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Çalışkan OF, Trabzon G, Güllü UU, Yazarlı EG, Sarı F, İpek S, El Ç. A Comparative Analysis of Pediatric Emergency Department Admissions Before and During the COVID-19 Pandemic. Cureus 2024; 16:e58436. [PMID: 38765335 PMCID: PMC11099559 DOI: 10.7759/cureus.58436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aims to evaluate the outbreak's impact on emergency services, with findings obtained from patients who applied to our pediatric emergency service before and during the pandemic period. Methods In this study, the Pediatric Emergency Polyclinic of Hatay Mustafa Kemal University (MKU) Department of Pediatrics was evaluated during the COVID-19 pre-pandemic period and the COVID-19 pandemic period. Demographic features, complaints, discharge situations, diagnostic groups, and diagnoses of 16,730 non-traumatic patients one month to 18 years old were compared retrospectively. Results Comparing the pre-pandemic period and the pandemic period, it was determined that there was a statistically significant difference in the average age of patients, age groups, admission hours, triage classification, complaints, and diagnoses seen. Conclusion According to the findings obtained in the study, pediatric emergency department admissions decreased significantly during the pandemic period. As a result of the pandemic measures taken, the incidence of diseases caused by infectious agents, such as respiratory tract infections, decreased. The change in pediatric emergency service habits with the pandemic highlights the importance of conducting more comprehensive epidemiological studies in terms of more efficient and effective use of pediatric emergency health services in Turkey.
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Affiliation(s)
- Osman Fırat Çalışkan
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Gül Trabzon
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Ufuk Utku Güllü
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Esra Gezmen Yazarlı
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Ferhat Sarı
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Sevcan İpek
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
| | - Çiğdem El
- Department of Pediatrics, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, TUR
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Wu D, Chen J, Fu X, Li Z, Tan F, Lin H. Study on the migration characteristics of bioaerosols and optimization of ventilation patterns in a negative pressure isolation ward considering different patient postures. PLoS One 2023; 18:e0290288. [PMID: 37590299 PMCID: PMC10434850 DOI: 10.1371/journal.pone.0290288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Due to the serious global harm caused by the outbreak of various viral infectious diseases, how to improve indoor air quality and contain the spread of infectious bioaerosols has become a popular research subject. Negative pressure isolation ward is a key place to prevent the spread of aerosol particles. However, there is still limited knowledge available regarding airflow patterns and bioaerosol diffusion behavior in the ward, which is not conducive to reducing the risk of cross-infection between health care workers (HCWs) and patients. In addition, ventilation layout and patient posture have important effects on aerosol distribution. In this study, the spatial and temporal characteristics as well as dispersion patterns of bioaerosols under different ventilation patterns in the ward were investigated using the computational fluid dynamics (CFD) technique. It is concluded that changes in the location of droplet release source due to different body positions of the patient have a significant effect on the bioaerosol distribution. After optimizing the layout arrangements of exhaust air, the aerosol concentration in the ward with the patient in both supine and sitting positions is significantly reduced with particle removal efficiencies exceeding 95%, that is, the ventilation performance is improved. Meanwhile, the proportion of aerosol deposition on all surfaces of the ward is decreased, especially the deposition on both the patient's body and the bed is less than 1%, implying that the risk of HCWs being infected through direct contact is reduced.
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Affiliation(s)
- Dieen Wu
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Jianji Chen
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Xihua Fu
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Zongkun Li
- School of Electric Power, South China University of Technology, Guangzhou, China
- Guangdong Province Key Laboratory of Efficient and Clean Energy Utilization, Guangzhou, China
| | - Futai Tan
- Guangzhou Huijin Energy Efficiency Technology Co. Ltd, Guangzhou, China
| | - Hai Lin
- Guangzhou Huijin Energy Efficiency Technology Co. Ltd, Guangzhou, China
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3
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Singhal S, Dhar B, Ayoub N, Quiñonez C. Impact of COVID-19 on hospital visits for non-traumatic dental conditions in Ontario, Canada. BMC Res Notes 2023; 16:160. [PMID: 37533079 PMCID: PMC10399067 DOI: 10.1186/s13104-023-06380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 06/07/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND RATIONALE As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems. METHODS Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed. RESULTS In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%. CONCLUSION Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care. PRACTICAL IMPLICATIONS Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems.
