scholarly journals Decline in stroke alerts and hospitalisations during the COVID-19 pandemic

2020 ◽  
Vol 5 (4) ◽  
pp. 403-405 ◽  
Author(s):  
Malveeka Sharma ◽  
Vasileios-Arsenios Lioutas ◽  
Tracy Madsen ◽  
Judith Clark ◽  
Jillian O'Sullivan ◽  
...  
Keyword(s):  
New York ◽  
Symptom Onset ◽  
Hospital Admissions ◽  
Healthcare Access ◽  
Healthcare Providers ◽  
Neurological Complications ◽  
Stroke Severity ◽  
Hospital Arrival ◽  
Hospital Systems ◽  
Public Health Officials

IntroductionPatients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic. We investigated a decline in admissions for stroke and transient ischaemic attack (TIA) and emergency department (ED) stroke alert activations.MethodsWe retrospectively compiled total weekly hospital admissions for stroke and TIA between 31 December 2018 and 21 April 2019 versus 30 December 2019 and 19 April 2020 at five US tertiary academic comprehensive stroke centres in cities with early COVID-19 outbreaks in Boston, New York City, Providence and Seattle. We collected available data on ED stroke alerts, stroke severity using the National Institutes of Health Stroke Scale (NIHSS) and time from symptom onset to hospital arrival.ResultsCompared with 31 December 2018 to 21 April 2019, a decline in stroke/TIA admissions and ED stroke alerts occurred during 30 December 2019 to 19 April 2020 (p trend <0.001 for each). The declines coincided with state stay-at-home recommendations in late March. The greatest decline in hospital admissions was observed between 23 March and 19 April 2020, with a 31% decline compared with the corresponding weeks in 2019. Three of the five centres with 2019 and 2020 stroke alert data had a 46% decline in ED stroke alerts in late March and April 2020, compared with 2019. Median baseline NIHSS during these 4 weeks was 10 in 2020 and 7 in 2019. There was no difference in time from symptom onset to hospital arrival.ConclusionAt these five large academic US hospitals, admissions for stroke and TIA declined during the COVID-19 pandemic. There was a trend for fewer ED stroke alerts at three of the five centres with available 2019 and 2020 data. Acute stroke therapies are time-sensitive, so decreased healthcare access or utilisation may lead to more disabling or fatal strokes, or more severe non-neurological complications related to stroke. Our findings underscore the indirect effects of this pandemic. Public health officials, hospital systems and healthcare providers must continue to encourage patients with stroke to seek acute care during this crisis.

Critical factors determining access to acute stroke care

Neurology ◽  
1998 ◽  
Vol 51 (2) ◽  
pp. 427-432 ◽  
Author(s):  
Sindhu C. Menon ◽  
Dilip K. Pandey ◽  
Lewis B. Morgenstern
Keyword(s):  
Access To Care ◽  
Acute Stroke ◽  
Symptom Onset ◽  
Multivariate Regression ◽  
Stroke Care ◽  
Care Physician ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Hospital Arrival ◽  
Ambulance Transport

Objective: Our objective was to assess gender, ethnic, and access-to-care factors critical in delay time (DT) for presentation to the hospital for acute stroke.Background: Little information is available on the effect of gender, ethnicity, and access issues on DT.Design: Demographic, access-to-care, and DT information was obtained from emergency department (ED) documentation of stroke patients admitted from July 1995 through June 1997 at Hermann Hospital, Houston, TX. Univariate and multivariate regression analyses were performed.Results: Of the 241 eligible patients, 126 were African American (AA), 82 were non-Hispanic white (NHW), and 33 were Hispanic American (HA). Median DT from symptom onset to presentation to the ED was 222 minutes for AAs, 280 minutes for HAs, and 230 minutes for NHWs. A multivariate regression model estimated DT to ED arrival decreased with ambulance transport (p= 0.003) and increased in patients with a primary care physician(p = 0.145) and in women (p = 0.052). DT to see an ED physician after hospital arrival decreased with ambulance transport (p < 0.001), hemorrhage patients (p = 0.006), and worse stroke severity (p = 0.038), and increased in women (p = 0.041). DT to see a neurologist decreased with hemorrhage (p = 0.002) and ambulance arrival (p = 0.010). Neurologists saw patients within 3 hours of symptom onset in 34% of NHWs, 28% of AAs, and 18% of HAs.Conclusion: Gender and access-to-care issues may be important determinants of delay in acute stroke care. Less than 20% of HAs presented to the ED within 3 hours of symptom onset.

