scholarly journals Lessons learnt from the impact of COVID-19 on arthroplasty services in Hong Kong: how to prepare for the next pandemic?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Lok Sze Lee ◽  
Ping Keung Chan ◽  
Wing Chiu Fung ◽  
Amy Cheung ◽  
Vincent Wai Kwan Chan ◽  
...  
Keyword(s):  
Hong Kong ◽  
Bone Loss ◽  
Waiting Time ◽  
Service Planning ◽  
Public Hospitals ◽  
Surgical Volume ◽  
Prosthesis Loosening ◽  
Orthopaedic Clinic ◽  
Number Of Patients ◽  
The Impact

Abstract Background Arthroplasty services worldwide have been significantly disrupted by the pandemic of coronavirus disease 2019 (COVID-19). This retrospective comparative study aimed to characterize its impact on arthroplasty services in Hong Kong. Methods From January 1 to June 30, 2020, the patients of “COVID-19 cohort” underwent elective total hip or knee replacement in Hong Kong public hospitals. The cohort was compared to the “control cohort” during the same period in 2019. Data analysis was performed to compare the two cohorts’ numbers of operations, hospital admission, orthopaedic clinic attendances, and waiting time. Results A total of 33,111 patient episodes were analyzed. During the study period, the elective arthroplasty operations and hospitalizations decreased by 53 and 54%, respectively (P < 0.05). Reductions were most drastic from February to April, with surgical volume declining by 86% (P < 0.05). The primary arthroplasty operations decreased by 91% (P < 0.05), while the revision operations remained similar. Nevertheless, 14 public hospitals continued performing elective arthroplasty for patients with semi-urgent indications, including infection, progressive bone loss, prosthesis loosening, dislocation or mechanical failure of arthroplasty, and tumor. At the institution with the highest arthroplasty surgical volume, infection (28%) was the primary reason for surgery, followed by prosthesis loosening (22%) and progressive bone loss (17%). The orthopaedic clinic attendances also decreased by 20% (P < 0.05). Increases were observed in waiting time and the total number of patients on the waiting list for elective arthroplasty. Conclusions Despite the challenges, public hospitals in Hong Kong managed to continue providing elective arthroplasty services for high-priority patients. Arthroplasty prioritization, infection control measures, and post-pandemic service planning can enhance hospital preparedness to mitigate the impact of current and future pandemics.

scholarly journals Impact of first wave of COVID-19 on outcomes of hospitalization for upper gastrointestinal bleeding in Hong Kong: a population-based study

2021 ◽  
Vol 09 (03) ◽  
pp. E284-E288
Author(s):  
Thomas K.L. Lui ◽  
Vivien W.M. Tsui ◽  
Wai K. Leung
Keyword(s):  
Hong Kong ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Pearson Correlation ◽  
Public Hospitals ◽  
Historical Cohort ◽  
Local Case ◽  
Number Of Patients ◽  
The Impact ◽  
Upper Gastrointestinal

Abstract Background and study aims The COVID-19 pandemic has caused a major disruption in the healthcare system. This study determined the impact of the first wave of COVID-19 on the number and outcome of patients hospitalized for upper gastrointestinal bleeding (UGIB) in Hong Kong. Patients and methods Records of all patients hospitalized for UGIB in Hong Kong public hospitals between October 2018 and June 2020 were retrieved. The number and characteristics of patients hospitalized for UGIB after COVID-19 was compared by autoregressive integrated moving average (ARIMA) model prediction and historical cohort. Results Since the first local case of COVID-19, there was an initial drop in UGIB hospitalizations (observed 29.8 vs predicted 35.5 per week; P = 0.05) followed by a rebound (39.8 vs 26.7 per week; P < 0.01) with a turning point at week 14 (Petitt’s test, P < 0.001). There was a negative association between the number of COVID-19 cases and the number of patients hospitalized for UGIB (Pearson correlation –0.53, P < 0.001). Patients admitted after the outbreak of COVID-19 had lower hemoglobin (7.5 vs baseline 8.3 g/dL; P < 0.01) and a greater need for blood transfusion (64.5 % vs baseline 50.4 %; P < 0.01), but similar rates of all-cause mortality (6.9 % vs 7.1 %; P = 0.82) and rebleeding (6.7 % vs 5.1 %; P = 0.11). There was also a higher proportion of patients with variceal bleeding (10.5 % vs baseline 5.3 %; P < 0 .01). Conclusions There was a dynamic change in the number of patients hospitalized for UGIB in Hong Kong during the first wave of the COVID-19 outbreak, with more obvious impact during the initial phase only.

