The Impact of Patient’s Fear of COVID-19 Infection on Neurology Service in University Hospital Center Sestre Milosrdnice During COVID-19 Epidemic Outbreak

Increasing evidence suggests that patients with medical emergencies are avoiding the emergency department because of fear of coronavirus disease 2019 (COVID-19) infection, leading to increased morbidity and mortality due to other diseases. In order to analyse the impact of patient’s fear of COVID-19 on the admittance rate of stroke patients and severity of neurological diseases, we compared the stroke admittance rate, numbers of thrombectomies and thrombolysis and hospitalization refusal rate during the time period from March 1st until June 30th 2020 in temporal relationship with the rising numbers of COVID-19 cases in Croatia. We assessed the patients’ neurologic disease severity measured by ventilation time and mortality rate in the same time period. We compared the data with the data obtained from the same time period in 2019. We observed dramatically decreased presentation in Neurologic Emergency Department due to stroke and neurologic disease in 2020 compared to 2019, increased refused hospitalization rate and similar stroke treatment rate despite bigger catchment area. Greater neurologic disease severity with almost 40% increased ventilation time and double mortality rate during the same time was observed. During the outbreak of COVID-19 epidemic, fear of infection had significant impact on neurologic service leading to decreased presentation to NED, resulting in increased stroke or neurologic disease-related morbidity and mortality.

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Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore

BMJ Open ◽

10.1136/bmjopen-2018-027220 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027220 ◽

Cited By ~ 4

Author(s):

Ian Yi Han Ang ◽

Chuen Seng Tan ◽

Milawaty Nurjono ◽

Xin Quan Tan ◽

Gerald Choon-Huat Koh ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Health System ◽

Emergency Admission ◽

Healthcare Utilisation ◽

Lower Mortality ◽

Post Discharge ◽

Discharge Care ◽

High Acuity ◽

The Impact

ObjectiveTo evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model.DesignA retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls.SettingThe National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population.ParticipantsLinked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients.InterventionsFor both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients’ post-discharge.Primary outcome measuresOne-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared.ResultsPatients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges.ConclusionsBoth NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.

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Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

Journal of Hospital Administration ◽

10.5430/jha.v3n3p17 ◽

2013 ◽

Vol 3 (3) ◽

pp. 17 ◽

Cited By ~ 1

Author(s):

Dan Brun Petersen ◽

Thomas Andersen Schmidt

Keyword(s):

Internal Medicine ◽

Emergency Department ◽

General Medicine ◽

University Hospital ◽

First Year ◽

Special Focus ◽

Diagnostic Study ◽

Diagnostic Unit ◽

Number Of Patients ◽

The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

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Effect of asymptomatic transmission and emergence time on multi-strain viral disease severity

10.1101/2021.04.18.21255684 ◽

2021 ◽

Author(s):

A. R. Alizad-Rahvar ◽

M. Sadeghi

Keyword(s):

Mortality Rate ◽

Disease Severity ◽

Reproduction Number ◽

Viral Disease ◽

Disease Prevalence ◽

Emergence Time ◽

High Fraction ◽

Viral Competition ◽

Simulation Results ◽

The Impact

AbstractBackgroundIn a viral epidemic, the emergence of a novel strain with increased transmissibility (larger value of basic reproduction number R0) sparks the fear that the increase in transmissibility is likely to lead to an increase in disease severity. It is required to investigate if a new, more contagious strain will be necessarily dominant in the population and resulting in more disease severity.MethodsThe impact of the asymptomatic transmission and the emergence time of a more transmissible variant of a multi-strain viral disease on the disease prevalence, disease severity, and the dominant variant in an epidemic was investigated by a proposed 2-strain epidemic model, called 2-SEICARD model, that is an extension of the SEIRD model.ResultsThe simulation results showed that considering only R0, is insufficient to predict the outcome of a new, more contagious strain in the population. A more transmissible strain with a high fraction of asymptomatic cases can substantially reduce the mortality rate. If the emergence time of the new strain is closer to the start of the epidemic, the new, more contagious variant has more chance to win the viral competition and be the dominant strain; otherwise, despite being more contagious, it cannot dominate previous strains.ConclusionsThree factors of R0, the fraction of asymptomatic transmission, and the emergence time of the new strain are required to correctly determine the prevalence, disease severity, and the winner of the viral competition.

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199 Impact of Frailty on Complications in Patients with Thoracic and Thoracolumbar Spinal Trauma

Neurosurgery ◽

10.1093/neuros/nyx417.199 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 253-254

Author(s):

Remi Aria Kessler ◽

Taylor Elise Purvis ◽

Rafael De la Garza Ramos ◽

Ali Karim Ahmed ◽

C Rory Goodwin ◽

...