scholarly journals P.037 Keeping track of time: emphasizing symptom onset-to-hospital time in stroke care

2019 ◽  
Vol 46 (s1) ◽  
pp. S23-S24
Author(s):  
DE Freedman ◽  
N Behih ◽  
A Elmeligi ◽  
D Sahlas
Keyword(s):  
Symptom Onset ◽  
Best Practice ◽  
Healthcare Providers ◽  
Onset Time ◽  
Stroke Care ◽  
Patient Identification ◽  
Hospital Arrival ◽  
Stroke Team ◽  
Patient Arrival ◽  
Stroke Centre

Background: The Canadian Stroke Best Practice Recommendations target a median door-to-needle time of 30 minutes. However, brain tissue becomes damaged with any delay from symptom onset. Efficiencies may be gained prior to hospital arrival, by evaluating the timeliness of patient access to hospital from symptom onset, as well as by improving healthcare provider communication, prior to arrival of the patient. Methods: We engaged with hospital administration, paramedic services, allied health colleagues, physicians, and engineers, to develop Kairos, a secure online platform that healthcare providers can utilize to track progress en route to hospital, as well as to share pertinent stroke patient information, prior to arrival. Results: Kairos is built on React Native, allowing users to access it on android or iOS devices. Paramedics select patient identification, symptom onset time, and associated symptoms. The receiving hospital can add doctors to the patient’s thread, and the stroke team can prepare for patient arrival. Conclusions: We plan to measure the median symptom onset-to-hospital time in patients with strokes, and monitor the change in door-to-needle time following implementation at an Ontario Regional Stroke Centre.

scholarly journals Development and validation of a machine learning model to predict mortality risk in patients with COVID-19

2021 ◽  
Vol 28 (1) ◽  
pp. e100235
Author(s):  
Anna Stachel ◽  
Kwesi Daniel ◽  
Dan Ding ◽  
Fritz Francois ◽  
Michael Phillips ◽  
...  
Keyword(s):  
Machine Learning ◽  
New York ◽  
Hospital Admissions ◽  
Characteristic Curve ◽  
Healthcare Providers ◽  
Mortality Prediction ◽  
Computer Assisted ◽  
Neutrophil Percentage ◽  
Patients At Risk ◽  
Development And Validation

New York City quickly became an epicentre of the COVID-19 pandemic. An ability to triage patients was needed due to a sudden and massive increase in patients during the COVID-19 pandemic as healthcare providers incurred an exponential increase in workload,which created a strain on the staff and limited resources. Further, methods to better understand and characterise the predictors of morbidity and mortality was needed.MethodsWe developed a prediction model to predict patients at risk for mortality using only laboratory, vital and demographic information readily available in the electronic health record on more than 3395 hospital admissions with COVID-19. Multiple methods were applied, and final model was selected based on performance. A variable importance algorithm was used for interpretability, and understanding of performance and predictors was applied to the best model. We built a model with an area under the receiver operating characteristic curve of 83–97 to identify predictors and patients with high risk of mortality due to COVID-19. Oximetry, respirations, blood urea nitrogen, lymphocyte per cent, calcium, troponin and neutrophil percentage were important features, and key ranges were identified that contributed to a 50% increase in patients’ mortality prediction score. With an increasing negative predictive value starting 0.90 after the second day of admission suggests we might be able to more confidently identify likely survivorsDiscussionThis study serves as a use case of a machine learning methods with visualisations to aide clinicians with a better understanding of the model and predictors of mortality.ConclusionAs we continue to understand COVID-19, computer assisted algorithms might be able to improve the care of patients.

