto, Canada
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
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Miazgowski B, Pakulski C, Miazgowski T. Length of Stay in Emergency Department by ICD-10 Specific and Non-Specific Diagnoses: A Single-Centre Retrospective Study. J Clin Med 2023; 12:4679. [PMID: 37510793 PMCID: PMC10380588 DOI: 10.3390/jcm12144679] [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: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The definition of non-specific presentation at a hospital emergency department (ED) has not yet been formally established. The purpose of this study was to assess the relationships between primary ED diagnoses identified by ICD-10 codes and ED length of stay (LOS). Over the course of three years, we examined 134,675 visits at a tertiary hospital. LOS was examined in groups with specific (internal, surgical, neurological, and traumatic diseases) and non-specific diagnoses. Our secondary objective was to measure LOS by age, day of the week, time of day, and season. The median LOS was 182 min (interquartile range: 99-264 min). LOS was 99 min in the traumatic group, while it was 132 min in the surgical group, 141 min in the non-specific group, 228 min in the internal medicine group, and 237 min in the neurological group. Other determinants of LOS were age, revisits, day of the week, and time of arrival-but not a season of the year. In the non-specific group (21% of all diagnoses), the percentage of hospitalizations was higher than in the specific groups. Our results suggest that in clinical practice, the non-specific group should be redefined to also encompass diagnoses from ICD-10 Chapter XXI (block Z00-Z99).
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Affiliation(s)
- Bartosz Miazgowski
- Doctoral School, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Cezary Pakulski
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Propaedeutic of Internal Diseases and Arterial Hypertension, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
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