1
|
Dowling-Cullen C, Sakellariou D. Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis. BMJ Open 2024; 14:e085796. [PMID: 39053956 DOI: 10.1136/bmjopen-2024-085796] [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] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.
Collapse
|
2
|
Hill K, McCabe C, Brenner M. Impact of adapting paediatric intensive care units for adult care during the COVID-19 pandemic: a scoping review. BMJ Open 2023; 13:e068174. [PMID: 37640456 PMCID: PMC10462976 DOI: 10.1136/bmjopen-2022-068174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research. DESIGN Scoping review. METHODS This study used Arksey and O'Malley's six-stage scoping review framework. A comprehensive search was conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE and grey literature search engines. A search strategy with predefined inclusion criteria was used to uncover relevant research in this area. Screening and data collection were done in duplicate. RESULTS 47 631 articles were obtained through searching. However, only 25 articles met the inclusion criteria and were included in the analysis. Three dominant themes emerged from the literature: (1) the reorganisation of space for managing increased capacity; (2) increased staffing and support; and (3) the resulting challenges. CONCLUSION COVID-19 has strained institutional resources across the globe. To relieve the burden on intensive care units (ICUs), some PICUs adjusted their units to care for critically ill adults, with other PICUs making significant changes, including the redeployment of staff to adult ICUs to provide extra care for adults. Overall, PICUs were collectively well equipped to care for adult patients, with care enhanced by implementing elements of holistic, family-centred PICU practices. The pandemic fostered a collaborative approach among PICU teams and wider hospital communities. However, specific healthcare guidelines had to be created to safely care for adult patients.
Collapse
Affiliation(s)
- Katie Hill
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Catherine McCabe
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Habib H, Prabowo Y, Sulistio S, Mulyana RM, Albar IA. The association of the COVID-19 outbreak with in-hospital mortality: A single-centre study from Indonesia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023; 20:101219. [PMID: 36778062 PMCID: PMC9898945 DOI: 10.1016/j.cegh.2023.101219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Objective The early outbreak period of Coronavirus Disease (COVID-19) has affected the emergency department (ED) and hospital services in many countries. This study aimed to investigate the association between COVID-19 outbreak and in-hospital mortality in Jakarta, Indonesia. Methods This retrospective cohort study was conducted in a single-centre referral hospital in Jakarta, Indonesia. Data were collected between May and October 2020. All patients who visited the ED and required inpatient care during the early COVID-19 outbreak period at the study location (March to April 2020) were included in the exposure group. All patients who visited the ED and required inpatient care during the non-outbreak period (March to April 2019) were included in the non-exposure group. In-hospital mortality was the primary outcome, whereas other variables, such as sex, age, triage categories, trauma cases, referral cases, and ED length of stay (LOS), were measured to identify confounding and effect modifications. Multivariate logistic regression analysis was performed to assess this association. Results A total of 2,808 patients during the outbreak period and 2,423 patients during the non-outbreak period participated in the study. The odds of in-hospital mortality increased during the outbreak period compared to that during the non-outbreak period (odds ratio [OR], 1.41; 95%CI 1.04-1.91; p = 0.01) after adjusting for age, sex, triage categories, trauma case, ED LOS, and interaction between the outbreak period and ED LOS. Conclusion COVID-19 outbreaks have been associated with an increased risk of in-hospital mortality in referral hospitals in Jakarta, Indonesia.
Collapse
Affiliation(s)
- Hadiki Habib
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/dr. Cipto Mangukusumo Hospital, Jakarta, Indonesia
| | - Yogi Prabowo
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Musculoskeletal Oncology Division, Department of Orthopaedic & Traumatology, dr.Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas, Indonesia
| | - Septo Sulistio
- Emergency Unit dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | |
Collapse
|
4
|
Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
Collapse
Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| |
Collapse
|
5
|
Quaglietta PR, Ramjist JK, Antwi J, Kissoondoyal A, Lapidus-Krol E, Baertschiger RM. Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery. J Pediatr Surg 2023; 58:931-938. [PMID: 36775681 PMCID: PMC9851992 DOI: 10.1016/j.jpedsurg.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children. METHODS We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018-June 2019) and COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables. RESULTS A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution. CONCLUSION Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare. LEVEL OF EVIDENCE Level III for "Treatment Studies".
Collapse
Affiliation(s)
- Paula R Quaglietta
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Joshua K Ramjist
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jeffrey Antwi
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ashby Kissoondoyal
- Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
6
|
Rethi S, Kairam N, Amato CS, Allegra JR, Eskin B. Six Diagnoses of Separation: Impact of COVID-19 on Pediatric Emergency Department Visits: A Multicenter Study. J Emerg Med 2022; 63:723-728. [PMID: 36522811 PMCID: PMC9485421 DOI: 10.1016/j.jemermed.2022.09.008] [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: 03/12/2022] [Revised: 07/28/2022] [Accepted: 09/04/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) arrived in the New York metropolitan area in early March 2020. Recommendations were made to self-quarantine within households and limit outside visits, including those to clinics and hospitals, to limit the spread of the virus. This resulted in a decrease in pediatric emergency department (ED) visits. However, it is unclear how this affected visits for some common diagnoses such as anxiety, appendicitis, asthma, headaches, seizures, and urinary tract infection (UTI). These diagnoses were chosen a priori, as they were felt to represent visits to the ED, for which the diagnoses would likely not be altered based on COVID exposure or quarantine due to their acute nature. OBJECTIVES Our goal was to investigate the effect of COVID-19 on common pediatric diagnoses seen in the pediatric ED using a large multihospital database. METHODS We conducted a retrospective cohort study of consecutive pediatric patients (age ≤ 21 years) between March 1 and November 30 in 2019 and 2020 in 28 hospital EDs within 150 miles of New York City. We compared the change in the number of visits from 2019 to 2020 for the following diagnoses: anxiety, appendicitis, asthma, headache, seizures, and UTI. RESULTS Our database contained 346,230 total pediatric visits. From 2019 to 2020, total visits decreased by 61%. Decreases for specific diagnoses were 75% for asthma, 64% for headaches, 47% for UTI, 32% for anxiety, 28% for seizures, and 18% for appendicitis (p value for each comparison < 0.0001). CONCLUSIONS We found a marked decrease in ED visits for six common pediatric diagnoses after COVID-19 arrived in our area. We suspect that this decrease was due to recommendations to quarantine and fear of contracting the virus. Further studies on other diagnoses and potential complications due to the delay in seeking care are needed.
Collapse
Affiliation(s)
| | - Neeraja Kairam
- Department of Emergency Medicine, Goryeb Children's Hospital/Morristown Medical Center, Morristown, New Jersey
| | - Christopher S Amato
- Department of Emergency Medicine, Goryeb Children's Hospital/Morristown Medical Center, Morristown, New Jersey
| | - John R Allegra
- Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey
| | - Barnet Eskin
- Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey
| |
Collapse
|
7
|
Falkenstein L, Eckel N, Kadel SB, Koenig J, Litaker D, Eichinger M. Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study. BMJ Open 2022; 12:e054054. [PMID: 36220317 PMCID: PMC9556743 DOI: 10.1136/bmjopen-2021-054054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Public health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators. METHODS AND ANALYSIS The study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage. ETHICS AND DISSEMINATION The study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020-650N). Study results will be published in journals with external peer-review.