scholarly journals Waiting time in public hospitals: case study of total joint replacement in Hong Kong

2018 ◽  
Vol 21 (2) ◽  
pp. 120-133 ◽  
Author(s):  
Yee-man Tsui ◽  
Ben Y.F. Fong
Keyword(s):  
Hong Kong ◽  
Waiting Time ◽  
Joint Replacement ◽  
Process Management ◽  
Emergency Services ◽  
Total Joint Replacement ◽  
Care Quality ◽  
Public Hospitals ◽  
Content Type

Purpose The purpose of this paper is to review the causes of long waiting time in Hong Kong public hospitals and to suggest solutions in the service, organisational, systems, financial and policy perspectives. Design/methodology/approach The paper is a review of waiting time of public hospital services. Total joint replacement, which is one of the elective surgeries in public hospitals, is presented as a case study. Findings The average waiting time of semi-urgent and non-urgent patients in the accident and emergency departments of public hospitals is two hours, and that of specialist outpatient (SOP) clinics is from 1 to 144 weeks. For total joint replacement, it is from 36 to 110 months. Measures like Government subsidisation programme for the replacement surgery and employing adequate physiotherapists, Chinese medicine practitioners, clinical psychologists and nurses to reduce the waiting time are suggested. Issues concerning the healthcare system of Hong Kong, such as structural reform, service delivery model, primary care, quality and process management, and policy reviews, are also discussed. Originality/value The ‬over-reliance of public services has resulted in long waiting time in public hospitals in Hong Kong, particularly in the emergency services and SOP clinics. However, the consequences of long waiting period for surgical operations, though much less discussed by the media and public, can be potentially detrimental to the patients and families, and may result in more burdens to the already stretched public hospitals‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

CAD and AM-fabricated moulds for fast cranio-maxillofacial implants manufacture

2016 ◽  
Vol 22 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Leopoldo Ruiz-Huerta ◽  
Yara Cecilia Almanza-Arjona ◽  
Alberto Caballero-Ruiz ◽  
Homero Alberto Castro-Espinosa ◽  
Celia Minerva Díaz-Aguirre ◽  
...  
Keyword(s):  
Waiting Time ◽  
Lead Time ◽  
Public Hospitals ◽  
Fused Deposition Modelling ◽  
Content Type ◽  
Fused Deposition ◽  
General Terms ◽  
Injury Model ◽  
Number Of Patients ◽  
Custom Made

Purpose – The purpose of this study is to suggest the joint use of computer-aided design (CAD) and additive manufacturing (AM) technology for the fabrication of custom-made moulds, designed for the manufacture of polymethyl methacrylate (PMMA) implants for cranio-maxillofacial reconstruction to reduce their fabrication time. Even though tailor-made skull prostheses with a high technological level and state-of-the-art materials are available in the market, they are not always accessible to the general population in developing countries. Design/methodology/approach – Computed tomography data were handled to create a three-dimensional (3D) model of the injury of the patient, by reconstructing Digital Imaging and Communications in Medicine (DICOM) images into an Standard Tessellation Language (STL) file that was further used to design the corresponding implant using CAD software. Accordingly, a two-piece core and cavity moulds that replicated the implant geometry was also CAD designed. The 3D-CAD data were sent to an AM machine (fused deposition modelling) and the moulds were fabricated using polycarbonate as thermoplastic material. A reacting mixture to produce PMMA was poured directly into the fabricated moulds, and left to polymerise until cure. Finally, a clear bubble-free case of study PMMA implant was obtained. Findings – The fabrication of CAD-designed moulds with AM, replacing the production of the injury model, resulted in the reduction of the lead-time in the manufacturing of PMMA around 45 per cent. Additionally, the implant showed better fit than the one produced by conventional process. The use of AM moulds for the fabrication of PMMA implants has demonstrated the reduction in lead-time, which potentially can reduce the waiting time for patients. Social implications – Currently, the demand of cranio-maxillofacial implants at only the Hospital General de México “Dr Eduardo Liceaga” (HGM) is 4,000 implants per year, and the average waiting time for each patient is between 5 and 10 weeks, including third-party services’ delays and the time needed to obtain the economical resources by the patient. Public hospitals in Mexico lack manufacturing facilities, so patients have to make use of laboratories abroad and most of the population have no access to them. The implementation of this suggested procedure in public hospitals may improve the accuracy of the implant, increase the number of patients attended per year (up to 83 per cent) and the reduction in waiting time can also reduce mortality and infection rates. Originality/value – The authors of this paper suggest the joint use of CAD and AM technologies to significantly reduce the production time of PMMA implants by producing moulds rather than the injury model, maintaining the general terms and known steps of the process already established for PMMA implants.

