Abstract 20050: Impact of Median Household Income and Hospital Variation in the Utilization of Do-not-resuscitate Order in Cardiac Arrest: A National Perspective

Background: The factors determining DNR status in patients (pts) with cardiac arrest have not been well elucidated. Objective: The goal of our study was to assess impact of median household income and inter-hospital variation in utilization of DNR in Cardiac arrest. Methods: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) database from 2011 using the ICD-9-CM code for cardiac arrest (427.5) as principal diagnosis. We defined pts’ DNR status with ICD code - V49.86 as a secondary diagnosis. Pts with age < 18 were excluded. NIS represents 20% of all US hospital pts. We built a hierarchical two level model adjusted for multiple confounding factors. Discrimination power of models was assessed using c statistics. Inter class correlation (ICC) and Median Odds Ratio (MOR) were generated from the hierarchical model. Results: We identified 1854 pts (weighted: 8915) with cardiac arrest across 1854 hospitals in the US, out of which 1.87% pts (366 pts, weighted: 1755) opted for DNR. Pts with higher median household income had decreased utilization of DNR (OR, 95% CI, P-Value) in 4th quartile: 0.59, 0.45-0.78, p<0.001, as compared to all other quartile. Also, with every 10 year increase in age, the rate of DNR increased (1.25, 1.18-1.32, p < 0.001). There was no statistically significant difference in other variables such as female gender, weekend admission, insurance type, teaching status of the hospital or hospital volume. C-statistics of model to generate ICC and MOR was 0.90. ICC was 60.6, which indicates that approximately 60.6 % of variation in utilization of DNR was attributable to the behavior of individual hospitals, and MOR was 8.5 which indicates that a randomly selected patient receiving DNR at a particular hospital would have approximately 9-fold higher odds of receiving DNR than an identical patient at a different randomly selected hospital. Conclusion: Our study highlights vast variation in utilization of DNR in randomly selected 2 different hospitals with cardiac arrest pts. It also indicates a disparity in utilization of DNR orders in Pts with higher median household income as compared to lower household income.

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Abstract 92: Demographic, Regional and Social Predictors of Do Not Resuscitate Order Utilization in Intracerebral Hemorrhage: A National Perspective

Stroke ◽

10.1161/str.46.suppl_1.92 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Vishal B Jani ◽

Achint Patel ◽

Girish Nadkarni ◽

Alexandre Benjo ◽

Narender Annapureddy ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Private Insurance ◽

Female Gender ◽

P Value ◽

Weighted Estimate ◽

Do Not Resuscitate ◽

Discrimination Power ◽

Social Predictors ◽

North East ◽

Dnr Orders

Background: Non-traumatic Intracerebral hemorrhage (ICH) is a life-threatening condition associated with substantial morbidity and mortality. Do-not-resuscitate (DNR) orders have recently linked to poor outcomes in ICH patients probably due to the inactive management associated with these orders. Hypothesis: We tested the hypothesis that demographic, regional and social factors not related to ICH severity are significant predictors of DNR utilization. Methods: We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2011-2012 for ICH admissions in patients >18 years using the ICD 9-CM code 431. We defined DNR status with ICD code - V49.86 entered during the same admission as a secondary diagnosis and estimated severity of illness by the 3M™ All Patient Refined DRG (APR DRG) classification System. A hierarchical two level multivariate regression model were generated to estimate odds ratios (OR) for predictors of DNR utilization and discrimination power of models was assessed using C statistics. We considered a two tailed p value of <0.01 to be significant. Results: We analyzed 25768 pts (weighted estimate 126254) with ICH out of which 4620 (18%) pts (weighted estimate 22668) had DNR orders placed. In multivariable regression analysis, female gender (OR 1.2, 95% CI 1.2-1.3), Ethnicity [White(OR 1.6, 95% CI 1.5-1.7) and Hispanic(OR 1.2, 95% CI 1.1-1.3) compared to Black], Insurance [Medicare (OR 1.1, 95% CI 1.1-1.2) and self or no pay (OR 1.1, 95% CI 1.0-1.2) compared to private insurance], Hospital location [West (OR 1.6, 95% CI 1.2-2.1) compared to North-East ] were significantly associated with high DNR utilization rates after adjusting for patient level, hospital level characteristics, APR DRG severity scale and other clinical characteristics. Conclusions: In conclusion, demographic (female gender/ethnicity), social (insurance status) and regional (hospital location) are significantly associated with increased DNR utilization. The reasons for this are likely multifactorial, qualitative, linked to both patient and provider practices and need to be explored in more detail.