Collapse
Affiliation(s)
- Lina Falkenstein
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Nathalie Eckel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Simone B Kadel
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - David Litaker
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
| | - Michael Eichinger
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health Baden-Wuerttemberg, Heidelberg University, Heidelberg, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Pediatric Epidemiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
8
|
Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study. PLoS Med 2022; 19:e1003974. [PMID: 36026507 PMCID: PMC9467376 DOI: 10.1371/journal.pmed.1003974] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/12/2022] [Accepted: 07/28/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258.
Collapse
|
9
|
Kyomba GK, Kiyombo GM, Grépin KA, Mayaka SM, Mambu TNM, Hategeka C, Mapatano MA, Alcayna-Stevens L, Kapanga SK, Konde JNN, Ngo DB, Babakazo PD, Mafuta EM, Lulebo AM, Ruton H, Law MR. Assessing routine health information system performance during the tenth outbreak of Ebola virus disease (2018-2020) in the Democratic Republic of the Congo: A qualitative study in North Kivu. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000429. [PMID: 36962427 PMCID: PMC10021379 DOI: 10.1371/journal.pgph.0000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
The Democratic Republic of Congo has implemented reforms to its national routine health information system (RHIS) to improve timeliness, completeness, and use of quality data. However, outbreaks can undermine efforts to strengthen it. We assessed the functioning of the RHIS during the 2018-2020 outbreak of Ebola Virus Disease (EVD) to identify opportunities for future development. We conducted a qualitative study in North Kivu, from March to May 2020. Semi-structured interviews were conducted with 34 key informants purposively selected from among the personnel involved in the production of RHIS data. The topics discussed included RHIS functioning, tools, compilation, validation, quality, sharing, and the use of data. Audio recordings were transcribed verbatim and thematic analysis was used to study the interviewees' lived experience. The RHIS retained its structure, tools, and flow during the outbreak. The need for other types of data to inform the EVD response created other parallel systems to the RHIS. This included data from Ebola treatment centers, vaccination against Ebola, points of entry surveillance, and safe and dignified burial. The informants indicated that the availability of weekly surveillance data had improved, while timeliness and quality of monthly RHIS reporting declined. The compilation of data was late and validation meetings were irregular. The upsurge of patients following the implementation of the free care policy, the departure of healthcare workers for better-paid jobs, and the high prioritization of the outbreak response over routine activities led to RHIS disruptions. Delays in decision-making were one of the consequences of the decline in data timeliness. Adequate allocation of human resources, equitable salary policy, coordination, and integration of the response with local structures are necessary to ensure optimal functioning of the RHIS during an outbreak. Future research should assess the scale of data quality changes during outbreaks.
Collapse
Affiliation(s)
- Gabriel Kalombe Kyomba
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Guillaume Mbela Kiyombo
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Karen A. Grépin
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Serge Manitu Mayaka
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | | | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mala Ali Mapatano
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Lys Alcayna-Stevens
- Department of Anthropology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Serge Kule Kapanga
- Département d’Anthropologie, Faculté des Sciences Sociales, Politiques et Administratives, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Joël Nkima-Numbi Konde
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Dosithée Bebe Ngo
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | | | - Eric Musalu Mafuta
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Aimée Mampasi Lulebo
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Hinda Ruton
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R. Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Tseng WM, Lin PH, Wu PC, Kao CH. Examining patient flow in a tertiary hospital's emergency department at a low coronavirus prevalence region. BMC Emerg Med 2022; 22:137. [PMID: 35896981 PMCID: PMC9328777 DOI: 10.1186/s12873-022-00694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taiwan's successful containment of the COVID-19 outbreak prior to 2021 provided a unique environment for the surveillance of unnecessary emergency medical use. The aim of the study is to examine the impact of the coronavirus disease (COVID-19) pandemic on the patient flow in the emergency department (ED) of a tertiary hospital over 1 year in southern Taiwan, a region with low COVID-19 prevalence. METHODS Cross-sectional observational study was conducted from January to December 2020. Essential parameters of patient flow in the ED between January and February 2020 and the subsequent 11-month period were compared to data from 2019. Data were analyzed with descriptive statistics, using an independent sample t-test or Mann-Whitney U test, as applicable. RESULTS The ED census showed an acute decline (- 30.8%) from January to February 2020, reaching its nadir (- 40.5%) in April 2020. From February to December 2020, there was an average decrease of 20.3% in ED attendance (p < 0.001). The impact was most significant in ambulatory visits, lower-urgency acuity (level III) visits, and pediatric visits, without change in the acuity proportion. The length of stay shortened mainly in the adult division, which typically had an overcrowding problem (median, 5.7-4.4 hours in discharge; 24.8-16.9 hours in hospitalization; p < 0.001). The incidence of 72-hour unscheduled return visits was also reduced (4.1-3.5%, p = 0.002). CONCLUSIONS In contrast to devastated regions, the impact on the ED patient flow in regions having low COVID-19 prevalence highlights a remodeling process of emergency medical care that would improve overcrowding.
Collapse
Affiliation(s)
- Wen-Min Tseng
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan
| | - Po-Hsiang Lin
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan
| | - Pin-Chieh Wu
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,Department of Nursing, Meiho University, Pingtung County, Taiwan
| | - Chih-Hsiang Kao
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414, Taiwan.
| |
Collapse
|
11
|
Effect of Quarantine and Reopening Measures on Pediatric Trauma Admissions During the 2019 SARS-CoV2 Virus Pandemic. J Am Coll Surg 2022; 234:685-690. [PMID: 35290289 DOI: 10.1097/xcs.0000000000000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients. STUDY DESIGN Registry data for an urban Level I pediatric trauma center were evaluated from April 1, 2018, to March 30, 2021. A timeline of local shutdown and reopening measures was established and used to partition the data into 6-month intervals. Data about demographics and injury characteristics were compared with similar intervals in 2018 and 2019 using appropriate statistical methodology for categorical, parametric, and nonparametric data. RESULTS A total of 3,110 patients met criteria for inclusion. A total of 1,106 patients were admitted the year after the closure of schools and nonessential businesses. Decreases in overall admissions and evaluations for suspected child abuse noted early in the pandemic were not sustained during shutdown or reopening periods. However, we observed a 77% increase in all-terrain vehicle injuries, along with a 59% reduction in sports injuries (chi-square [8, N = 3,110] = 49.7; p < 0.001). Significant shifts in demographic and payor status were also noted. CONCLUSIONS This is the first study to comprehensively examine the effects of quarantine and reopening policies on admission patterns for a pediatric trauma center in a metropolitan area. Total admissions and child abuse evaluations were not impacted. If shutdown measures are re-instituted, preventative efforts should be directed towards ATV use and recreational activities.
Collapse
|
12
|
Kim WG, Brown SD, Johnston PR, Nagler J, Jarrett DY. Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic. Emerg Radiol 2022; 29:1-8. [PMID: 34729649 PMCID: PMC8562366 DOI: 10.1007/s10140-021-01994-3] [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: 08/16/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED). METHODS We retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates based on pre-pandemic years. RESULTS A total of 2198 imaging studies were included. During the COVID-19 pandemic, fewer ED imaging studies were performed compared to predicted. The decrease was greater in April 2020 (RR = 0.56, p < 0.001) than in April 2021 (RR = 0.80, p = 0.038). The odds of positive diagnosis was higher during the pandemic than before, and higher in 2020 (OR 2.53, p < 0.001) than in 2021 (OR 1.38, p = 0.008). The expected numbers of positive diagnoses and hospital admittances remained within the predicted range during the pandemic (p = 0.505-0.873). CONCLUSIONS Although imaging volumes decreased during the studied months of the pandemic, the number of positive findings was unchanged compared to prior years. No differences were demonstrated in the percentage of patients admitted to the hospital with positive imaging findings. This suggests that, at our institution, the pandemic did not lead to a substantial number of missed diagnoses or severely delay the diagnosis of non-COVID-related conditions. While still lower than expected, imaging volumes increased in April 2021 suggesting a return towards baseline patient behavior as the pandemic conditions improved.