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Affiliation(s)
- Sonica Singhal
- Health Promotion, Chronic Disease and Injury Prevention Department, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
| | - Badal Dhar
- Data and Information Management Services, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Nardin Ayoub
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Carlos Quiñonez
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Sodani R, Gupta S, Sharma AG. Influence of lockdown during the COVID-19 pandemic on use of pediatric emergency health services: A retrospective observational study from a Tertiary Care Hospital in New Delhi. Indian J Public Health 2023; 67:309-312. [PMID: 37459030 DOI: 10.4103/ijph.ijph_1007_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
January 30, 2020, marked the beginning of the COVID-19 pandemic in India. Various emergency measures were taken to contain the spread of COVID-19 including extended periods of complete lockdown. The impact of these measures on routine and emergency health services was unforeseen. Hence, we conducted this study to critically analyze the effects of restrictions imposed during the COVID-19 pandemic (including lockdown) on the utilization of health services, especially emergency services. We compared patient's attendance in the outpatient department and pediatric emergency department (PED) and changes in clinicepidemiological profiles (before and during COVID-19) in a tertiary care hospital. We observed a 43% decline in PED visits which decreased to 75% during the period of strict lockdown (P = 0.005). Reduction in emergency department visits was noticed uniformly in all disease categories. This study highlights the urgent need to plan for robust health-care support system for the delivery of preventive and curative services to vulnerable age groups during any emergency.
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Affiliation(s)
- Ravitanaya Sodani
- Assistant Professor, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - Shalu Gupta
- Director Professor, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - Ankita Goel Sharma
- Associate Professor, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
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Lin PY, Kaplan W, Lin CH, Lee YH. Taiwan's National Health Insurance at the Emergency Department following the COVID-19 outbreak. Public Health Nurs 2023. [PMID: 36882994 DOI: 10.1111/phn.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID-19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective.
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Affiliation(s)
- Pei-Ying Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | | | - Chia-Hung Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Taiwan University, Taipei City, Taiwan
| | - Yen-Han Lee
- University of Central Florida, Orlando, Florida
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Juang WC, Chiou SMJ, Chen HC, Li YC. Differences in Characteristics and Length of Stay of Elderly Emergency Patients before and after the Outbreak of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1162. [PMID: 36673917 PMCID: PMC9859462 DOI: 10.3390/ijerph20021162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: COVID-19 has spread worldwide and affected Taiwan's medical system and people's lives. This study aimed to explore the impact of medical utilization on the characteristics and length of stay (LOS) of elderly emergency department (ED) patients before and after COVID-19; (2) Methods: We gathered ED visits from January to September 2019 (pre-pandemic group) and from January to September 2020 (pandemic group). The data analysis methods included descriptive statistics, the Pearson's chi-square test, the independent sample t-test, and binary logistic regression; (3) Results: In 2020, during COVID-19, a significant decrease in ED monthly visits occurred from January; the maximum decrease was 32% in March. The average LOS during COVID-19 was shortened, with a significant reduction in diagnoses compared with the pre-pandemic period; (4) Conclusions: The threat of COVID-19 has changed the elderly's behavior in ED visits and shortened the LOS of ED. The study's results emphasize the importance of analyzing the medical utilization of elderly ED patients and understanding the medical quality of healthcare institutions. With Taiwan's rapidly aging society, the demand for healthcare increases from time to time. The overcrowding of medical attention is often a problem. The results recommend that the overcrowding problem has the opportunity to be solved.
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Affiliation(s)
- Wang-Chuan Juang
- Quality Management Center, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
| | - Sonia Ming-Jiu Chiou
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
| | - Hsien-Chih Chen
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
| | - Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
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Lin PH, Su HY, Tsai IT, Lee KH, Wang YH, Chang CS, Hsu MC, Tsai JL, Hsu CW. Impact of COVID-19 Pandemic on Emergency Department Volume and Acuity in Low Incidence Area: Taiwan's Experience in Three Hospitals. J Acute Med 2022; 12:105-112. [PMID: 36313608 PMCID: PMC9561484 DOI: 10.6705/j.jacme.202209_12(3).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/08/2021] [Accepted: 11/12/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The decrease in emergency department (ED) patient visits during the COVID-19 pandemic was reported by various studies. Our study aimed to investigate whether a similar trend can be observed in a country with a low incidence of COVID-19 as well as the impact caused by the pandemic on ED patients in different triage levels and categories. METHODS This multicenter retrospective study collected data from three regional hospitals between March 2019 and December 2020. We evaluated the differences between patient volume, disease severity, and patient composition in ED before and after the COVID-19 pandemic among these hospitals. RESULTS There was a 23% reduction in ED patient volume in the urban hospital (hospital A) as well as a 16% reduction in suburban hospitals (hospitals B and C) during the pandemic period, respectively. The regression analysis showed a high correlation in the change in monthly patient volume among these hospitals. In terms of severity, there was a 24% reduction in ED visits with high severity levels (Taiwan Triage and Acuity Scale [TTAS] I, II) in hospital A, as well as 16% and 12% in hospitals B and C during the pandemic period, respectively. Similarly, there was a 23% reduction in ED visits with low severity levels (TTAS III, IV, V) in hospital A, as well as 20% and 16% in hospitals B and C during the pandemic period, respectively. In terms of patient types, there was a significant decline in non-traumatic adult patients (19%, 17%, and 10%), and pediatric patients (49%, 50%, and 46%) in hospitals A, B, and C, respectively. CONCLUSIONS Despite the low incidence of COVID-19 in Taiwan, a decrease in total ED visits was still found during the pandemic, especially in non-trauma adult visits and pediatric visits. In addition, ED visits in both high and low severity levels decreased in these regional hospitals.