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Abstract 67: Cardiac Arrest and Surgical Case Volume, Household Income and Availability of Trauma and Cardiac Surgery Are Associated with Higher Risk-Standardized Survival After Cardiac Arrest Among University Hospital Consortium Institutions in 2012

Circulation ◽

10.1161/circ.130.suppl_2.67 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michael C Kurz ◽

John P Donnelly ◽

Henry E Wang

Keyword(s):

Cardiac Arrest ◽

Cardiac Surgery ◽

Household Income ◽

University Hospital ◽

Individual Risk ◽

P Value ◽

Case Volume ◽

Surgical Case ◽

Catchment Areas ◽

Cardiac Arrest Survival

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

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Prehospital Disposition and Patient Outcomes in Cardiac Arrest AFTER Resuscitation Termination Protocol Change in an Urban Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000473 ◽

2020 ◽

Vol 35 (3) ◽

pp. 285-292

Author(s):

Brian H. Cheung ◽

Mary P. Mercer

Keyword(s):

Cardiac Arrest ◽

The United States ◽

Urban Setting ◽

Transport Rate ◽

Do Not Resuscitate ◽

Patient Transport ◽

Adjusted Analysis ◽

Significant Difference ◽

Utstein Style ◽

Unadjusted Analysis

AbstractIntroduction:Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the United States, and efforts have been made to develop termination of resuscitation protocols utilizing clinical criteria predictive of successful resuscitation and survival to discharge. A termination of resuscitation protocol utilizing longer resuscitation time and end-tidal carbon dioxide (EtCO2) monitoring criteria for termination was implemented for Emergency Medical Service (EMS) providers in an urban prehospital system in 2017. This study examines the effect the modified termination of resuscitation protocol had on rates of patient transport to a hospital, return of spontaneous circulation (ROSC), and survival to discharge.Methods:A retrospective analysis was performed utilizing data from the Cardiac Arrest Registry to Enhance Survival (CARES) database. A total of 1,005 prehospital cardiac arrest patients 18 years and older from 2016 through 2017 were included in the analysis. Patients with traumatic cardiac arrest or had valid do-not-resuscitate orders were excluded. Unadjusted analysis using chi-square statistics was performed, including an analysis stratified by Utstein style reporting. Adjusted analysis was also performed using logistic regression with multiple imputation for missing values.Results:Unadjusted analysis showed a significant decrease in ROSC on emergency department (ED) arrival (30% versus 13%; P <.001) following the change in protocol. There was no significant difference in patient transport rate (62%) and a statistically non-significant decrease in overall survival (15% versus 11%). When stratified by Utstein style analysis, statistically significant decreases in ED arrival with ROSC were seen for unwitnessed asystolic, as well as bystander witnessed asystolic, pulseless electrical activity (PEA), and shockable OHCA. Adjusted analysis showed a decreased likelihood of ROSC with the protocol change (0.337; 95% CI, 0.235-0.482).Conclusion:The modification of termination of resuscitation protocol was not associated with a statistically significant change in transport rate or survival. A significant decrease in rate of arrivals to the ED with ROSC was seen, particularly for bystander witnessed OHCA.

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“Association between Median Household Income, State Medicaid Expansion Status, and COVID-19 Outcomes Across US Counties”

10.1101/2021.02.03.21251075 ◽

2021 ◽

Author(s):

Tsikata Apenyo ◽

Antonio Vera-Urbina ◽

Khansa Ahmad ◽

Tracey H. Taveira ◽

Wen-Chih Wu

Keyword(s):