scholarly journals Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria

2021 ◽  
pp. 1260-1269
Author(s):  
Chidinma P. Anakwenze Akinfenwa ◽  
Abiola Ibraheem ◽  
Kenneth Nwankwo ◽  
Nwamaka Lasebikan ◽  
Musa Ali-Gombe ◽  
...  
Keyword(s):  
Public Hospitals ◽  
Public Private Partnerships ◽  
External Beam Radiation ◽  
Linear Accelerators ◽  
Beam Radiation ◽  
Maintenance And Repair ◽  
The Public ◽  
Number Of Patients ◽  
The Impact ◽  
Maintenance Plan

PURPOSE Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.

scholarly journals Exploring overcrowding trends in an inner city emergence department in the UK before and during COVID-19 epidemic

2021 ◽  
Author(s):  
J Panovska-Griffiths ◽  
J Ross ◽  
S Elkhodair ◽  
C Baxter-Derrington ◽  
C Laing ◽  
...  
Keyword(s):  
Waiting Time ◽  
Hospital Emergency ◽  
Number Of Patients ◽  
Before And After ◽  
Ed Overcrowding ◽  
University College London ◽  
Flow Through ◽  
Multifaceted Interventions ◽  
The Uk ◽  
The Impact

AbstractBackgroundWe compared impact of three pre-COVID-19 interventions and of the COVID-19 UK-epidemic and the first UK national lockdown on overcrowding within University College London Hospital Emergency Department (UCLH ED). The three interventions: target the influx of patients at ED (A), reduce the pressure on in-patients’ beds (B) and improve ED processes to improve the flow of patents out from ED (C).MethodsWe analysed the change in overcrowding metrics (daily attendances, the proportion of people leaving within four hours of arrival (four-hours target) and the reduction in overall waiting time) across three analysis. The first analysis used data 01/04/2017-31/12-2019 to calculate changes over a period of six months before and after the start of interventions A-C. The second and third analyses focused on evaluating the impact of the COVID-19 epidemic, comparing the first 10 months in 2020 and 2019, and of the first national lockdown (23/03/2020-31/05/2020).ResultsPre-COVID-19 all interventions led to small reductions in waiting time (17%, p<0.001 for A and C;9%, p=0.322 for B) but also to a small decrease in the number of patients leaving within four hours of arrival (6.6%,7.4%,6.2% respectively A-C,p<0.001).In presence of the COVID-19 pandemic, attendance and waiting time were reduced (40% and 8%;p<0.001), and the number of people leaving within four hours of arrival was increased (6%,p<0.001). During the first lockdown, there was 65% reduction in attendance, 22% reduction in waiting time and 8% increase in number of people leaving within 4 hours of arrival (p<0.001). Crucially, when the lockdown was lifted, there was an increase (6.5%,p<0.001) in the percentage of people leaving within four hours, together with a larger (12.5%,p<0.001) decrease in waiting time. This occurred despite the increase of 49.6%(p<0.001) in attendance after lockdown ended.ConclusionsThe mixed results pre-COVID-19 (significant improvements in waiting time with some interventions but not improvement in the four-hours target), may be due to a ‘spill-over effect’ where clogging up one part of the ED system affects other parts. Hence multifaceted interventions and a system-wide approach to improve the pathway of flow through the ED system is necessary.During 2020 and in presence of the COVID-19 epidemic, a shift in public behaviour with anxiety over attending hospitals and higher use of virtual consultations, led to notable drop in UCLH ED attendance and consequential curbing of overcrowding.Importantly, once the lockdown was lifted, although there was an increase in arrivals at UCLH ED, overcrowding metrics were reduced. Thus, the combination of shifted public behaviour and the restructuring changes during COVID-19 epidemic, maybe be able to curb future ED overcrowding, but longer timeframe analysis is required to confirm this.

scholarly journals Impact of COVID-19 on Cleft Surgical Care

FACE ◽  
2021 ◽  
pp. 273250162199600
Author(s):  
Andrew M. Ferry ◽  
Han Zhuang Beh ◽  
Rami P. Dibbs ◽  
Lesley W. Davies ◽  
Amy S. Xue ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Alveolar Bone ◽  
Surgical Care ◽  
The United States ◽  
Surgical Volume ◽  
Case Volume ◽  
Volume Number ◽  
Number Of Patients ◽  
Alveolar Bone Grafting ◽  
The Impact

