Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department

Canadian Association of Radiologists Journal ◽

10.1177/0846537119899321 ◽

2020 ◽

pp. 084653711989932

Author(s):

Sabeena Jalal ◽

Hugue Ouellette ◽

Zharmaine Ante ◽

Peter Munk ◽

Faisal Khosa ◽

...

Keyword(s):

Chart Review ◽

Emergency Radiology ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Turnaround Time ◽

Radiology Department ◽

Tertiary Care Center ◽

Imaging Studies ◽

The Impact

Objective: To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department. Patients and Methods: This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted. Results: The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42). Conclusion: Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

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Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00018.1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Kim Bjorklund ◽

Emily A. Eismann ◽

Roger Cornwall

Keyword(s):

Emergency Department ◽

Continuity Of Care ◽

Broad Spectrum ◽

Medical Records ◽

Care Center ◽

Tertiary Care ◽

Well Being ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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1696. Epidemiology, Clinical Characteristics and Outcomes of Invasive Aspergillosis in a Tertiary Care Hospital in Mexico

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1560 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S621-S621

Author(s):

Carla Marina Román-Montes ◽

María F Gonzalez-Lara ◽

Alfredo Ponce de Leon ◽

Maria O Valenzuela-Almada ◽

Andrea Rangel-Cordero

Keyword(s):

Liver Failure ◽

Invasive Aspergillosis ◽

Clinical Characteristics ◽

Care Center ◽

Tertiary Care ◽

Solid Organ ◽

Cell Transplant ◽

Care Hospital ◽

Tertiary Care Center ◽

Eortc Criteria

Abstract Background Invasive aspergillosis is an important cause of life-threatening infection in immunocompromised patients. The objective was to describe the epidemiology, clinical characteristics, and outcome of patients with invasive aspergillosis (IA) in a tertiary care center in Mexico. Methods A laboratory-based survey was done to identify patients with positive Aspergillus culture or galactomannan from 2014 to 2018. The medical records were reviewed to include patients with proven and probable IA, according to the EORTC criteria. Descriptive analysis of clinical characteristics and risk factors for 6-week mortality was made through X2, T-test or Mann–Whitney test. A multivariate logistic regression model including variables with a P-value of <0.2 in univariate analysis was made. Results 240 cases of IA were identified: 193 (80%) probable, 27 (11%) proven, and 20 (8.3%) not meeting the EORTC criteria but considered infection. 53% were male, median age was 44 years (IQR 28–58), 78 (32.5%) had acute leukemia (AL), 42 (17.5%) hematological neoplasia, 29 (12%) hematopoietic stem-cell transplant (HSCT), 25 (10.4%) solid-organ transplant and 44 (18.3%) autoimmune diseases, 17.5% patients with AL underwent induction remission chemotherapy of which 31% received antifungal prophylaxis. Among patients with IA, 183 (82%) had a positive galactomannan and 109 (45%) had a culture with Aspergillus. Eleven had > 1 species: 55/120 (46%) were A. fumigatus, 18 (15%) A. niger and 18 (15%) A. flavus. Pulmonary disease occurred in 214 (89%). 212 patients (88%) received antifungal treatment with a median duration of 42 days (IQR 20–42). 129 (61%) received voriconazole (VRC), 20 (8.3%) Amphotericin B and 20(8.3%) were randomized to a posaconazole vs. VRC trial. Six-week mortality was 35% (n = 85). Lymphopenia (OR 3.6; 95% CI 1.4–9.0), liver failure (OR 3.3; 95% CI 1.7–6.5) and older age (OR 1.03; 95% CI 1.01–1.05) (marginally) were independently associated with increased 6-week mortality. Conclusion 240 patients with IA were identified in a 5-year period in a tertiary care center. Most had hematological neoplasias and low prevalence of antimold prophylaxis due to economical reasons. Six-week mortality was 35%, nonsurvivors had liver failure and lymphopenia more often. Increased awareness to prevent IA is needed. Disclosures All authors: No reported disclosures.

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2520. Epidemiology, Clinical Manifestations, and Outcomes of the 2017–2018 Influenza Season Among Hospitalized Patients at a Tertiary Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.2172 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S757-S758

Author(s):

Rohini Ramamoorthy ◽

Soujanya Thummathati ◽

Bhavyaa Bahl ◽

Ali Hassoun

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

Clinical Manifestations ◽

Hospitalized Patients ◽

Tertiary Care Center

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Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.6.2334 ◽

2020 ◽

Vol 36 (6) ◽

Author(s):

Noman Ali ◽

Nadeem Ullah Khan ◽

Shahid Waheed ◽

Syed Mustahsan

Keyword(s):

Emergency Department ◽

Enteric Fever ◽

Care Center ◽

Tertiary Care ◽

Practical Importance ◽

University Hospital ◽

Categorical Variables ◽

Care Hospital ◽

Tertiary Care Center ◽

Continuous Variables

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians. doi: https://doi.org/10.12669/pjms.36.6.2334 How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2334 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A retrospective observational study of poisoning and hanging cases during lockdown as a marker of emotional tide of COVID-19 pandemic in a tertiary care center in Northwestern India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20213237 ◽

2021 ◽

Vol 8 (9) ◽

pp. 1354

Author(s):

Aradhana Singh ◽

C. L. Nawal ◽

H. L. Saini ◽

Khusboo . ◽

Abhishek Yadav ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Public Health Emergency ◽

Behavioral Changes ◽

Tertiary Care Center ◽

Legal Cases ◽

Medical College ◽

Northwestern India ◽

Organophosphorus Poisoning ◽

The Impact

Background: In January 2020, WHO declared the outbreak of a new coronavirus disease COVID-19 to be a public health emergency of international concern. Worldwide lockdown led to panic, mass unemployment, poverty and domestic violence. The present study was designed to observe the impact of lockdown on the spectrum of medico-legal cases being admitted with drastic events of poisoning and hanging.Methods:In this retrospective, observational and comparative study, around 131 patients were recruited from the admitted patients in the medicine wards in SMS medical college and hospital during COVID-19 lockdown period from 23 March 2020 to 31 May 2020 after applying inclusion and exclusion criterias. Their clinical profile were noted and comparatively assessed with patients admitted in medicine wards during adjoining pre-lockdown period, that is, from 12 January 2020 to 22 March 2020.Results: Out of 131 cases recruited during lockdown period, hanging cases were 10 (8%) while it was 10 cases out of 213 (5% )during pre-lockdown period. Organophosphorus poisoning was 4.5% and 1.4%, celphos poisoning was 3.8% and 2.3%, rat killer poisoning was 3.05% and 1.4% during lockdown and pre-lockdown period respectively. Cases due to ingestion of other than the major group of poisoning were lower (3.8%) during lockdown period while it was 10.3% during pre-lockdown period.Conclusions:Extreme negative behavioral changes precipitated by corona and this might be aggravated further by complete lockdown, to which people resorted to the means which were easily available to them at home like hanging and common poisonings.

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