Mortality Risk ◽

Low Income ◽

Household Income ◽

Medicaid Expansion ◽

Median Household Income ◽

Incidence And Mortality ◽

Significant Difference ◽

Us Counties ◽

The Relationship ◽

Income Quartile

AbstractObjectiveThe relationship between socioeconomic status and its interaction with State’s Medicaid-expansion policies on COVID-19 outcomes across United States (US) counties are uncertain. To determine the association between median-household-income and its interaction with State Medicaid-expansion status on COVID-19 incidence and mortality in US countiesMethodsLongitudinal, retrospective analysis of 3142 US counties (including District of Columbia) to study the relationship between County-level median-household-income (defined by US Census Bureau’s Small-Area-Income-and-Poverty-Estimates) and COVID-19 incidence and mortality per 100000 of the population in US counties from January 20, 2020 through December 6, 2020. County median-household-income was log-transformed and stratified by quartiles. Medicaid-expansion status was defined by US State’s Medicaid-expansion adoption as of first reported US COVID-19 infection, January 20, 2020. Multilevel mixed-effects generalized-linear-model with negative binomial distribution and log link function compared quartiles of median-household-income and COVID-19 incidence and mortality, reported as incidence-risk-ratio (IRR) and mortality-risk-ratio (MRR), respectively. Models adjusted for county socio-demographic and comorbidity conditions, population density, and hospitals, with a random intercept for states. Multiplicative interaction tested for Medicaid-expansion*income quartiles on COVID-19 incidence and mortality.ResultsThere was no significant difference in COVID-19 incidence across counties by income quartiles or by Medicaid expansion status. Conversely, significant differences exist between COVID-19 mortality by income quartiles and by Medicaid expansion status. The association between income quartiles and COVID-19 mortality was significant only in counties from non-Medicaid-expansion states but not significant in counties from Medicaid-expansion states (P<0.01 for interaction). For non-Medicaid-expansion states, counties in the lowest income quartile had a 41% increase in COVID-19 mortality compared to counties in the highest income quartile (MRR 1.41, 95% CI: 1.25-1.59).Conclusions and RelevanceMedian-household-income was not related to COVID-19 incidence but negatively related to COVID-19 mortality in US counties of states without Medicaid-expansion. It was unrelated to COVID-19 mortality in counties of states that adopted Medicaid-expansion. These findings suggest that expanded healthcare coverage should be investigated further to attenuate the excessive COVID-19 mortality risk associated with low-income communities.Key FindingsQuestionIs there a relationship between COVID-19 outcomes (incidence and mortality) and household income and status of Medicaid expansion of US counties?FindingsIn this longitudinal, retrospective analysis of 3142 US counties, we found no significant difference in COVID-19 incidence across US counties by quartiles of household income. However, counties with lower median household income had a higher risk of COVID-19 mortality, but only in non-Medicaid expansion states. This relationship was not significant in Medicaid expansion states.MeaningExpanded healthcare coverage through Medicaid expansion should be investigated as an avenue to attenuate the excessive COVID-19 mortality risk associated with low-income communities.

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Diastolic dysfunction in cases with Type II diabetes mellitus.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.12.229 ◽

2019 ◽

Vol 26 (12) ◽

pp. 2040-2043

Author(s):

Munir Ahmed ◽

Abdul Hayee ◽

Shahla Afsheen Memon ◽

Ismail Salim Memon ◽

Abdul Qayoom Memon

Keyword(s):

Diabetes Mellitus ◽

Diastolic Dysfunction ◽

Type Ii Diabetes ◽

Female Gender ◽

Type Ii Diabetes Mellitus ◽

P Value ◽

Type I ◽

Type Ii ◽

Cross Sectional ◽

Significant Difference

Objectives: To determine the frequency of diastolic dysfunction in patients presenting with type II Diabetes Mellitus. Study Design: Cross sectional study. Setting: Sheikh Zayed Hospital, Rahim Yar Khan. Period: From 01-01-2017 to 30-06-2017. Material & Methods: In this study the cases were selected via non probability consecutive sampling of both male and female gender with age more than 40 years having type II DM of at least more than 2 years were included. The cases suffering from type I DM, gestational DM and those with HTN, end stage kidney and liver failure were excluded. Trans thoracic echocardiography was done to label diastolic dysfunction and was labelled as yes when the E/A ratio was <0.8. The data was analysed using chi square test and p value less than 0.05 was taken as significant. Results: In this study, 100 cases of type II DM were included with mean age of 51.31±7.89 years at presentation. There were 61% males and 39% females. Diastolic dysfunction was observed in 53% of the cases. There was no significant difference in terms of gender where it affected 56.41% of females with p= 0.92. Diastolic dysfunction was more in cases that had duration of DM more than 3 years affecting 48 (70.58%) cases with p= 0.001 and it was also significantly high in cases that had BMI more than 30 where it was seen in 40 (70.17%) of cases with p= 0.001. Conclusion: Diastolic dysfunction seen in half of the cases suffering from type II DM and it is significantly high in cases that had duration of DM more than 3 years and BMI more than 30.