Background: Coronavirus disease 2019 (COVID-19) has greatly impacted pediatric healthcare facilities throughout the United States due to widespread case rescheduling and the implementation of supplementary COVID-19 perioperative protocols. To our knowledge, no studies have investigated the impact of COVID-19 on case volume, surgical timing, or operational aspects of cleft surgical procedures. The aim of this study is to investigate the impact that COVID-19 has had on cleft surgical care at our institution. Methods: A retrospective study comparing cleft surgical care in 2019 (the pre-pandemic cohort) and 2020 (the COVID-19 cohort) was designed. All patients who underwent a cleft surgical procedure from April 1st to August 31st in 2019 and 2020 were included for analysis. Procedures were stratified into 4 groups: primary cleft lip repairs, primary cleft palate repairs, alveolar bone grafting procedures, and revisional/secondary repair procedures. Variables investigated in this study included: surgical volume, number of patients receiving timely surgery, causes for untimely surgery, number of combined cases, number of delayed cases, delay time, time under anesthesia, and procedure length. Results: A total of 191 cleft surgeries, 102 in 2019 and 89 in 2020, were identified during the study period. We observed no statistically significant differences in cleft surgical volume and other investigated variables across all surgical subgroups from 2019 to 2020. Conclusion: Cleft surgical care was largely unaffected by COVID-19 despite high rates of case rescheduling and the addition of supplementary perioperative safety protocols. More studies are needed to assess the impact of COVID-19 on cleft surgical care at other cleft centers and to investigate the long-term outcomes of these patients.

scholarly journals Leaving The Emergency Department Without Being Seen or Without Complete Treatment; A Study From Saudi Arabia

2021 ◽  
Vol 1 (1) ◽  
pp. 1-4
Author(s):  
Mishal Abdulrahman Almarshady ◽  
Sharafaldeen Bin Nafisah ◽  
Yousef Almubarak ◽  
Husam Althobyane
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Mortality Rate ◽  
Waiting Time ◽  
Management Strategies ◽  
Tertiary Hospital ◽  
Health Concern ◽  
Contributing Factors ◽  
Number Of Patients ◽  
The Impact

Background, The attitude of Leaving the emergency department (ED) without being seen or without completing treatment is attributed to prolonged waiting time. The impact of such behaviour and fate of such patients remain undetermined. Aim This study aimed to investigate the prevalence of Left Without Being Seen (LWBS) and Left Without Completing Treatment (LWCT), analyse the contributing factors for such behaviour and the mortality rate within one week of leaving the ED. Methods A retrospective observational study was performed in a tertiary hospital in Riyadh, Saudi Arabia, for three months. All adult patients of more than  14  years of age who visited the ED and LWBS or LWCT were included. Patients were seen by physicians and triaged-out, and those who were directed towards the outpatient clinic were excluded. Patients were asked about the reason for leaving, and their intention to return to the same ED again via call. Results The total number of LWBS and LWCT was 286 patients, with a response rate of 75%. The mean age was 45.8 years. About 46.6% sought medical help within seven days of leaving ED. However, the mortality rate was nil. Many patients (69.3%) reported their intention to revisit the same ED in the near future. A positive correlation was found between increasing age and admission within the same seven days’ period. Conclusion Prolonged waiting time is a public health concern that needs management strategies, the number of patients whom LWBS and LWCT require continuous monitoring and exploration.

scholarly journals Global Impact of Peripheral Obstructive Arterial Disease in Portugal: An Eight Year Study

2019 ◽  
Vol 32 (5) ◽  
pp. 348
Author(s):  
Mariana Moutinho ◽  
Inês Simões ◽  
Sónia Rodrigues ◽  
Daisy Abreu ◽  
Emanuel Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Primary Diagnosis ◽  
Public Hospitals ◽  
National Database ◽  
Number Of Patients ◽  
Peripheral Arterial ◽  
The Impact