Keyword(s):

Mortality Rate ◽

Surgical Intervention ◽

Adult Spinal Deformity ◽

Frailty Index ◽

Neck Surgery ◽

Thoracolumbar Fracture ◽

Morbidity And Mortality ◽

Frailty Status ◽

Frail Patients ◽

The Impact

Abstract INTRODUCTION It is well-documented that geriatric patients are at risk for serious injuries after trauma due to pre-existing medical conditions, physical changes of aging, and medication effects. Frailty has been demonstrated to be a predictor of morbidity and mortality in inpatient head and neck surgery, and for surgical intervention for adult spinal deformity and degenerative spine disease. However, the impact of frailty on complications following traumatic thoracolumbar/thoracic fracture is unknown and has not been previously assessed in the literature, particularly in a nationwide setting. METHODS This was a retrospective study of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database for the years 2007 through 2012. Patients who underwent spinal decompression (+/− fusion) or an alternative intervention, defined as vertebroplasty or kyphoplasty (VP/KP) for thoracic or thoracolumbar fracture were identified. Frailty status was determined using a modified frailty index from the Canadian Study of Health and Aging Frailty Index, with frailty defined as a score = 0.27. 30-day morbidity and mortality were compared between frail and non-frail patients in each treatment group. RESULTS >A total of 303 patients were included in this study. Of these, 38% of patients had VP/KP and 62% underwent surgery. Within the VP/KP cohort, 26% were frail. The proportion of these patients who developed at least one complication was 3.3% versus 3.6% for non-frail patients (P = 1.0). The 30-day mortality for frail versus not frail patients in this cohort was 0% versus 2.4% (P = 1.0) Among the surgical group, 13% were frail. In contrast, the likelihood of complications was 33.3% among frail patients and 4.2% for non-frail patients (P = <0.001). Frail patients also had a 16.7% 30-day mortality rate as compared to 0.6% in the non-frail group (P = 0.001). CONCLUSION Frailty and traditional surgical intervention are correlated with a higher 30-day complication and mortality rate in patients with traumatic thoracic and thoracolumbar fracture.

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Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland

Bone & Joint Open ◽

10.1302/2046-3758.16.bjo-2020-0040.r1 ◽

2020 ◽

Vol 1 (6) ◽

pp. 261-266

Author(s):

Stephen Fahy ◽

Joss Moore ◽

Michael Kelly ◽

Olivia Flannery ◽

Paddy Kenny

Keyword(s):

Emergency Department ◽

Traffic Accident ◽

Road Traffic ◽

Imaging System ◽

Healthcare Systems ◽

Unintended Consequence ◽

Outdoor Activities ◽

Time Period ◽

The Uk ◽

The Impact

Aims Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland. Methods A retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location. Results A 21% decrease in radiologically proven trauma was observed on comparison with the same time-period last year. Additionally, a 40% reduction in trauma admissions was observed during the COVID-19 lockdown. A 60% reduction in sports-related injuries and road traffic accident-related injuries was noted during the national lockdown. However, a 17% increase was observed in patients sustaining trauma because of domestic accidents. Conclusion Variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown. As would be expected, a reduction was seen in the number of injuries resulting from outdoor activities. Interestingly, increased rates of domestic injuries were seen during this period which could represent an unintended consequence of the prolonged period of lockdown. Cite this article: Bone Joint Open 2020;1-6:261–266.

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Repatriations of Ill and Injured Travelers and Emigrants to Switzerland: A Retrospective Analysis at a Tertiary Emergency Department from 2013–2018

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052777 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2777

Author(s):

Lara Brockhus ◽

Anne-Sophie Eich ◽

Aristomenis Exadaktylos ◽

Anne Jachmann ◽

Jolanta Klukowska-Rötzler

Keyword(s):