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Portal vein thrombosis post-splenectomy in thalassemia major patients

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i4.1645 ◽

2019 ◽

Vol 10 (4) ◽

pp. 3356-3368

Author(s):

Kussay M. Abbas Zwain ◽

Samer M. Mohamed Al-Hakkak ◽

Alaa A. Al-Wadees ◽

Zainab Mahdi Majeed

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Female Gender ◽

Thalassemia Major ◽

Spleen Weight ◽

P Value ◽

Vein Thrombosis ◽

Significant Difference ◽

The Mean ◽

Wbc Count

β-thalassemia major is a chronic, inherited hematological disease that leads to chronic anemia in the affected children. One of the options of treatment in such patients was splenectomy; however, it is not without risk of many complications; one of them is the thrombotic events. A prospective study of 55 patients with β-thalassemia inscribes in this study. 14 patients (25.5%) had a normal thrombocyte count and 41 patients (74.5%) have an abnormally high thrombocytes count which was significantly associated with PVT (P. Value <0.001), Regarding the WBC count, it extended between 4000 to more than 30,000, in both genders with non-statistically significant differences between both genders, (P>0.05). Regarding the serum ferritin, the mean level was 2908.5 ± 1024.3 ng/ml. In males, the mean S. Ferritin was relatively higher than that of females, 3167.6 ± 1841.3 mg/dl, and 2573.8 ± 1150.6 ng/ml. The weight of the spleen was up to 1500 grams in 25 (80.6%) of males and 20 (83.3 %) of females while it was more than 1500 grams in the remaining and females and males, without a significant difference statistically in the spleen weight of, (P>0.05). The most frequent presenting symptom was abdominal pain. It was founded in 46 patients (83.6%), followed by fever in 76.4%, diarrhea in 58.2%, and Nausea and vomiting in 31 (56.4%). 3 patients out of the 55 (5.5%) developed portal vein thrombosis in their follow up period. Post splenectomy PVT in thalassemia the patient is relatively frequent (5.5%) complication that require a high degree of doubt for diagnosis early, especially in patients with postoperative pain of the abdomen within 2 months after surgery, Female gender, Large spleen and postoperative increase number of platelets are risk factors for PVT so one can initiate surveillance by Doppler ultrasound postoperatively and start antiplatelet prophylactic therapy immediately for such patients.

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Abstract 239: The Effect of an Interdisciplinary Simulation Training Program on Translational Outcomes for In-Hospital Cardiopulmonary Arrests

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.239 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

John Hunninghake ◽

Justin Reis ◽

Heather Delaney ◽

Matthew Borgman ◽

Raquel Trevino ◽

...

Keyword(s):