scholarly journals Injury-related falls from bicycles, skateboards, roller skates, and non-motorized scooters in the United States: 2005 - 2014

2017 ◽  
Vol 4 (1) ◽  
pp. 16
Author(s):  
William Milczarski ◽  
Peter Tuckel ◽  
Richard Maisel
Keyword(s):  
Public Health ◽  
New York ◽  
Negative Binomial ◽  
Local Level ◽  
Specific Treatment ◽  
Negative Binomial Regression ◽  
The United States ◽  
Treatment Modalities ◽  
Public Health Officials ◽  
National Databases

Purpose: To provide an updated and comparative analysis of injury-related falls from bicycles, skateboards, roller skates and non-motorized scooters.Methods: The study uses two national databases – the Nationwide Emergency Department Sample and the Nationwide Inpatient Sample  – and subnational databases for New York, California, and Maryland.  Univariate and multivariate analyses (negative binomial regression) are performed to identify effects of age, gender, racial-ethnic background, and region on the incidence of injury-related falls from each of the four devices.Results: The rate of injuries due to falls from bicycles far surpasses the rates due to falls from the other devices.  When a measure of “exposure” is taken into consideration, however, the rate of injuries from skateboards outstrips the rates from bicycles or roller skates.  The profile of patients who are injured from falls from each of the four devices is distinctive.  Asian-Americans are greatly underrepresented among those who suffer a fall-related injury from any of the four devices.  The incidence of injuries attributable to falls varies considerably by geographic region.Conclusions: Public health officials need to be mindful that while certain activities such as scootering might be gaining in popularity, the number of injuries sustained from bicycles still dwarfs the number attributable to falls from skateboards, roller skates, and scooters combined.  Thus special attention needs to be paid to both prevent falls from bicycles and specific treatment modalities.  It is important for public health officials to gather injury data at the local level to allocate prevention and treatment resources more efficiently.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and type of engagement in practice transformation. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care; and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported their perceptions of early outcomes of the PCMH model of care, describing enhanced patient and staff satisfaction and also noting fewer hospital admissions, as likely to reduce costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH models of care. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

scholarly journals Health Inequalities amongst Refugees and Migrant Workers in the Midst of the COVID-19 Pandemic: a Report of Two Cases

2022 ◽  
Author(s):  
Shu Hui Ng
Keyword(s):  
Migrant Workers ◽  
Asylum Seekers ◽  
Financial Constraints ◽  
Equal Opportunity ◽  
Healthcare Access ◽  
Healthcare Providers ◽  
Good Health ◽  
Ethical Challenge ◽  
Economic Policies ◽  
Resource Limited

AbstractMalaysia hosts a significant number of refugees, asylum-seekers and migrant workers. Healthcare access for these individuals has always proved a challenge: language barriers, financial constraints and mobility restrictions are some of the frequently cited hurdles. The COVID-19 pandemic has exacerbated these existing inequalities, with migrants and refugees bearing the brunt of chronic systemic injustices. Providing equitable healthcare access for all, regardless of their citizenship and social status remains an ethical challenge for healthcare providers, particularly within the framework of a resource-limited healthcare system. Inclusive healthcare and socio-economic policies are necessary to ensure every individual’s equal opportunity to attain good health. The collective experiences of refugees and migrants in the pursuit of healthcare, as highlighted by the two cases described, showcases the importance of equity in healthcare access and the detrimental implications of non-inclusive healthcare and socio-economic policies.

scholarly journals Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: A qualitative study

2019 ◽  
Author(s):  
Christine Metusela ◽  
Tim Usherwood ◽  
Kenny Lawson ◽  
Lisa Angus ◽  
Walter Kmet ◽  
...  
Keyword(s):  
General Practice ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Models Of Care ◽  
Shared Vision ◽  
Fee For Service ◽  
Structured Interviews ◽  
Practice Nurses ◽  
Funding Model ◽  
Sydney Australia

Abstract Objectives Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Design We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. Setting and participants We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and approaches to PCMH transitions. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported early outcomes of the PCMH model of care, in particular enhanced patient and staff satisfaction and fewer hospital admissions which were described as likely to reduce the costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH Primary Health Care approaches. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

scholarly journals Mobile Traveling Healthcare Teams: An Innovative Delivery System for Underserved Populations