Public Health ◽

Emergency Department ◽

Mortality Rate ◽

Surgical Intervention ◽

Mean Value ◽

University Hospital ◽

Health Concern ◽

Median Cost ◽

The University ◽

Public Health Promotion

Background: As more and more people are travelling abroad, there are also increasing numbers who fall ill or have accidents in foreign countries. Some patients must be repatriated. While it has been reported that the number of repatriations is rising steadily, little is known about patients’ characteristics, calling for in depth investigations of this patient group. Methods: We have conducted a retrospective study including 447 patients repatriated to the Emergency Department at the University Hospital (Inselspital) in Bern, Switzerland from 2013–2018. Results: Between 2013 and 2018, the number of repatriated patients increased by 42.6%, from 54 to 77 cases. In total, 59% of these patients were male and the median age was 60 years. Overall, 79% of patients were repatriated from European countries, with the top five countries being Italy, France, Spain, Germany and Austria. About half the cases (51.9%) were caused by illness, the other half by accidents. In total, 127 patients had to undergo surgical intervention abroad; another 194 patients underwent surgery after repatriation. The hospitalization rate was 81.4%, with a median length of in-hospital stay of 9 days (IQR 5–14) at the Inselspital. The mortality rate of at the Inselspital hospitalized patients was 4.4%, with 16 patients dying within the first 30 days after repatriation. The median cost per case was 12,005.79 CHF (IQR 4717.66–24,462.79). A multiple regression analysis showed a significant association of total costs with hospitalization (p = 0.001), surgical intervention (p = 0.001), as well as treatment in the intensive care unit (p = 0.001). Conclusions: The number of repatriations has been continuously increasing in recent years and reached a mean value of more than one case per week at the Inselspital (77 cases per year in 2018). The 30 day-mortality rate of 4.4% and the median cost per case are relatively high, demonstrating a neglected Public Health concern. These findings may provide impetus—not only for further research into repatriations but also for Public Health Promotion strategies.

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Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation

British Journal of Cardiac Nursing ◽

10.12968/bjca.2021.0004 ◽

2021 ◽

pp. 1-6

Author(s):

Chun Shing Kwok ◽

Jessica Bennett ◽

Sonia Curry ◽

Debbie Jackson ◽

Hayley Burke ◽

...

Keyword(s):

Emergency Department ◽

Healthcare Services ◽

Tertiary Hospital ◽

Service Evaluation ◽

University Hospital ◽

Accident And Emergency ◽

Cardiac Assessment ◽

Accident And Emergency Department ◽

The Impact ◽

Health Service Evaluation

Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.

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936 Outcomes of A Single Site Receiving Model for General Surgery During the COVID-19 Pandemic in A Scottish NHS Board

British Journal of Surgery ◽

10.1093/bjs/znab134.099 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Kilpatrick ◽

A MacDonald

Keyword(s):

Mortality Rate ◽

General Surgery ◽

Conservative Management ◽

Average Length ◽

Operative Management ◽

Single Site ◽

University Hospital ◽

Average Length Of Stay ◽

Time Period ◽

Surgical Conditions

Abstract Aim: To assess overall patient outcomes of converting to a single-site receiving unit for general surgery during the height of the covid-19 pandemic. Method Prospective study of all general surgery inpatients, who would normally be looked after at University Hospital Monklands, between 17/04/20-06/06/20, the beginning and end of a single-site receiving model within NHS Lanarkshire. Results There was a 32% reduction in admissions from 278 to 188, from the same time period in 2019. The 30-day mortality rate was 3.2% in comparison to 2.8% in 2019. Of 59 patients (31.4%) who had surgery, 13.5% had a complication of varying degree. The post-operative 30-day mortality rate was 0%. Only 4 patients (2%) were diagnosed with covid-19, none of which died. Laparoscopic appendicectomy was favoured over conservative management, with average length of stay (LoS) being 3.2 days and 5 days respectively. Acute cholecystitis was overall managed conservatively with average LoS being 8.8 days for operative management, compared to 4.1 days for conservative management. Conclusions Overall outcomes during this time were not found to be significantly worse when compared to the previous year. The rate of contracting covid-19 in the unit was low. Laparoscopic surgery can still be carried out safely for selected acute surgical conditions.

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Impact of the COVID-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

Scientific Reports ◽

10.1038/s41598-020-80309-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

V. Crenn ◽

M. El Kinani ◽

G. Pietu ◽

M. Leteve ◽

M. Persigant ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Patient ◽

Musculoskeletal Injuries ◽

University Hospital ◽

Surgical Indications ◽

Patient Admissions ◽

Period 2 ◽

Number Of Patients ◽

Hospital Transfer ◽

The Impact

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the 4-week pre-lockdown period and the 8-week lockdown period divided into two 4-week periods: early lockdown and late lockdown. There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19s wave lockdown.

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First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy

BMJ Open ◽

10.1136/bmjopen-2021-054069 ◽

2022 ◽

Vol 12 (1) ◽

pp. e054069

Author(s):

Marianna Meschiari ◽

Alessandro Cozzi-Lepri ◽

Roberto Tonelli ◽

Erica Bacca ◽

Marianna Menozzi ◽

...

Keyword(s):

Mortality Rate ◽

Regression Model ◽

Cox Regression ◽

Severe Pneumonia ◽

University Hospital ◽

P Value ◽

Cox Regression Model ◽

Hospitalised Patients ◽

The Impact ◽

Second Wave

ObjectiveThe first COVID-19–19 epidemic wave was over the period of February–May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients.DesignObservational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed.SettingUniversity Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February–31 May 2020) and second (1 October–31 December 2020) waves were included.ResultsDuring the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56–80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01).ConclusionsIn our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.

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