Cardiac Arrest ◽

Training Program ◽

Hospital Discharge ◽

Team Training ◽

Quality Data ◽

P Value ◽

Significant Difference ◽

Event Location ◽

Cpr Quality ◽

Hospital Cardiac Arrest

Purpose: High-quality cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) is the primary component influencing return of circulation (ROSC) and survival to hospital discharge, but few hospitals regularly track these metrics. Other studies have demonstrated significant improvements in survival after IHCA events following implementation of a dedicated code team training program. Therefore, we developed a unique curriculum for a Code Team Training (CTT) course, and evaluated its post-implementation effect on CPR quality and post-IHCA patient outcomes at our institution. Methods: CPR quality data was prospectively collected for quality improvement purposes once our institution had that capability, with 12-months pre-CTT and 21 months post-CTT. Pre-CTT data shaped the elements of the four-hour CTT course that included didactics, small group sessions, and high-fidelity simulation exercises. A total of 456 multi-professional code team members were trained in 22 courses. Data collection included CPR quality and translational outcomes for events where CPR was performed, except the ED. CodeNet® software was used for CPR quality measures, cardiac rhythm, defibrillation metrics, use of continuous waveform capnography, and pauses in compressions. Target metrics for CPR quality were based on 2015 AHA guidelines. Key translational outcomes measures included event location, ROSC, and survival to hospital discharge. Results: CPR quality was obtained from 140 of 230 (61%) in- and out-of-hospital pulseless adult cardiac arrest events over 33 months (50 [36%] before CTT and 90 [64%] following the first course). There was no significant difference between groups in terms of event location within the hospital nor initial event rhythm. A total of 116,908 chest compressions were evaluated. Median compressions in target rate improved from 32% before CTT to 49% after CTT (p<0.05). When accounting for target rate and depth, the median compressions rate improved to 38% post-CTT compared to 31% pre-CTT (p<0.05). While compression depth had a non-statistically significant decline (90.8% pre-CTT and 83.4% post-CTT), mean rate and median rate-in-target improved from 119.99 +/- 15.6 cpm and 32.4% pre-CTT to 113.7 +/- 16.1 cpm and 48.6% post-CTT (p<0.05). The rate of ROSC improved from 60% (30 of 50) to 78% (70 of 90) after implementation of CTT (p=0.003), excluding IHCA in the ED. Index IHCA survival rate for our institution improved from 26% to 33% before and after CTT [p-value NS], which far surpasses the national average (23.8%). Conclusions: After the initiation of a CTT course that targets key code team member personnel, CPR quality significantly improved, which was associated with an increase in ROSC and a trend towards increased survival for in-hospital cardiac arrest patients.

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Effect of Household Income on Short-Term Outcomes Following Cerebellopontine Angle Tumor Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722664 ◽

2021 ◽

Author(s):

Vincent Huang ◽

Stephen P. Miranda ◽

Ryan Dimentberg ◽

Kaitlyn Shultz ◽

Scott D. McClintock ◽

...

Keyword(s):

Regression Analysis ◽

Household Income ◽

Cerebellopontine Angle ◽

Univariate Analysis ◽

Tumor Resection ◽

Index Admission ◽

P Value ◽

Short Term ◽

Significant Difference ◽

The Impact

Abstract Objectives The objective of this study is to elucidate the impact of income on short-term outcomes in a cerebellopontine angle (CPA) tumor resection population. Design This is a retrospective regression analysis. Setting This study was done at a single, multihospital, urban academic medical center. Participants Over 6 years (from June 7, 2013, to April 24, 2019), 277 consecutive CPA tumor cases were reviewed. Main Outcome Measures Outcomes studied included readmission, emergency department evaluation, unplanned return to surgery, return to surgery after index admission, and mortality. Univariate analysis was conducted among the entire population with significance set at a p-value <0.05. The population was divided into quartiles based on median household income and univariate analysis conducted between the lowest (quartile 1 [Q1]) and highest (quartile 4 [Q4]) socioeconomic quartiles, with significance set at a p-value <0.05. Stepwise regression was conducted to determine the correlations among study variables and to identify confounding factors. Results Regression analysis of 273 patients demonstrated decreased rates of unplanned reoperation (p = 0.015) and reoperation after index admission (p = 0.035) at 30 days with higher standardized income. Logistic regression between the lowest (Q1) and highest (Q4) socioeconomic quartiles demonstrated decreased unplanned reoperation (p = 0.045) and decreasing but not significant reoperation after index admission (p = 0.15) for Q4 patients. No significant difference was observed for other metrics of morbidity and mortality. Conclusion Higher socioeconomic status is associated with decreased risk of unplanned reoperation following CPA tumor resection.

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Critical food safety violations in Surrey

BCIT Environmental Public Health Journal ◽

10.47339/ephj.2018.57 ◽

2018 ◽

Author(s):

Judy Tung ◽

BCIT School of Health Sciences, Environmental Health ◽

Helen Heacock

Keyword(s):

