scholarly journals A Targeted Geospatial Approach to COVID-19 Vaccine Delivery: Findings from the Johns Hopkins Hospital Emergency Department

2021 ◽  
Author(s):  
Sunil S Solomon ◽  
Yu-Hsiang Hsieh ◽  
Richard E Rothman ◽  
Oliver Laeyendecker ◽  
Shruti H Mehta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Optimal Strategies ◽  
Johns Hopkins Hospital ◽  
Infection Prevalence ◽  
Hospital Emergency Department ◽  
Rt Pcr ◽  
Hospital Emergency ◽  
Suspected Infection ◽  
Blood Specimens ◽  
Zip Code

While COVID-19 vaccines have been shown to significantly decrease morbidity and mortality, there is still much debate about optimal strategies of vaccine rollout. We tested identity-unlinked stored remnant blood specimens of patients at least 18 years presenting to the Johns Hopkins Hospital emergency department (ED) between May to November 2020 for IgG to SARS-CoV-2. Data on SARS-CoV-2 RT PCR were available for patients who were tested due to suspected infection. SARS-CoV-2 infections was defined as either a positive IgG and/or RT-PCR. SARS-CoV-2 infection clustering by zipcode was analyzed by spatial analysis using the Bernoulli model (SaTScan software, Version 9.7). Median age of the 7,461 unique patients visiting the ED was 47 years and 50.8% were female; overall, 740 (9.9%) unique patients had evidence of SARS-CoV-2 infection. Prevalence of infection in ED patients by ZIP code ranged from 4.1% to 22.3%. The observed number of cases in ZIP code C was nearly double the expected (observed/expected ratio = 1.99; 95% CI: 1.62, 2.42). These data suggest a targeted geospatial approach to COVID vaccination should be considered to maximize vaccine rollout efficiency and include high-risk populations that may otherwise be subjected to delays, or missed.

scholarly journals The Effect of Viral Suppression on Cross-Sectional Incidence Testing in the Johns Hopkins Hospital Emergency Department

2008 ◽  
Vol 48 (2) ◽  
pp. 211-215 ◽  
Author(s):  
Oliver Laeyendecker ◽  
Richard E Rothman ◽  
Charlamaine Henson ◽  
Bobbi Jo Horne ◽  
Kerunne S Ketlogetswe ◽  
...  
Keyword(s):  
Emergency Department ◽  
Viral Suppression ◽  
Johns Hopkins Hospital ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Cross Sectional

scholarly journals SARS-CoV-2 Antigen Detection to Expand Testing Capacity for COVID-19: Results from a Hospital Emergency Department Testing Site

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1211
Author(s):  
Giulia Menchinelli ◽  
Giulia De Angelis ◽  
Margherita Cacaci ◽  
Flora Marzia Liotti ◽  
Marcello Candelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Tertiary Care ◽  
Antigen Detection ◽  
Care Hospital ◽  
Hospital Emergency Department ◽  
Rt Pcr ◽  
Hospital Emergency ◽  
Asymptomatic Patients ◽  
Antigen Testing

Background: SARS-CoV-2 antigen detection has currently expanded the testing capacity for COVID-19, which yet relies on the SARS-CoV-2 RNA RT-PCR amplification. Objectives: To report on a COVID-19 testing algorithm from a tertiary care hospital emergency department (ED) that combines both antigen (performed on the ED) and RT-PCR (performed outside the ED) testing. Methods: Between December 2020 and January 2021, in a priori designated, spatially separated COVID-19 or non-COVID-19 ED areas, respectively, symptomatic or asymptomatic patients received SARS-CoV-2 antigen testing on nasopharyngeal swab samples. Antigen results were promptly accessible to guide subsequent, outside performed confirmatory (RT-PCR) testing. Results: Overall, 1083 (100%) of 1083 samples in the COVID-19 area and 1815 (49.4%) of 3670 samples in the non-COVID-19 area had antigen results that required confirmation by RT-PCR. Antigen positivity rates were 12.4% (134/1083) and 3.7% (66/1815), respectively. Compared to RT-PCR testing results, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antigen testing were, respectively, 68.0%, 98.3%, 88.8%, and 94.1% in the COVID-19 area, and 41.9%, 97.3%, 27.3%, and 98.6% in non-COVID-19 area. Practically, RT-PCR tests were avoided in 50.6% (1855/3670) of non-COVID-19 area samples (all antigen negative) from patients who, otherwise, would have needed antigen result confirmation. Conclusions: Our algorithm had value to preserve RT-PCR from avoidable usage and, importantly, to save time, which translated into a timely RT-PCR result availability in the COVID-19 area.

Designing Affordance-Based Procedures Using Heuristic Cognitive Work Analysis: Application to Triage in an Emergency Department

2021 ◽  
pp. 155534342110295
Author(s):  
Thierry Morineau ◽  
Mounia Djenidi-Delfour ◽  
Fabrice Arnault
Keyword(s):  
Emergency Department ◽  
Degrees Of Freedom ◽  
Qualitative Evaluation ◽  
Hospital Emergency Department ◽  
Extended Version ◽  
Cognitive Work Analysis ◽  
Hospital Emergency ◽  
Work Analysis ◽  
Cognitive Work ◽  
Analysis Application

This study describes the concept of affordance-based procedure and its implementation in a triage station in a hospital emergency department. Rather than seeking to increase operators’ adherence to procedures, an affordance-based procedure (1) aims to induce task steps using affordances that also (2) support degrees of freedom for action. The design of this procedure was guided by the application of an extended version of cognitive work analysis, named “heuristic cognitive work analysis.” This design process produced a new procedural document: a reception card. Ten months after its implementation, a qualitative evaluation with 10 triage nurses shows that the reception card is viewed as supporting coordination between the different nurses’ tasks and providing an external memory to cope with frequent interruptions during high patient inflow, even though the document is used for convenience and with unexpected and partial uses of its items. The document assessed also afforded emerging benefits, that is, acceleration of ambulance release, higher level of confidentiality, assistance for staff hand-overs. Finally, novice triage nurses are particularly sensitive to the benefits brought by this affordance-based procedure.

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