Collapse
Affiliation(s)
- Wendy G Kim
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Stephen D Brown
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joshua Nagler
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Delma Y Jarrett
- Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
13
|
Watson G, Pickard L, Williams B, Hargreaves D, Blair M. 'Do I, don't I?' A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic. Arch Dis Child 2021; 106:1118-1124. [PMID: 33692082 PMCID: PMC7948150 DOI: 10.1136/archdischild-2020-321260] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Paediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care. METHODS Semistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach. RESULTS From interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them. CONCLUSION A pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.
Collapse
Affiliation(s)
- Gabriella Watson
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Lucy Pickard
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Bhanu Williams
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
- Paediatrics, Imperial College London, Harrow, UK
| |
Collapse
|
14
|
Impact of SARS-CoV-2 Pandemic on Bronchiolitis Hospitalizations: The Experience of an Italian Tertiary Center. CHILDREN-BASEL 2021; 8:children8070556. [PMID: 34203542 PMCID: PMC8304517 DOI: 10.3390/children8070556] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 01/09/2023]
Abstract
SARS-CoV-2 pandemic restrictions have deeply altered the common respiratory illnesses burden. The aim of this paper was to clarify how these measures may have influenced bronchiolitis epidemiology, exploring possible explanations. We studied 342 infants hospitalized for bronchiolitis at our center from four different epidemic seasons (October–April 2017–2018, 2018–2019, 2019–2020 and 2020–2021). March–April hospitalization rate, RSV (respiratory syncytial virus) infection, pediatric intensive care unit (PICU) admission and oxygen therapy administration data were compared among different seasons to outline any changes during the SARS-CoV-2 outbreak. In March–April, 30 (23.1%), 28 (24.6%) and 5 (5.1%) infants were hospitalized for bronchiolitis, respectively, in 2017–2018, 2018–2019 and 2019–2020, with a lower rate in March–April 2020 (p < 0.001). No hospitalizations for bronchiolitis occurred during the epidemic season of 2020–2021. No significant differences in RSV infections, oxygen therapy administration and PICU admissions across seasons were outlined. In conclusion, we report a severe decrease in hospitalizations for bronchiolitis at our center throughout the entire SARS-CoV-2 outbreak rather than only during the lockdown periods. This seems to suggest a pivotal role for the systematic implementation of cost-effective non-pharmaceutical interventions (NPIs) such as compulsory face masks and hand hygiene, which were deployed for the entire pandemic, in reducing the circulation of infectious agents.
Collapse
|
15
|
Chou YC, Yen YF, Chu D, Hu HY. Impact of the COVID-19 Pandemic on Healthcare-Seeking Behaviors among Frequent Emergency Department Users: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126351. [PMID: 34208194 PMCID: PMC8296173 DOI: 10.3390/ijerph18126351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/03/2022]
Abstract
In 2020, Taiwan’s healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019–January 2020 (before the pandemic) and February 2020–January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4–5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease.
Collapse
Affiliation(s)
- Yi-Chang Chou
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan; (Y.-C.C.); (Y.-F.Y.)
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan; (Y.-C.C.); (Y.-F.Y.)
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei 111, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Department of Psychology and Counseling, University of Taipei, Taipei 100, Taiwan
| | - Dachen Chu
- Department of Health and Welfare, University of Taipei, Taipei 100, Taiwan;
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Neurosurgery, Taipei City Hospital, Taipei 103, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan; (Y.-C.C.); (Y.-F.Y.)
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Health and Welfare, University of Taipei, Taipei 100, Taiwan;
- Correspondence:
| |
Collapse
|
16
|
Lee DD, Jung H, Lou W, Rauchwerger D, Chartier LB, Masood S, Sathiaseelan S, Taher AK. The Impact of COVID-19 on a Large, Canadian Community Emergency Department. West J Emerg Med 2021; 22:572-579. [PMID: 34125029 PMCID: PMC8202991 DOI: 10.5811/westjem.2021.1.50123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/26/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION As the COVID-19 pandemic unfolded, emergency departments (EDs) across the world braced for surges in volume and demand. However, many EDs experienced decreased demand even for higher acuity illnesses. In this study we sought to examine the change in utilization at a large Canadian community ED, including changes in patient demographics and presentations, as well as structural and administrative changes made in response to the pandemic. METHODS This retrospective observational study took place in Ontario, Canada, from March 17-June 30, 2020, during province-wide lockdowns in response to COVID-19. We used a control period of March 17-June 30 in 2018-2019. Differences between observed and expected values were calculated for total visits, Canadian Triage and Acuity Scale (CTAS) groups, and age groups using Fisher's exact test. Length of stay (LOS), physician initial assessment time (PIA), and top primary and admission diagnoses were also examined. RESULTS Patient visits fell to 66.3% of expected volume in the exposure period (20,901 vs 31,525, P<0.0001). CTAS-1 (highest acuity) patient volumes dropped to 86.8% of expected (P = 0.1964) while CTAS-5 (lowest acuity) patient volumes dropped to 32.4% of expected (P <0.0001). Youth (0-17), adult (18-64), and senior (65+) visits all decreased to 37.4%, 71.7%, and 72.9% of expected volumes, respectively (P <0.0001). Median PIA and median ED LOS both decreased (1.1 to 0.6 hours and 3.3 to 3.0 hours, respectively). The most common primary diagnosis in both periods was "other chest pain." Viral syndromes were more prevalent in the exposure period. The top admission diagnoses were congestive heart failure in the control period (4.8%) and COVID-19 in the study period (3.5%). CONCLUSION ED utilization changed drastically during COVID-19. Our ED responded with wide stakeholder engagement, spatial reorganization, and human resources changes informed by real-time data. Our experiences can help prepare for potential subsequent "waves" of COVID-19 and future pandemics.
Collapse
Affiliation(s)
- Daniel Dongjoo Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - David Rauchwerger
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada
| | - Lucas B Chartier
- University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
| | - Sameer Masood
- University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
| | - Seyon Sathiaseelan
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada.,University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,McMaster University, Department of Family Medicine, Hamilton, Ontario, Canada
| | - Ahmed Khaled Taher
- Mackenzie Health, Department of Emergency Medicine, Richmond Hill, Ontario, Canada.,University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, Ontario, Canada.,University Health Network, Department of Emergency Medicine, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Pines JM, Zocchi MS, Black BS, Kornas R, Celedon P, Moghtaderi A, Venkat A. The Effect of the COVID-19 Pandemic on the Economics of United States Emergency Care. Ann Emerg Med 2021; 78:487-499. [PMID: 34120751 PMCID: PMC8075818 DOI: 10.1016/j.annemergmed.2021.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Study objective We describe how the coronavirus disease 2019 (COVID-19) pandemic affected the economics of emergency department care (ED). Methods We conducted an observational study of 136 EDs from January 2019 to September 2020, using 2020-to-2019 3-week moving ratios for ED visits, complexity, revenue, and staffing expenses. We tabulated 2020-to-2019 staffing ratios and calculated hour and full-time-equivalent changes. Results Following the COVID-19 pandemic’s onset, geriatric (age ≥65), adult (age 18 to 64), and pediatric (age <18) ED visits declined by 43%, 40%, and 73%, respectively, compared to 2019 visits and rose thereafter but remained below 2019 levels through September. Relative value units per visit rose by 8%, 9%, and 18%, respectively, compared to 2019, while ED admission rates rose by 32%. Both fell subsequently but remained above 2019 levels through September. Revenues dropped sharply early in the pandemic and rose gradually but remained below 2019 levels. In medium and large EDs, staffing and expenses were lowered with a lag, largely compensating for lower revenue at these sites, and barely at freestanding EDs. Staffing and expense reductions could not match revenue losses in smaller EDs. During the pandemic, emergency physician and advanced practice provider clinical hours and compensation fell 15% and 27%, respectively, corresponding to 174 lost physician and 193 lost advanced practice provider full-time-equivalent positions. Conclusion The COVID-19 pandemic adversely impacted the economics of ED care, with large drops in overall and, in particular, low-acuity ED visits, necessitating reductions in clinical hours. Staffing cutbacks could not match reduced revenue at small EDs with minimum emergency physician coverage requirements.