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Affiliation(s)
- Pei-Hsien Lin
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
| | - Hung-Yuan Su
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- I-Shou University School of Chinese Medicine for Post Baccalaureate Kaohsiung Taiwan
| | - I-Ting Tsai
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- I-Shou University School of Medicine Kaohsiung Taiwan
| | - Kuo-Hsin Lee
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- I-Shou University School of Chinese Medicine for Post Baccalaureate Kaohsiung Taiwan
| | - Yu-Han Wang
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- E-Da Hospital Center of Quality Management Kaohsiung Taiwan
| | - Chao-Sheng Chang
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- I-Shou University Department of Occupational Therapy Kaohsiung Taiwan
| | - Meng-Chun Hsu
- Pingtung National Pingtung Girls' Senior High School Taiwan
| | - Jeng-Long Tsai
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
| | - Chih-Wei Hsu
- E-Da Hospital and I-Shou University Department of Emergency Medicine Kaohsiung Taiwan
- I-Shou University School of Medicine for International Students Kaohsiung Taiwan
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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.
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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.
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Shock Index Is a Validated Prediction Tool for the Short-Term Survival of Advanced Cancer Patients Presenting to the Emergency Department. J Pers Med 2022; 12:jpm12060954. [PMID: 35743739 PMCID: PMC9225656 DOI: 10.3390/jpm12060954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Advanced cancer patients who are not expected to survive past the short term can benefit from early initiation of palliative care in the emergency department (ED). This discussion, however, requires accurate prognostication of their short-term survival. We previously found in our retrospective study that shock index (SI) is an ideal risk stratification tool in predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. This study is a follow-up prospective validation study conducted from January 2019 to April 2021. A total of 410 advanced cancer patients who presented to the ED of a medical centre and could be followed-up feasibly were recruited. Univariate and multivariable logistic regression analyses were performed with receiver operator calibrating (ROC) curve analysis. Non-survivors had significantly lower body temperatures, higher pulse rates, higher respiratory rates, lower blood pressures, and higher SI. Each 0.1 increment of SI increased the odds of 60-day mortality by 1.591. Area under ROC curve was 0.7819. At optimal cut-off of 0.94, SI had 66.10% accuracy. These results were similar to our previous study, thus validating the use of SI in predicting the 60-day mortality of advanced cancer patients presenting to the ED. Identified patients may be offered palliative care.
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Ventilation Performance Evaluation of a Negative-Pressurized Isolation Room for Emergency Departments. Healthcare (Basel) 2022; 10:healthcare10020193. [PMID: 35206808 PMCID: PMC8872354 DOI: 10.3390/healthcare10020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Due to the emergence of COVID-19 becoming a significant pandemic worldwide, hospitals are expected to be capable and flexible in responding to the pandemic situation. Moreover, as frontline healthcare staff, emergency department (ED) staff have a high possibility of exposure risk to infectious airborne. The ED isolation room will possibly and effectively isolate the infected patient, therefore safekeeping frontline healthcare staff and controlling the outbreak. However, there is still limited knowledge available regarding isolation room facilities specifically for the emergency department. In this study, field measurement is conducted in an ED isolation room located in Taiwan. CFD simulation is employed to simulate and investigate the airflow and airborne contaminant distribution. Instead of high air-change rates (ACH) that purposes for dilution, this study proposes the arrangement of exhaust air grilles to improve the contaminant removal. The results reveal that the exhaust air grille placed behind the patient’s head is optimized to dilute airborne contaminants.
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