Food Safety ◽

Low Socioeconomic Status ◽

Household Income ◽

Food Service ◽

Foodborne Illness ◽

P Value ◽

Median Household Income ◽

P Values ◽

Addition Chain ◽

Hazard Rating

Background: Foodborne illness affects 4 million (1 in 8) Canadians each year, with at least 50% of these illnesses linked to restaurants. Environmental Health Officers (EHOs) conduct routine, demand, and follow-up restaurant inspections to safeguard the public. Critical violations (CVs) must be corrected during inspection because they have a high probability of causing a foodborne illness. Examples of CVs include: previously served food not being discarded, and infrequent handwashing from employees. Previous research has shown that individuals of low socioeconomic status are more susceptible to foodborne illness. According to Statistics Canada, the poverty rate in Surrey, British Columbia, is 14.8%, which is slightly higher than the national rate of 14.2%. Unfortunately, there is limited research that assesses the safety of food service establishments in different socioeconomic neighbourhoods. This study examined the relationship between the number of CVs in chain and independent restaurants and median household income in three communities within Surrey. Methods: Secondary data was used for this study. The researcher collected publicly accessible restaurant inspection reports from the Fraser Health website. Three communities (Whalley, Fleetwood, South Surrey) within Surrey were selected for comparison according to their median household income (from City of Surrey Community Demographic Profiles webpage). Whalley and South Surrey had the lowest and highest median household income, respectively. Fleetwood was chosen based on its proximity to the median household income for Surrey. The researcher then recorded the name and restaurant type within these communities using Zomato. 25 chain and 25 independent restaurants were randomly selected in each community. In total, 150 restaurants were analyzed. The number of CVs, violation code, and hazard rating were compared between January 2016 and December 2017. Results: Independent restaurants were found to have more CVs than chain restaurants in all communities. There was an association between the number of CVs observed in both types of restaurants and the restaurant's hazard rating. The p-values for chain restaurants in Whalley, Fleetwood, and South Surrey are: 0.00, 0.00006, and 0.00, respectively. Meanwhile the p-values for independent restaurants in all three communities are 0.00. In general, independent restaurants had more moderate or high hazard ratings than chain restaurants. The top four CVs found in all communities were related to poor sanitation of equipment, improper storage of cold potentially hazardous foods,and lack of adequate handwashing stations. Finally, a negative correlation was observed between the number of CVs in both restaurant types and the neighbourhood median household income (p-value for chain and independent restaurants = 0.0186 and 0.0073, respectively). Conclusion: The findings indicate that communities with lower median household income had more CVs. Further research is needed to analyze this relationship. In addition, chain restaurants have fewer CVs than independent restaurants possibly due to their internal food safety monitoring systems. Therefore, independent restaurants may benefit from more education because this pattern has been observed in the past. Finally, an educational intervention is potentially necessary for restaurant operators in Surrey to reduce the top four CVs, thereby improving the restaurants' hazard rating.

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Emergency department crowdedness and emergency department cardiac arrest occurrence: an observational study in the COVID-19 pandemic

10.22514/sv.2021.236 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Survival Rates ◽

Spontaneous Circulation ◽

Patient Volume ◽

Do Not Resuscitate ◽

Tertiary Teaching ◽

Significant Difference ◽

Ed Overcrowding ◽

The Relationship

Emergency department (ED) crowdedness is a global phenomenon that can lead to many adverse effects. The relationship of crowdedness and emergency department cardiac arrest (EDCA) occurrence is still debated. The COVID-19 pandemic precipitated a change in the patient volume of the ED and the crowdedness of the ED varied with the epidemic in a continuous period. Different degrees of crowdedness provided us with an opportunity to study the relationship between crowdedness and EDCA occurrence. Our aim of this study was to determine the relationship between EDCA occurrence and prognosis and ED crowdedness.This was a longitudinal study conducted in a tertiary teaching hospital. The study period was from October 1, 2019, to September 30, 2020, and was divided into three periods according to daily patient volume and crowdedness. All nontraumatic and adult EDCA patients during the study period were included, and out-of-hospital cardiac arrest (OHCA) patients and patients with do-not-resuscitate orders were excluded.During the study period, a total of 126 EDCA patients were included. The ratio of EDCA events to daily patient volume was compared among these 3 periods, and there was no significant difference (P2: p = 0.109, P3: p = 0.761, P1 as reference). No significant difference in the prognosis of EDCA patients was found among the 3 periods, regardless of the return of spontaneous circulation (ROSC) (p = 0.437) or survival rates (p = 0.838). In conclusion, there was no obvious correlation between ED crowdedness and EDCA occurrence. The prognosis of EDCA patients was not significantly associated with crowdedness. The metrics of ED overcrowding is unknown and may need further study to develop a generally accepted standard or index.

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