Introduction: Peripheral arterial disease has an important impact on morbidity/mortality. The objective of this study was to quantify the impact of this disease in Portugal during the last eight years, expressed by the volume of admissions, treatment strategies and associated morbidity and mortality.Material and Methods: We collected data from the Diagnosis Related Group national database on primary diagnosis, procedures codes, demographic variables, a number of risk factors, and mortality of all cases admitted from 2009 to 2016 with a primary diagnosis of peripheral arterial disease coded according to the 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-9).Results: In this study, peripheral arterial disease led to 27 684 hospitalisations, which corresponded to 26.7% of all admissions for vascular disease in this period. Approximately 49.9% of patients were admitted to the emergency department. The volume of procedures in patients with claudication decreased over the eight years, unlike patients with critical ischaemia, in which the number of procedures increased.Discussion: Age and the presence of cardiovascular risk factors have been associated with the severity of disease, as observed in our series. Overall hospital mortality varied, being significantly higher in patients with more advanced severity of the disease.Conclusion: Peripheral arterial disease represents an important burden in the overall volume of admissions in Portuguese public hospitals. A large number of patients was admitted in the context of emergency.

scholarly journals Technical Efficiency of Regional Public Hospitals in China Based on the Three-Stage DEA

2020 ◽  
Vol 17 (24) ◽  
pp. 9383
Author(s):  
Zhensheng Chen ◽  
Xueli Chen ◽  
Xiaoqing Gan ◽  
Kaixuan Bai ◽  
Tomas Baležentis ◽  
...  
Keyword(s):  
Healthcare Services ◽  
Public Hospitals ◽  
Chinese Government ◽  
Operational Environment ◽  
The Public ◽  
Time Period ◽  
Number Of Patients ◽  
The Social ◽  
Low Efficiency ◽  
The Impact

Many countries are facing the increasing cost of healthcare services and the low efficiency of public hospitals. These issues are also evident in China. This paper offers a comprehensive assessment of the efficiency of public hospitals operating in China’s 31 regions. The impact of the third round of reform of the health system in 2009 is assessed based on the three-stage data envelopment analysis procedure. The time period from 2011 to 2018 is covered in this study. Due to different functions performed by the public hospitals and other ones, the number of patients with infectious diseases is incorporated as an output variable reflecting the social function. The outpatient visits and inpatient visits are considered to reflect the outputs related to the private functions. The results imply an increase in the mean efficiency of public hospitals from 0.927 to 0.981 after taking the impact of environmental variables and statistic noise into account. These results indicate that the efficiency of public hospitals is dependent in the operational environment. There are 11 regions whose hospitals operate on the efficiency frontier during the whole period covered. Therefore, the Chinese government should reasonably design and apply the regulatory tools to improve the efficiency of public hospitals.

scholarly journals Analysis of the impact of sub-acute care activities on consumption of hospital resources in Milan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M G Perri ◽  
S Zanardi ◽  
C Mosconi ◽  
M Mosillo ◽  
D Nicolosi
Keyword(s):  
Acute Care ◽  
Public Hospitals ◽  
Term Care ◽  
Diagnostic Categories ◽  
Use Of Resources ◽  
Daily Rate ◽  
Number Of Patients ◽  
Hospital Resources ◽  
The Impact

Abstract Background In 2011, a new health service called 'sub-acute care activities' (SA) has been provided by Lombardy. It is a protected hospitalization of patients, especially elderlies, suffering for clinical issues following an acute disease or for non-complex clinical failures due to a chronic pathology. This is a hospitalization area between the hospital and home, created to reduce the number of post-acute hospitalized patients who can't be discharged. The goal of this study is the analysis of the hospitalizations in the SA setting within medical structures located in the Metropolitan area of Milan. Methods The data extracted from the hospital discharge card database, is focused on hospitalizations in SA that occurred from 2016 to 2019. The analysis describes yearly production, the characteristics of hospitalizations and patients, finally some trends. Results 16,395 hospitalizations in SA were analyzed (0.7% of the total). Some data are constant in time: hospitalizations (1%), age (average 79), days of hospitalization (average 26). Patients coming from public hospitals (from 28% to 22%) are decreasing while those coming from other in-patient admission typologies within the same organization (from 44% to 54%) are increasing. The major diagnostic categories are related to cardiovascular and respiratory diseases. Over the 85% of hospitalizations are paid with the highest daily rate among those allowed by law. Talking about discharge typologies, 57% of patients return home, 20% are re-transferred to the acute ward, 16% are sent to rehabilitation/long-term care while 7% have died. Conclusions The use of the highest daily tariff and the high number of patients who need to be re-transferred to the acute ward place, gives many doubts on how appropriate is allocation of resources and about the accuracy of admissions in the SA unit during the patient care path. We're planning to return to these issues with further targeted studies. Key messages The analysis showed constant characteristics of SA activities during the four years. Data showed that there may be management issues in the appropriate use of resources in SA assistence.

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