Collapse
Affiliation(s)
- Jesse M Pines
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
| | - Mark S Zocchi
- Department of Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Bernard S Black
- Pritzker School of Law and Kellogg School of Management, Northwestern University, Evanston, IL
| | - Rebecca Kornas
- Department of Emergency Medicine, Avista Hospital, Louisville, CO
| | | | - Ali Moghtaderi
- Department of Health Policy and Management, George Washington University, Washington, DC
| | - Arvind Venkat
- US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | | |
Collapse
|
18
|
Tung KK, Lee YH, Lin CC, Lee CH, Lin MC, Wei JCC. Opposing Trends in Total Knee and Hip Arthroplasties for Patients With Rheumatoid Arthritis vs. the General Population-A 14-Year Retrospective Study in Taiwan. Front Med (Lausanne) 2021; 8:640275. [PMID: 33959623 PMCID: PMC8095393 DOI: 10.3389/fmed.2021.640275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine the trend of incidence rate of total knee arthroplasty (TKA), total hip arthroplasty (THA), and TKA or THA (major joint arthroplasty, MJA) among rheumatoid arthritis (RA) population and compared them with general population (GP) in Taiwan. Methods: Incidence rates and trends of TKA, THA, and MJA were determined over a 14-year period (2000–2013) among RA patients and compared them with GP. RA of patients was diagnosed based on the ACR 1987 criteria and extracted from GP. Subanalyses of incidences of TKA, THA, and MJA by year, 10-year age group, and gender were further conducted for demographic analysis. Patient profiles were extracted from the National Health Insurance Research Database (NHIRD) for interrupted time-series analysis and cohort studies. Results: Patients enrolled were 168,457 receiving TKA, 64,543 receiving THA, and 228,191 receiving MJA surgery. Incidences of TKA, THA, and MJA in RA patients were significantly lower by 49.0, 41.5, and 41.0% compared with concomitantly rises in GP by 131.0, 25.1, and 90.0% among the GP during the study period. The dominant age population for TKA, THA, and MJA were those aged 70–79 years in both GP and RA groups. Conclusions: We found an opposing trend in incidence of TKA, THA, and MJA between RA patients and the GP. The possible influence of pharmacological treatment is implicated for the lower incidence rates of TKA, THA, and MJA surgeries among RA patients.
Collapse
Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yung-Heng Lee
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan.,Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chuan-Chao Lin
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
19
|
Sokoloff WC, Krief WI, Giusto KA, Mohaimin T, Murphy-Hockett C, Rocker J, Williamson KA. Pediatric emergency department utilization during the COVID-19 pandemic in New York City. Am J Emerg Med 2021; 45:100-104. [PMID: 33677263 PMCID: PMC7896495 DOI: 10.1016/j.ajem.2021.02.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/14/2021] [Accepted: 02/12/2021] [Indexed: 01/30/2023] Open
Abstract
Objectives This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses. Study Design We performed an observational retrospective review of patients younger than 18 years old seen in a New York City pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation. Results ED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01). Conclusions Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse.
Collapse
Affiliation(s)
- William C Sokoloff
- Division of Emergency Medicine, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA.
| | - William I Krief
- Division of Emergency Medicine, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Kimberly A Giusto
- Division of Emergency Medicine, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Tasnima Mohaimin
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Cole Murphy-Hockett
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Joshua Rocker
- Division of Emergency Medicine, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Kristy A Williamson
- Division of Emergency Medicine, Cohen Children's Medical Center, Northwell Health, Queens, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| |
Collapse
|
20
|
Bover-Bauza C, Rosselló Gomila MA, Díaz Pérez D, Millán Pons AR, Gil Sánchez JA, Peña-Zarza JA, Figuerola Mulet J, Osona B. The Impact of the SARS-CoV-2 Pandemic on the Emergency Department and Management of the Pediatric Asthmatic Patient. J Asthma Allergy 2021; 14:101-108. [PMID: 33568921 PMCID: PMC7868176 DOI: 10.2147/jaa.s284813] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/01/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Asthma exacerbation is among the commonest causes for pediatric emergency room visits, and respiratory viruses are frequent triggers of such exacerbations. Few studies have evaluated the consequences of the novel human coronavirus that causes the illness currently known as COVID-19, in the pediatric population. PURPOSE The objective of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on the emergency department in the pediatric asthmatic patient. PATIENTS AND METHODS This retrospective observational study evaluated pediatric patients treated at the Pediatric Emergency Service for wheezing episodes. Changes in the number and characteristics of these patients over the same period of 2019 as compared to 2020 during the month following the alarm declaration (March 14 to April 15) were evaluated. RESULTS In total, data of 30 asthma patients managed in the period after the declaration of the coronavirus pandemic and of 158 asthma patients managed in the pre-COVID-19 period were included. In 2020, patient visits decreased by 82% in 2019. No statistically significant differences among age, sex, oxygen saturation, fever status, or number of severe bronchospasm episodes were found. Nebulized medication usage was reduced significantly since the alarm declaration. No significant increase in requests for complementary testing in the COVID-19 period was found. No patient requiring hospital admission was found to be PCR SARS-CoV-2 positive. Median time spent in the emergency department decreased from 180 minutes in 2019 to 85 minutes in the COVID-19 era. CONCLUSION The COVID-19 pandemic and ensuing lockdown measures have led to an extraordinary reduction in emergency visits to the pediatric service. The ongoing pandemic has also led to improvements in the approach to asthma exacerbations and wheezing, to reduce the risk of exposure to the virus, such as increased use of pressurized metered dose inhaler and decreased time in the Emergency Department.
