10: Early Identification of COVID-19 Patients Susceptible to Rapid Deterioration Using the Rothman Index

Abstract Introduction During the first surge of COVID-19 it was well recognised that early identification of a plan for escalation in the event of deterioration for each patient was vital. If no decision is documented it results in junior staff frequently making decisions regarding escalation in the out of hours period. This leads to patients, or family members, having these conversations with a doctor they may never have met before. My aim was to improve the documentation of escalation plans in all patients within the first 24 hrs of admission. Method Baseline data was collected in September 2019 with further samples in April 2020 and August 2020. Patient medical notes were reviewed to identify if an escalation plan had been made during the period from admission to post take ward round. A COVID admission pathway document was introduced with a specific section on Clinical Frailty Score and Escalation plan between the baseline and April 2020 data. Results Baseline data showed that only 12.8% of medical patients had a documented escalation plan within the first 24 hrs of admission to hospital. During the first surge in April 2020 this number had improved to 47% following introduction of the COVID-19 admission pathway. This included 100% of patients admitted to respiratory wards. Unfortunately when reassessed in August 2020, this number had fallen to 16%. Conclusion Introduction of clinical frailty scoring and an area specifically to document escalation discussions resulted in a marked improvement. Heightened awareness of rapid deterioration of patients during the first surge almost certainly played a role in this. Unfortunately this was not sustained once staff discontinued the use of COVID-19 admission document. Moving forward we will incorporate these sections into the medical and surgical admissions pathways in the hope it produces similar results.

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A Clinical Study of Twenty-seven Children Exhibiting Functional Hearing Loss

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1201.26 ◽

1981 ◽

Vol 12 (1) ◽

pp. 26-35 ◽

Cited By ~ 14

Author(s):

Donald L. McCanna ◽

Giacinto DeLapa

Keyword(s):

Hearing Loss ◽

Clinical Study ◽

Early Identification ◽

Behavioral Responses ◽

Upper Elementary ◽

Elementary Grades ◽

Ability Level ◽

Hearing Problem

This report reviews 27 cases of children exhibiting functional hearing loss. The study reveals that most students were in the upper elementary grades and were predominantly females. These subjects were functioning below their ability level in school and were usually in conflict with school, home, or peers. Tests used were selected on the basis of their helping to provide early identification. The subjects' oral and behavioral responses are presented, as well as ways of resolving the hearing problem. Some helpful counseling techniques are also presented.

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The Need for Aggressive Pursuit of Healthy Childhood Voices

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.2001.102 ◽

1989 ◽

Vol 20 (1) ◽

pp. 102-107 ◽

Cited By ~ 18

Author(s):

Joel C. Kahane ◽

Robert Mayo

Keyword(s):

Early Identification ◽

Voice Disorders ◽

Prevention Programs ◽

Incidence Trends ◽

Aggressive Management ◽

Prevention And Treatment ◽

Current Incidence

In this paper we argue for the aggressive management of voice disorders. Aggressive management includes early identification, prevention, and treatment of voice disorders. The argument for aggressive management is supported by current incidence trends, laryngologists' expectations, and the benefits of prevention programs.

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From the President: The Power of Early Identification

ASHA Leader ◽

10.1044/leader.ftp.19022014.8 ◽

2014 ◽

Vol 19 (2) ◽

pp. 8-9

Author(s):

Elizabeth McCrea

Keyword(s):

Early Identification

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Early Identification of Youth at Risk for Suicidal Behavior

Crisis ◽

10.1027/0227-5910/a000569 ◽

2019 ◽

Vol 40 (5) ◽

pp. 326-332

Author(s):

Ivonne Andrea Florez ◽

Devon LoParo ◽

Nakia Valentine ◽

Dorian A. Lamis

Keyword(s):

At Risk ◽

Early Identification ◽

Suicide Risk ◽

Psychiatric Symptoms ◽

Demographic Factors ◽

Health Centers ◽

Lack Of Information ◽

Youth At Risk ◽

Logistic Regressions ◽

Lethal Means

Abstract. Background: Early identification and appropriate referral services are priorities to prevent suicide. Aims: The aim of this study was to describe patterns of identification and referrals among three behavioral health centers and determine whether youth demographic factors and type of training received by providers were associated with identification and referral patterns. Method: The Early Identification Referral Forms were used to gather the data of interest among 820 youth aged 10–24 years who were screened for suicide risk (females = 53.8%). Descriptive statistics and binary logistic regressions were conducted to examine significant associations. Results: Significant associations between gender, race, and age and screening positive for suicide were found. Age and race were significantly associated with different patterns of referrals and/or services received by youths. For providers, being trained in Counseling on Access to Lethal Means was positively associated with number of referrals to inpatient services. Limitations: The correlational nature of the study and lack of information about suicide risk and comorbidity of psychiatric symptoms limit the implications of the findings. Conclusion: The results highlight the importance of considering demographic factors when identifying and referring youth at risk to ensure standard yet culturally appropriate procedures to prevent suicide.

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