2018 ◽  
Vol 23 (3) ◽  
Author(s):  
Glenda Walker ◽  
Viviana Martinez-Gómez ◽  
Roberto Gonzalez
Keyword(s):  
Delivery System ◽  
Underserved Populations ◽  
Healthcare Access ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Department ◽  
State Mental Health ◽  
Social Determinant ◽  
Healthcare Team ◽  
Health Project

Reaching disenfranchised clients who are either underinsured or who have no insurance presents unique challenges for healthcare providers and organizations. To reach clients experiencing disparities in healthcare access, a social determinant of health, innovative models of healthcare delivery must be developed. The Juntos for Better Health project directly focused on the social determinant of lack of access to care for prevention and treatment of diabetes, depression, and obesity. In the article, we discuss the background that provided the framework for this project, reviewing literature related to mobile vans and traveling nurses, and then describe the geographical traveling healthcare team setting. The article discusses the Juntos for Better Health project, including several phases of implementation, services of the traveling healthcare team delivery system, and partnerships that included four healthcare providers and a state university in a United States-Mexico border town located in Texas. Partnering agencies included a community-based federally qualified healthcare center, the local state mental health authority, the city health department, and the local drug treatment agency. The conclusion briefly describes plans for the future.

Abstract P125: The First Year of Pre-Hospital Triage for Emergent Large Vessel Stroke Across a Large New York City Health System

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian D Kim ◽  
Jacob Morey ◽  
Naoum Fares Marayati ◽  
Danielle Wheelwright ◽  
Tara L Roche ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Los Angeles ◽  
Health System ◽  
York City ◽  
Large Vessel ◽  
Access Time ◽  
Hospital Arrival ◽  
Arterial Access ◽  
Triage Protocol

Introduction: On April 1 2019, New York City EMS began a triage protocol using a modified Los Angeles Motor Scale (S-LAMS for addition of speech) to identify potential endovascular thrombectomy (EVT) eligible patients in the field (S-LAMS 4-6 with last known well (LKW) <5 hours). These patients are routed to the nearest thrombectomy capable center, driving past potentially closer primary stroke centers. Methods: Patients brought by EMS to a large multicenter health system across NYC for the year following April 1, 2019 were extracted from a prospectively collected stroke database. S-LAMS triage positive (STP) patients were assessed for diagnostic accuracy and treatment times. They were compared with a cohort that underwent EVT during the same period, but triaged as S-LAMS triage negative (STN). Results: STP patients (N=145) were 56.6% women, mean age of 70, median baseline mRS of 0, S-LAMS score of 5, and arrival NIHSS of 13. Stroke was diagnosed in 110 (75.8%) patients, 32 intracerebral hemorrhage and 78 ischemic. Of the ischemic, 45 were large vessel occlusion stroke (ELVO) and 34 underwent EVT (PPV of 0.31 for ELVO). STN patients (N=65) with LKW of < 5 hours were brought by EMS and underwent EVT; 34 were brought directly to EVT capable centers, and 36 required transfer for EVT. Mean time to hospital arrival from EMS scene arrival was significantly longer for STP patients than STN patients (38 vs. 29 minutes, p<0.01). Mean ambulance travel time was significantly longer for STP patients than STN patients (10 vs. 7 minutes, p<0.01). Mean tPA administration time from EMS scene arrival was not significantly different between STP (N=41) and STN patients (N=40) (90 vs. 91 minutes, p=0.89). Mean arterial access time for EVT from EMS scene arrival was significantly shorter for STP patients than STN patients (137 vs. 200 minutes, p<0.01). Conclusions: Pre-hospital stroke triage using the streamlined S-LAMS scale is comparable with other pre-hospital scales in predictive value for ELVO. While pre-hospital evaluation and transport times are longer, they add minimal delay to the hospital arrival, do not affect tPA times, and improve times to EVT in a large, urban environment. Further analysis on effect of the triage protocol on patient outcomes is warranted.

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