Collapse
Affiliation(s)
- Catalina Bover-Bauza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Maria Antonia Rosselló Gomila
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - David Díaz Pérez
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - Aina Rosa Millán Pons
- Department of Statistic and Methodological Support, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Jose Antonio Gil Sánchez
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Jose Antonio Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Research Group in Sleep Apnea and Hypopnea Syndrome, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Joan Figuerola Mulet
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain
| |
Collapse
|
21
|
Lin CF, Huang YH, Cheng CY, Wu KH, Tang KS, Chiu IM. Public Health Interventions for the COVID-19 Pandemic Reduce Respiratory Tract Infection-Related Visits at Pediatric Emergency Departments in Taiwan. Front Public Health 2020; 8:604089. [PMID: 33392141 PMCID: PMC7772199 DOI: 10.3389/fpubh.2020.604089] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/23/2020] [Indexed: 01/16/2023] Open
Abstract
Background and objective: Public health interventions such as social distancing, wearing surgical or N95 masks, and handwashing are effective in significantly reducing the risk of infection. The purpose of this article is to analyze the effect of public health interventions on respiratory tract infection-related visits to pediatric emergency departments during the COVID-19 pandemic in Taiwan. Method: Pediatric emergency department visits between January 1 2020 and April 30 2020 were included for trend analysis and compared to the same period during the past 3 years. The datasets were retrieved from Taiwan National Infectious Disease Statistics System and Kaohsiung Chang Gung Memorial Hospital. Respiratory tract infections with other diagnoses categories, including fever, asthma, and urinary tract infections, were included for subgroup analysis. Result: A significant decrease of more than 50% in respiratory tract infection-related visits was found from February to April 2020 in the national database. With regard to diagnosis category, the proportion of respiratory tract infections in Kaohsiung Chang Gung Hospital also became significantly lower in 2020 during the months of March (43.4 vs. 37.4%, p = 0.024) and April (40.1 vs. 32.2%, p < 0.001). On the other hand, the proportion of urinary tract infections was significantly higher in 2020 during March (3.7 vs. 5.2%, p = 0.033) and April (3.9 vs. 6.5%, p < 0.001), and that of asthma was also higher in April (1.6 vs. 2.6%, p = 0.025). Furthermore, the intensive care unit admission rate was relatively higher in 2020 from February, with significant differences noted in March (1.3 vs. 2.8%, p < 0.001). Conclusion: Due to public health interventions for the COVID-19 pandemic, the transmission of not only COVID-19 but also other air droplet transmitted diseases in children may have been effectively prevented.
Collapse
Affiliation(s)
- Chien-Fu Lin
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yet-Sen University, Kaohsiung, Taiwan
| | - Kuan-Han Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuo-Shu Tang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yet-Sen University, Kaohsiung, Taiwan
| |
Collapse
|
22
|
Lee L, Mannix R, Guedj R, Chong SL, Sunwoo S, Woodward T, Fleegler E. Paediatric ED utilisation in the early phase of the COVID-19 pandemic. Emerg Med J 2020; 38:100-102. [PMID: 33273041 DOI: 10.1136/emermed-2020-210124] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Past epidemics, including influenza, have resulted in increased paediatric patient volume in EDs. During the early weeks of the COVID-19 pandemic, it was unclear how ED volume would be impacted in paediatric hospitals. The objective of this study was to examine differences in the international experience of paediatric ED utilisation and disposition at five different children's hospitals. METHODS We obtained data on ED volume, acuity level and disposition (hospitalisation and intensive care unit (ICU) admission) for the time period 1 December1-10 August for the years 2017-2020 from hospitals in five cities (Boston, Massachusetts, USA; Singapore; Melbourne, Australia; Seattle, Washington, USA; and Paris, France). Per cent change was analysed using paired t-tests or Wilcoxon signed rank test. RESULTS Overall ED volume dramatically decreased in all five hospitals during the early months of COVID-19 compared with prior years. There was a more varied response of decreases in ED volume by acuity level, hospitalisation and ICU admission among the five hospitals. The one exception was a 2% increase in ICU admissions in Paris. As of August 2020, all hospitals have demonstrated increases in ED volume; however, they are still below baseline. CONCLUSION Paediatric EDs in these five cities demonstrated differential decreases of ED volume by acuity and disposition during the early months of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Lois Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Romain Guedj
- Division of Pediatric Emergency Medicine, Hôpital Armand-Trousseau, Paris, Île-de-France, France
| | - Shu-Ling Chong
- Department of Children's Emergency, KK Women's and Chlidren's Hospital, Singapore
| | - Sidney Sunwoo
- Division of Emergency Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Tony Woodward
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
23
|
Maizlin NN, Ohorodnyk P. Investigating the initial effect of COVID-19 on the functioning of outpatient diagnostic imaging facilities. J Med Imaging Radiat Sci 2020; 51:574-578. [PMID: 33121887 PMCID: PMC7425712 DOI: 10.1016/j.jmir.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As a result of the COVID-19 pandemic, outpatient diagnostic imaging (DI) facilities experienced decreased operations and even unprecedented closures. The purpose of this study was to examine the impact of COVID-19 on the practices of DI clinics, and investigate the reasons for the change in their operations during the initial period of the pandemic starting in mid-March 2020. MATERIALS AND METHODS A questionnaire was created and distributed to the managers of eighteen outpatient DI clinics in London, Hamilton, and Halton, Ontario, Canada. The managers indicated whether their clinics had closed or decreased operations, the reasons for closure, and the types of imaging examinations conducted in the initial period of the COVID-19 pandemic. RESULTS Fifty percent of the DI clinics surveyed (9/18) closed as a result of COVID-19, and those that remained open had decreased hours of operation. The clinics that closed indicated decreased referrals as the primary reason for closure, followed by staff shortage, concerns for safety, and suspension of elective imaging. Chest radiography and obstetric ultrasound were the most commonly conducted examinations. Clinics that were in close geographical proximity were able to redistribute imaging examinations amongst themselves. All DI clinics had suspended BMD examinations and elective breast screening, and some transitioned to booked appointments only. CONCLUSION Many DI clinics needed to close or decrease operations as a result of COVID-19, a phenomenon that is unprecedented in radiological practice. The results of this study can assist outpatient DI clinics in preparing for subsequent waves of COVID-19, future pandemics, and other periods of crisis.
Collapse
Affiliation(s)
- Nick N Maizlin
- Schulich School of Medicine and Dentistry (NNM), Department of Radiology (PO), Western University, London, Ontario, Canada.
| | - Pavlo Ohorodnyk
- Schulich School of Medicine and Dentistry (NNM), Department of Radiology (PO), Western University, London, Ontario, Canada
| |
Collapse
|
24
|
Lo HY, Chaou CH, Chang YC, Ng CJ, Chen SY. Prediction of emergency department volume and severity during a novel virus pandemic: Experience from the COVID-19 pandemic. Am J Emerg Med 2020; 46:303-309. [PMID: 33046313 PMCID: PMC7403852 DOI: 10.1016/j.ajem.2020.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background During a novel virus pandemic, predicting emergency department (ED) volume is crucial for arranging the limited medical resources of hospitals for balancing the daily patient- and epidemic-related tasks in EDs. The goal of the current study was to detect specific patterns of change in ED volume and severity during a pandemic which would help to arrange medical staff and utilize facilities and resources in EDs in advance in the event of a future pandemic. Methods This was a retrospective study of the patients who visited our ED between November 1, 2019 and April 30, 2020. We evaluated the change in ED patient volume and complexity of patients in our medical record system. Patient volume and severity during various periods were identified and compared with data from the past 3 years and the period that SARS occurred. Results A reduction in ED volume was evident. The reduction began during the early epidemic period and increased rapidly during the peak period of the epidemic with the reduction continuing during the late epidemic period. No significant difference existed in the percentages of triage levels 1 and 2 between the periods. The admission rate, length of stay in the ED, and average number of patients with out-of-hospital cardiac arrest increased during the epidemic periods. Conclusion A significant reduction in ED volume during the COVID-19 pandemic was noted and a predictable pattern was found. This specific change in pattern in the ED volume may be useful for performing adjustments in EDs in the future during a novel virus pandemic. The severity of patients visiting the ED during epidemic periods was inconclusive.
Collapse
Affiliation(s)
- Hsiang-Yun Lo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.); Institute of health policy and management, National, Taiwan University, Taiwan (R.O.C.)
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.)
| | - Yu-Che Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.)
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.)
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.); Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.).
| |
Collapse
|
25
|
Keays G, Friedman D, Gagnon I. Injuries in the time of COVID-19. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2020; 40:336-341. [PMID: 32924925 DOI: 10.24095/hpcdp.40.11/12.02] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Research has shown that during the 2003 SARS pandemic, emergency department (ED) visits among the pediatric population decreased. We set out to investigate if this was also true for injury-related ED visits during the COVID-19 pandemic. METHODS Using data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), we looked at 28 years of injury-related ED visits at the Montreal Children's Hospital, a provincially designated Pediatric Trauma Centre. We compared data from a two-month period during the COVID-19 lockdown (16 March to 15 May) to the same period in previous years (1993-2019) to determine whether the 2020 decrease in ED visit numbers was unprecedented (i.e. a similar decrease had never occurred) for different age groups, nature of injuries, mechanisms and severity. RESULTS The 2020 decrease was unprecedented across all age groups between 1993 and 2019. When compared with the 2015 to 2019 average, the decrease was smallest in children aged 2 to 5 years (a 35% decrease), and greatest in the group aged 12 to 17 years (83%). Motor vehicle collisions and sports-related injuries practically vanished during the COVID-19 lockdown. Surprisingly, more children aged 6 to 17 years presented with less urgent injuries during the COVID-19 lockdown than in previous years. CONCLUSION As was the case with SARS in 2003, COVID-19 acted as a deterrent for pediatric ED visits. The lockdown in particular had a profound impact on injury-related visits. The de-confinement period will be monitored to determine the impact in both the short and the long term.
Collapse
Affiliation(s)
- Glenn Keays
- Trauma, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montréal, Quebec, Canada.,Canadian Hospitals Injury Reporting and Prevention Program, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada
| | - Debbie Friedman
- Trauma, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montréal, Quebec, Canada.,Canadian Hospitals Injury Reporting and Prevention Program, Montreal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada.,Department of Pediatrics and Pediatric Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.,The WELL Office, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.,Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal Children's Hospital, Montréal, Quebec, Canada
| |
Collapse
|
26
|
Dean P, Zhang Y, Frey M, Shah A, Edmunds K, Boyd S, Schwartz H, Frey T, Stalets E, Schaffzin J, Vukovic AA, Reeves S, Masur T, Kerrey B. The impact of public health interventions on critical illness in the pediatric emergency department during the SARS-CoV-2 pandemic. J Am Coll Emerg Physicians Open 2020; 1:1542-1551. [PMID: 32838393 PMCID: PMC7436689 DOI: 10.1002/emp2.12220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 01/20/2023] Open
Abstract
Study objective The impact of public health interventions during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic on critical illness in children has not been studied. We seek to determine the impact of SARS‐CoV‐2 related public health interventions on emergency healthcare utilization and frequency of critical illness in children. Methods This was an interrupted time series analysis conducted at a single tertiary pediatric emergency department (PED). All patients evaluated by a provider from December 31 through May 14 of 6 consecutive years (2015‐2020) were included. Total patient visits (ED and urgent care), shock trauma suite (STS) volume, and measures of critical illness were compared between the SARS‐CoV‐2 period (December 31, 2019 to May 14, 2020) and the same period for the previous 5 years combined. A segmented regression model was used to explore differences in the 3 outcomes between the study and control period. Results Total visits, STS volume, and volume of critical illness were all significantly lower during the SARS‐CoV‐2 period. During the height of public health interventions, per day there were 151 fewer total visits and 7 fewer patients evaluated in the STS. The odds of having a 24‐hour period without a single critical patient were >5 times higher. Trends appeared to start before the statewide shelter‐in‐place order and lasted for at least 8 weeks. Conclusions In a metropolitan area without significant SARS‐CoV‐2 seeding, the pandemic was associated with a marked reduction in PED visits for critical pediatric illness.
Collapse
Affiliation(s)
- Preston Dean
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Yin Zhang
- Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Mary Frey
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Ashish Shah
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Katherine Edmunds
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Stephanie Boyd
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Hamilton Schwartz
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Theresa Frey
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Erika Stalets
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA.,Division of Critical Care Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Joshua Schaffzin
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA.,Division of Infectious Diseases Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Adam A Vukovic
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Scott Reeves
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Tonya Masur
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Benjamin Kerrey
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
| |
Collapse
|
27
|
Munir MM, Martins RS, Mian AI. Emergency Department Admissions During COVID-19: Implications from the 2002-2004 SARS Epidemic. West J Emerg Med 2020; 21:744-745. [PMID: 32726232 PMCID: PMC7390544 DOI: 10.5811/westjem.2020.5.48203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Asad I Mian
- Aga Khan University Hospital, Department of Emergency Medicine, Karachi City, Sindh, Pakistan
| |
Collapse
|
28
|
Lin FH, Chen HC, Lin C, Chiu YL, Lee HS, Chang H, Huang GS, Chang HL, Yeh SJ, Su W, Wang CC, Su SL. The increase in total knee replacement surgery in Taiwan: A 15-year retrospective study. Medicine (Baltimore) 2018; 97:e11749. [PMID: 30075592 PMCID: PMC6081077 DOI: 10.1097/md.0000000000011749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Total knee replacement (TKR) is considered as one of the most success among clinical interventions for patients with who suffering from knee osteoarthritis (OA). We sought to estimate the incidence of TKR using demographics, incidence rates, lengths of hospital stay, and costs from 1996 to 2010 by analyzing Taiwan's National Health Insurance Research Database. A total of 154,553 patients obtained primary TKR surgery between 1996 and 2010. The diagnosis code for knee OA and the procedure code for TKR were selected from the records. To compare the rate of TKR between covariables, we calculated the TKR risk ratios and 95% confidence interval (CI) of these variables (gender, age, age group, and primary diagnoses). A 2-tailed P-value of .05 was considered statistically significant. The statistical package SPSS version 20.0 (SPSS, Chicago, IL) was used to conduct all the statistical analyzes. We analyzed 154,553 TKRs performed by surgeons in Taiwan from 1996 to 2010. The overall crude incidence increased from 26.4 to 74.55 TKR per 100,000 inhabitants from 1996 to 2010. TKR incidence for the 70 to 79 years age group increased from 227 to 505 per 100,000 people from 1996 to 2010. The age-standardized rate ratios for TKR of women to men ranged from 2.5 to 3.0. The mean average length of stay in hospital was 15 days in 1996 and decreased to 8 days in 2010. During the study period, the adjusted mean cost per patient decreased from US$7485 to US$4827. Health expenditures for TKR were 5% of total National Health Insurance expenditure every year. Over the 15-year period, Taiwan's TKR incidence tripled, which is consistent with population ageing. Arthritis will be a major public health issue in the ageing population in the future.
Collapse
Affiliation(s)
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | | | | | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hung Chang
- Department of Physiology and Biophysics
- Division of Thoracic Surgery
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | | | - Shih-Jen Yeh
- Department of Research and Development, Da-Yeh University, Changhua
| | | | - Chih-Chien Wang
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | | |
Collapse
|
29
|
Burke LK, Brown CP, Johnson TM. Historical Data Analysis of Hospital Discharges Related to the Amerithrax Attack in Florida. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2016; 13:1c. [PMID: 27843420 PMCID: PMC5075231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Interrupted time-series analysis (ITSA) can be used to identify, quantify, and evaluate the magnitude and direction of an event on the basis of time-series data. This study evaluates the impact of the bioterrorist anthrax attacks ("Amerithrax") on hospital inpatient discharges in the metropolitan statistical area of Palm Beach, Broward, and Miami-Dade counties in the fourth quarter of 2001. Three statistical methods-standardized incidence ratio (SIR), segmented regression, and an autoregressive integrated moving average (ARIMA)-were used to determine whether Amerithrax influenced inpatient utilization. The SIR found a non-statistically significant 2 percent decrease in hospital discharges. Although the segmented regression test found a slight increase in the discharge rate during the fourth quarter, it was also not statistically significant; therefore, it could not be attributed to Amerithrax. Segmented regression diagnostics preparing for ARIMA indicated that the quarterly data time frame was not serially correlated and violated one of the assumptions for the use of the ARIMA method and therefore could not properly evaluate the impact on the time-series data. Lack of data granularity of the time frames hindered the successful evaluation of the impact by the three analytic methods. This study demonstrates that the granularity of the data points is as important as the number of data points in a time series. ITSA is important for the ability to evaluate the impact that any hazard may have on inpatient utilization. Knowledge of hospital utilization patterns during disasters offer healthcare and civic professionals valuable information to plan, respond, mitigate, and evaluate any outcomes stemming from biothreats.
Collapse
Affiliation(s)
- Lauralyn K Burke
- Division of Health Informatics and Information Management at Florida A&M University in Tallahassee, FL
| | - C Perry Brown
- Public health in the Institute of Public Health at the College of Pharmacy and Pharmaceutical Sciences at Florida A&M University in Tallahassee, FL
| | - Tammie M Johnson
- Department of Public Health at the University of North Florida in Jacksonville, FL
| |
Collapse
|
30
|
|
31
|
Parental reasons for utilization of an urban pediatric emergency department during the 2009 H1N1 influenza epidemic. Pediatr Emerg Care 2011; 27:261-5. [PMID: 21490538 DOI: 10.1097/pec.0b013e3182131420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to understand the utilization of the pediatric emergency department (PED) of an academic hospital during regular primary care office hours during the 2009 H1N1 epidemic. Children with a usual source of care presenting for influenza-like illness (ILI) symptoms were compared with those presenting with other symptoms. METHODS During the 2009 H1N1 outbreak, parents visiting a PED in a low-income area in New York City in June 2009 were surveyed using open- and close-ended questions. Sociodemographic factors and reasons for seeking care in the PED rather than their usual source of care were compared between groups. RESULTS There were no sociodemographic differences among children brought to the PED for ILI and those brought for other presenting symptoms. Those families with a child with ILI symptoms were less likely to report urgency as the primary reason they brought their child to the PED. A common reason reported for coming to the PED was limited access to care. In further exploration of limited access, parents with a child with ILI symptoms were more likely to report that their usual source of care did not have any evening and/or weekend hours, and they did not know how to reach their provider after hours. CONCLUSIONS Enhancing access to primary care settings and encouraging parents to use their primary care providers might reduce the utilization of the PED for nonurgent problems during epidemics.
Collapse
|
32
|
Rubin GJ, Dickmann P. How to Reduce the Impact of “Low-Risk Patients” Following a Bioterrorist Incident: Lessons from SARS, Anthrax, and Pneumonic Plague. Biosecur Bioterror 2010; 8:37-43. [DOI: 10.1089/bsp.2009.0059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G. James Rubin
- G. James Rubin, PhD, is a Lecturer in King's College London, London, UK. Petra Dickmann, MA, is an MD/PhD candidate and research fellow at Frankfurt University Hospital, Department of Infectious Diseases, Frankfurt, Germany, and an independent consultant on risk communication for global industries and international organizations
| | - Petra Dickmann
- G. James Rubin, PhD, is a Lecturer in King's College London, London, UK. Petra Dickmann, MA, is an MD/PhD candidate and research fellow at Frankfurt University Hospital, Department of Infectious Diseases, Frankfurt, Germany, and an independent consultant on risk communication for global industries and international organizations
| |
Collapse
|
33
|
Huang YT, Lee YC, Hsiao CJ. Hospitalization for ambulatory-care-sensitive conditions in Taiwan following the SARS outbreak: a population-based interrupted time series study. J Formos Med Assoc 2009; 108:386-94. [PMID: 19443292 PMCID: PMC7135451 DOI: 10.1016/s0929-6646(09)60082-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 09/23/2008] [Accepted: 12/02/2008] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE In 2003, the severe acute respiratory syndrome (SARS) outbreak resulted in 8096 probable cases and 774 deaths in 26 countries. The purpose of this study was to explore the effect of the SARS outbreak on hospitalization for chronic ambulatory-care-sensitive conditions (ACSCs) in Taiwan. METHODS We applied a population-based interrupted time series study design and used the time series auto-regressive integrated moving-average model to compare the actual and predicted admission rates of seven selected chronic ACSCs. The analyses were based on National Health Insurance hospital inpatient claims data from 1997 to 2003. RESULTS The impact of SARS on ACSCs after the outbreak varied among seven selected chronic conditions. Hospitalization for respiratory conditions was significantly lower than the predicted values, whereas hospitalization for diabetes was significantly higher than the predicted values after the outbreak. CONCLUSION Admission rates for most ACSCs, except for diabetes, did not change in the post-SARS period. The reductions in outpatient utilization during the SARS outbreak did not appear to affect adversely admissions for most ACSCs.
Collapse
Affiliation(s)
- Yu-Tung Huang
- Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Ju Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
34
|
Chu D, Chen RC, Ku CY, Chou P. The impact of SARS on hospital performance. BMC Health Serv Res 2008; 8:228. [PMID: 18990210 PMCID: PMC2613902 DOI: 10.1186/1472-6963-8-228] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 11/06/2008] [Indexed: 11/22/2022] Open
Abstract
Background During the SARS epidemic, healthcare utilization and medical services decreased significantly. However, the long-term impact of SARS on hospital performance needs to be further discussed. Methods A municipal hospital in Taipei City was shut down for a month due to SARS and then became the designated SARS and infectious disease hospital for the city. This study collected the outpatient, inpatient and emergency service volumes for every year from April to March over four years. Average monthly service amount ± standard deviation were used to compare patient volume for the whole hospital, as well as the outpatient numbers accessing different departments. The ARIMA model of outpatient volume in the pre-SARS year was developed. Results The average monthly service volume of outpatient visits for the base year 2002 was 52317 ± 4204 visits per month, and number for 2003 and the following two years were 55%, 82% and 84% of the base year respectively. The average emergency service volume was 4382 ± 356 visits per month at the base year and this became 45%, 77% and 87% of the base year for the following three years respectively. Average inpatient service volume was 8520 ± 909 inpatient days per month at the base year becoming 43%, 81% and 87% of the base year for the following three years respectively. Only the emergency service volume had recovered to the level of a non-significant difference at the second year after SARS. In addition, the departments of family medicine, metabolism and nephrology reached the 2002 patient number in 2003. The ARIMA (2,1,0) model was the most suitable for outpatient volume in pre-SARS year. The MAPE of the ARIMA (2,1,0) model for the pre-SARS year was 6.9%, and 43.2%, 10.6%, 6.2% for following 3 years. Conclusion This study demonstrates that if a hospital is completely shut down due to SARS or a similar disease, the impact is longer than previous reported and different departments may experience different recover periods. The findings of this study identify subspecialties that are particularly vulnerable in an infectious disease designated hospital and such hospitals need to consider which subspecialties should be included in their medical structure.
Collapse
Affiliation(s)
- Dachen Chu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | | | | | | |
Collapse
|
35
|
Health impact of hospital restrictions on seriously ill hospitalized patients: lessons from the Toronto SARS outbreak. Med Care 2008; 46:991-7. [PMID: 18725855 DOI: 10.1097/mlr.0b013e3181792525] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Restrictions on non-urgent hospital care imposed to control the 2003 Toronto severe acute respiratory syndrome outbreak led to substantial disruptions in hospital clinical practice, admission, and transfer patterns. OBJECTIVES We assessed whether there were unintended health consequences to seriously ill hospitalized patients. STUDY DESIGN, SETTING, AND POPULATION: Population-based longitudinal cohort study of patients residing in Toronto or an urban control region with an incident admission for 1 of 7 serious conditions in the 3 years before, or the 4 months during or after restrictions. OUTCOME MEASURES Short-term mortality, overall readmissions, cardiac readmissions for acute myocardial infarction patients, serious complications for very low birth weight babies, and quality of care measures, comparing adjusted rates across time periods within regions. RESULTS Mortality, readmission, and complication rates did not change for any condition during or after severe acute respiratory syndrome restrictions. Although rates of invasive cardiac procedures for acute myocardial infarction patients decreased 11-37% in Toronto, rates of nonfatal cardiac outcomes did not change. CONCLUSIONS Restrictions on non-urgent hospital utilization and hospital transfers may be a safe public health strategy to employ to control nosocomial outbreaks or provide hospital surge capacity for up to several months, in large, well-developed healthcare systems with good availability of community-based care.
Collapse
|
36
|
Powers R. Evidence-based ED Disaster Planning. J Emerg Nurs 2008; 35:218-23; quiz 272-3. [PMID: 19446126 PMCID: PMC7112353 DOI: 10.1016/j.jen.2008.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 03/06/2008] [Accepted: 03/15/2008] [Indexed: 11/24/2022]
Affiliation(s)
- Robert Powers
- Heart of Carolina Chapter, Emergency Services Disaster Consulting and Research, Raleigh, NC, USA.
| |
Collapse
|
37
|
Hwang SW, Cheung AM, Moineddin R, Bell CM. Population mortality during the outbreak of Severe Acute Respiratory Syndrome in Toronto. BMC Public Health 2007; 7:93. [PMID: 17535440 PMCID: PMC1894965 DOI: 10.1186/1471-2458-7-93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 05/29/2007] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Extraordinary infection control measures limited access to medical care in the Greater Toronto Area during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. The objective of this study was to determine if the period of these infection control measures was associated with changes in overall population mortality due to causes other than SARS. METHODS Observational study of death registry data, using Poisson regression and interrupted time-series analysis to examine all-cause mortality rates (excluding deaths due to SARS) before, during, and after the SARS outbreak. The population of Ontario was grouped into the Greater Toronto Area (N = 2.9 million) and the rest of Ontario (N = 9.3 million) based upon the level of restrictions on delivery of clinical services during the SARS outbreak. RESULTS There was no significant change in mortality in the Greater Toronto Area before, during, and after the period of the SARS outbreak in 2003 compared to the corresponding time periods in 2002 and 2001. The rate ratio for all-cause mortality during the SARS outbreak was 0.99 [95% Confidence Interval (CI) 0.93-1.06] compared to 2002 and 0.96 [95% CI 0.90-1.03] compared to 2001. An interrupted time series analysis found no significant change in mortality rates in the Greater Toronto Area associated with the period of the SARS outbreak. CONCLUSION Limitations on access to medical services during the 2003 SARS outbreak in Toronto had no observable impact on short-term population mortality. Effects on morbidity and long-term mortality were not assessed. Efforts to contain future infectious disease outbreaks due to influenza or other agents must consider effects on access to essential health care services.
Collapse
Affiliation(s)
- Stephen W Hwang
- Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital; Department of Medicine, Division of General Internal Medicine, University of Toronto, Canada
| | - Angela M Cheung
- Women's Health Program, University Health Network; Department of Medicine, Division of General Internal Medicine, University of Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Canada
| | - Chaim M Bell
- The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital; Department of Medicine, Division of General Internal Medicine, University of Toronto, Canada
| |
Collapse
|
38
|
Heiber M, Lou WYW. Effect of the SARS outbreak on visits to a community hospital emergency department. CAN J EMERG MED 2007; 8:323-8. [PMID: 17338843 DOI: 10.1017/s148180350001397x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the effect of severe acute respiratory syndrome (SARS) on visits to a community hospital emergency department (ED) during the early stage of the Toronto outbreak in 2003 and for the same period in 2004. We focused on visits for respiratory illness (SARS-like symptoms) and different age groups. METHODS This study is a retrospective review of ED discharge diagnoses obtained from a computerized database, examining the 4-week period starting March 28 for the years 2001-2004. We obtained the discharge diagnosis, age and visit date for each ED patient during the relevant time intervals, then compared visit data from 2003 and 2004 with a baseline derived from the average number of visits during 2001 and 2002. We constructed groupings based on age and respiratory-illness symptoms. RESULTS During the SARS outbreak in 2003, ED visits declined by 21% (95% confidence interval [CI], 18%-24%) over the 4-week study period. The greatest reduction was for combined infant and toddler visits (69%; 95% CI, 58%-79%); these did not recover the following year. However, during the SARS outbreak there was a large increase in the number of visits for respiratory illnesses in adults (61%; 95% CI, 46%-75%) and in teenagers (132%; 95% CI, 82%-182%). CONCLUSIONS During the SARS outbreak, total ED visits fell. The relative decline was most notable for infants and toddlers. By contrast, there was an increase in respiratory illness-related visits for adults and teenagers. In 2004, the year following the SARS outbreak, visit patterns shifted toward baseline levels, but ED visits by infants and toddlers remained depressed.
Collapse
Affiliation(s)
- Michael Heiber
- Department of Family and Community Medicine, Scarborough Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
39
|
Chen TJ, Lin MH, Chou LF, Hwang SJ. Hospice utilization during the SARS outbreak in Taiwan. BMC Health Serv Res 2006; 6:94. [PMID: 16889656 PMCID: PMC1559606 DOI: 10.1186/1472-6963-6-94] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 08/04/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan. METHODS The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic. RESULTS Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ. CONCLUSION Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.
Collapse
Affiliation(s)
- Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
40
|
Shuster JJ, Winterstein AG. Automated medication error studies with audit supplementation were effectively designed and analyzed by time series. J Clin Epidemiol 2006; 59:957-63. [PMID: 16895819 DOI: 10.1016/j.jclinepi.2006.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 12/19/2005] [Accepted: 01/07/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To provide researchers with an efficient yet methodologically robust method to design and analyze studies of the effectiveness of quality improvement interventions targeted at medical errors. METHODS An interrupted time-series design was chosen. Error rates of a preintervention observational period are compared to those of an intervention period (interrupted by a brief transitional period not used in the analysis). Potential errors are flagged by computerized analysis. The positive predictive value of this automated method is established by targeted expert review of random samples of monthly admissions with flagged errors. The lengths of the preintervention and intervention observational periods and number of audits per month are determined via power and type I error analysis. The setting was a future study of electronic alert systems for errors related to nephrotoxic agents in a medium-sized hospital. RESULTS Based on these methods, a study was deemed feasible to be conducted over a 38-month period, auditing 40 potential errors per month. CONCLUSION A logistic monthly error process model with independent variables (1) time in months (same slope pre vs. postintervention), and (2) a discrete jump postintervention to assess the effect size, offers a flexible, easy-to-interpret way to attack this problem.
Collapse
Affiliation(s)
- Jonathan J Shuster
- Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, 1600 W. Archer Raod, #100212, Gainesville, FL 32610-0212, USA.
| | | |
Collapse
|